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A systematic review and individual patient data meta-analysis of published randomized clinical trials comparing early versus interval appendectomy for children with perforated appendicitis

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Abstract

Purpose

Our objective was to perform a meta-analysis on RCTs that compared outcomes in children with perforated appendicitis (PA) who underwent either early appendectomy (EA) or interval appendectomy (IA). We also sought to determine if the presence of an intra-abdominal abscess (IAA) at admission impacted treatment strategy and outcomes.

Methods

We identified two RCTs comparing EA versus IA in children with PA. A meta-analysis was performed using regression models and the overall adverse event rate was analyzed. The treatment effect variation depending on the presence of IAA at admission was also evaluated.

Results

EA significantly reduced the odds of an adverse event (OR 0.28, 95 % CI 0.1–0.77) and an unplanned readmission (OR 0.08, 95 % CI 0.01–0.67), as well as the total charges (79 % of the IA, 95 % CI 63–100) for those who did not have an IAA at admission. In children with an IAA, there was no difference between EA and IA. However, heterogeneity of treatment effect was present regarding IAA at presentation.

Conclusions

While EA appears to improve outcomes in patients without an abscess, the published data support no significant difference in outcomes between EA and IA in patients with an abscess.

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Acknowledgments

Supported by the National Center for Research Resources, Grant UL1RR024975-01 and National Center for Advancing Translational Sciences, Grant 2UL1TR000445-06.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, DOT 7100, Nashville, TN, 37232, USA

    Eileen M. Duggan, Andre P. Marshall, Jamie Tice & Martin L. Blakely

  2. Department of Pediatric Surgery, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA

    Katrina L. Weaver & Shawn D. St. Peter

  3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Li Wang & Leena Choi

Authors
  1. Eileen M. Duggan
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  2. Andre P. Marshall
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  3. Katrina L. Weaver
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  4. Shawn D. St. Peter
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  5. Jamie Tice
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  6. Li Wang
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  7. Leena Choi
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  8. Martin L. Blakely
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Corresponding authors

Correspondence to Shawn D. St. Peter or Martin L. Blakely.

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Duggan, E.M., Marshall, A.P., Weaver, K.L. et al. A systematic review and individual patient data meta-analysis of published randomized clinical trials comparing early versus interval appendectomy for children with perforated appendicitis. Pediatr Surg Int 32, 649–655 (2016). https://doi.org/10.1007/s00383-016-3897-y

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  • DOI: https://doi.org/10.1007/s00383-016-3897-y

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