Appendicitis is the most common and costly surgical disease treated in the pediatric population.1 The subject has stimulated correspondingly robust inquiry and debate, including the current article by Serres et al2 in this journal. Central to this effort is the desire to understand disease progression better and, in turn, optimize clinical management based on new evidence. Adoption of minimally invasive techniques and reduction of ionizing radiation for diagnostic purposes exemplify recent evidence-based strides toward improved clinical care and resource use, but challenges remain.3,4 Ruptured or complicated appendicitis as defined by Serres et al2 is known to substantially affect morbidity, increasing the risk for infectious complications, length of hospital stay, and overall cost.2,5,6 This subset of patients with complex appendicitis represents a challenge and is a major focus of the efforts to diminish patient morbidity. Historically, surgeon efforts to prevent complex appendicitis included emergent “immediate” appendectomies, driven by fears that treatment delay would result in progression of acute appendicitis to appendiceal necrosis, perforation, and peritonitis. However, this practice has been challenged as data supporting the salutary effect of antibiotics and an urgent (<24 hours after presentation) rather than emergent (immediate) appendectomy have been presented in recent years.7-9
Landisch RM, Arca MJ, Oldham KT. Emergent or Urgent Appendectomy?—A Changing Perspective. JAMA Pediatr. 2017;171(8):727–729. doi:10.1001/jamapediatrics.2017.1445
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