Early vs interval appendectomy for children with perforated appendicitis

Arch Surg. 2011 Jun;146(6):660-5. doi: 10.1001/archsurg.2011.6. Epub 2011 Feb 21.


Objective: To compare the effectiveness and adverse event rates of early vs interval appendectomy in children with perforated appendicitis.

Design: Nonblinded randomized trial.

Setting: A tertiary-referral urban children's hospital.

Patients: A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis.

Interventions: Early appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis).

Main outcome measures: Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission).

Results: Early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P < .001). The overall adverse event rate was 30% for early appendectomy vs 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P = .003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1).

Conclusions: Early appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.

Trial registration: clinicaltrials.gov Identifier: NCT00435032.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Appendectomy* / adverse effects
  • Appendicitis / surgery*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Laparoscopy
  • Length of Stay
  • Male
  • Recovery of Function
  • Time Factors

Associated data

  • ClinicalTrials.gov/NCT00435032