For parents and healthcare providers weighing the decision between surgery and antibiotics for treating uncomplicated appendicitis in children, a recent study offers interesting insights.

An appendectomy is a surgical procedure typically recommended for patients with appendicitis, which causes inflammation and infection of the appendix, leading to severe abdominal pain, nausea, and vomiting. While it is one of the most common surgeries performed in hospitals, it is also one of the most expensive procedures during inpatient stays.

The researchers of the latest study suggest treatment with antibiotics as a safe, cost-effective alternative compared to laparoscopic appendectomy for pediatric uncomplicated appendicitis.

"We know that nonoperative management of appendicitis is safe and effective, so what surgeons want to know is whether nonoperative management is cost-effective. Our study helps answer that question. This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective management strategy over one year, compared to upfront surgery," said study co-author Dr. Peter C. Minneci in a news release.

The study reviewed data from 1,068 patients treated for uncomplicated acute appendicitis at different hospitals in the Midwest between 2015 and 2018. Of the total patients, 370 chose to be treated by antibiotics alone and 698 opted for urgent laparoscopic appendectomy. Treatment with antibiotics involved at least 24 hours of intravenous antibiotics administration.

While analyzing the cost of both treatments, researchers noted a difference of over $1,000, with laparoscopic appendectomy costing an average of $9,791 and nonoperative management costing $8,044. However, the quality-adjusted life years were nearly the same, with a slightly higher score for nonoperative management (0.895) compared to 0.884 for surgery.

Since lower scores of quality-adjusted life years reflect worsening health and dysfunction, the study suggests that, although the laparoscopic appendectomy is more expensive, it does not significantly improve the patient's health outcomes compared to nonoperative management.

"Nonoperative management was both less costly and more effective in three analyses, including an analysis using disability days and alternative methods of calculating quality of life and cost over one year," the news release stated.

"Our study findings add an additional benefit to the antibiotics-only approach being safe and effective for children in that this strategy is shown to be cost effective. In short, nonoperative management is a safe and cost-effective initial therapy and a reasonable alternative to surgery," said Dr. Minneci.

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