Non-Operative Management of Pediatric, Uncomplicated Acute Appendicitis: A Survey of Pediatric Surgeons' Perceptions and Practice

BACKGROUND: Despite evidence supporting selective use of non-operative management (NOM) for children with uncomplicated, acute appendicitis, no consensus exists regarding its clinical application. This study characterizes surgeons' contemporary perceptions and utilization of NOM.

STUDY DESIGN: A survey addressing NOM was distributed to attending pediatric surgeons through the American Pediatric Surgical Association, the American Academy of Pediatrics Section on Surgery, and the Pediatric Surgery Research Collaborative between 12/2023-6/2024.

RESULTS: The survey achieved a response rate of 41.0% (433/1,056). 42.0% reported regularly discussing NOM, but only half of those who discussed NOM did so in a balanced fashion. Fewer regularly offered NOM to eligible patients (27.9%). Common reasons for not offering NOM included the belief that recovery is faster after appendectomy (52.0%) and concern for high recurrence rates (51.5%). Common reasons for offering NOM included the belief that patients appreciate having options (49.2%) and the potential to avoid surgery (48.5%). 71.2% of surgeons considered absence of an appendicolith essential for attempting NOM, while fewer used symptom duration (50.8%), age (36.0%), or WBC (33.3%) when determining NOM eligibility. Therefore, many respondents did not apply the inclusion criteria used in early clinical trials, and when applied, some deviated from them, especially with increased present-day willingness to use NOM in younger patients.

CONCLUSIONS: NOM is infrequently discussed with or offered to eligible patients due to limited surgeon buy-in and different valuations of its risks and benefits. However, many surgeons who do offer NOM are comfortable applying it to a broader patient population than initially studied.

LEVEL OF EVIDENCE: IV.