Treatment pathways and outcomes for pediatric complex appendicitis patients presenting beyond 3 days: A retrospective cohort study.

BACKGROUND

The optimal management of complicated appendicitis in children whose symptom duration exceeds 3 days remains controversial. This study compared the outcomes of different treatment strategies in this population.

METHODS

We conducted a retrospective analysis of pediatric complex appendicitis patients treated at Zhejiang University Children’s Hospital between June 2017 and May 2024. The clinical data, treatment approaches, and outcomes were analyzed.

RESULTS

A total of 542 children were included in this study. Acute-phase surgery during the initial episode resulted in lower readmission rates than did conservative treatment (2.4% vs. 21.1%, P = 0.013). Among initially successful conservative cases, delayed surgery led to higher readmission rates than did continued observation (95.2% vs. 17.9%, P < 0.001), more extended hospital stays, and higher costs (both P < 0.001). Multivariate analysis revealed that each additional day of symptoms (OR = 1.03, P = 0.027) and each 1 mg/L increase in CRP (OR = 1.01, P < 0.001) increased the risk of conservative treatment failure whereas traditional Chinese medicine was protective (OR = 0.37, P = 0.007). The recurrence rate after successful conservative treatment was 14.6% (58 patients), with the presence of an appendicolith as an independent risk factor (OR = 2.177, P = 0.010). Rerecurrence was more common with repeated conservative management than with surgery (P = 0.001).

CONCLUSION

For hemodynamically stable children with complicated appendicitis beyond 3 days, acute-phase surgery is not contraindicated and should be considered on the basis of their clinical condition and preferences. Most patients who were successfully treated conservatively, particularly those without an appendicolith, remained recurrence-free. Delayed surgery is not recommended, and acute-phase surgery is advised if recurrence occurs.