LAUSR

Interest in the outcomes of nonoperative management of appendicitis in children has highlighted several important aspects of care. Namely, the association of the failure of nonoperative management with patient and parent choice and the clinical and demographic variables associated with the failure in the nonoperative management of appendicitis in children. Minneci and colleagues 1 assess the demographic and clinical characteristics and the patient-reported outcome differences between the success and failure of nonoperative management of appendicitis in children. The investigators present a secondary subset analysis of the study from the Midwest Pediatric Surgery Consortium in which parents chose between appendectomy and nonoperative management. 2 There were 370 patients (34.6% of 1068 total patients) treated with nonoperative management, of whom 33.8% (125 of 370) had experienced treatment failure at 1 year. Of these, 14.3% (53 of 370) underwent an appendectomy during the index admission, whereas 19.5% (72 of 370) experienced treatment failure or recurrence of appendicitis after hospital discharge. Sociodemographic and clinical characteristics were not associated with an increased risk of treatment failure. However, the risk of in-hospital treatment failure was doubled for patients presenting with higher reported pain scores (between 7 and 10). Duration of pain greater than 24 hours was associated with decreased delayed treatment failure (but not in-hospital or 1-year treatment failure). Health care satisfaction, health-related quality of life, and satisfaction with decision scores were high for all patients. Patients with successful nonoperative management at 1 year had higher satisfaction with decision scores than those whose treatment failed. Consistent presentation of the treatment options resulted in a similar proportion of families choosing surgery (65%) between the single-site pilot study 3 and the consortium study. 2 The priority citedforthosechoosingnonoperativemanagementwastoavoidtheoperation.Theprioritiesshared bybothgroupswereavoidingrecurrenceofappendicitisaswellasavoidingbleedingandinfection. 4 Despite a nonoperative management failure