LAUSR

Overview Appendicitis is the most common acute surgical condition, with a lifetime risk of 8%. Over the last 2 decades, there have been significant improvements in the diagnosis and surgical management, which has led to fewer negative appendectomies, shorter hospitalizations, and faster recoveries.1 The prospect of nonoperative management has been proposed as the next major advance in appendicitis care, which shows promise but also brings challenges. The concept of medical management of uncomplicated appendicitis is attractive, and some of the early studies among adults and children have shown 58% to 75% 1-year cure rates and, importantly, no increase in complications when antibiotics fail.2-4 Recent studies have provided insight into which patients may be amenable to nonoperative management; those with a more advanced disease, evidence of perforation, or an appendicolith appear to be at higher risk for early failure. Accordingly, recent pediatric comparative trials have only considered nonoperative management if the patient’s symptoms were fewer than 48 hours along with the absence of the following findings: signs of peritonitis by examination, perforation by imaging studies, or significant fever or leukocytosis. Through the patientcentered lens, nonoperative care may be enticing, even with the potential of treatment failure. Furthermore, it provides an opportunity for parents (and patients) to engage in shared decision making in choosing a treatment plan.