Journal article
Non-Operative Management of Pediatric, Uncomplicated Acute Appendicitis: A Survey of Pediatric Surgeons' Perceptions and Practice
Journal of pediatric surgery, Vol.61(1), 162535
01/2026
DOI: 10.1016/j.jpedsurg.2025.162535
PMID: 40812405
Abstract
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.
Details
- Title: Subtitle
- Non-Operative Management of Pediatric, Uncomplicated Acute Appendicitis: A Survey of Pediatric Surgeons' Perceptions and Practice
- Creators
- Nitin Sajankila - Cleveland ClinicCecilia Gigena - Cleveland ClinicKylie Callier - University of ChicagoMatthew Boelig - Nemours Children's Hospital, Delaware. Electronic address: matthew.boelig@nemours.orgAfif N Kulaylat - Pennsylvania State UniversityFaraz A Khan - Lucile Packard Children's HospitalJose H Salazar - Children's Hospital of WisconsinKyle J Van Arendonk - Nationwide Children's HospitalJamie R Robinson - Monroe Carell Jr. Children's HospitalJason Sulkowski - Children's Hospital of Richmond at VCUHanna Alemayehu - Children's Healthcare of AtlantaJennifer Murphy - Thomas Jefferson UniversitySeth D Goldstein - Lurie Children's HospitalErica Carlisle - University of IowaShannon L Castle - Children's Hospital Central CaliforniaJeffrey Burford - Arkansas Children's HospitalJason C Fisher - NYU Langone HealthMoiz M Mustafa - Joe DiMaggio Children's HospitalDaniel S Rhee - Johns Hopkins Children's CenterChris Streck - Medical University of South CarolinaCatherine J Hunter - Children's Hospital of OklahomaDavid H Rothstein - Seattle Children's HospitalJoshua Ramjist - SickKids FoundationHoward Jen - Mattel Children's HospitalStefan Scholz - Children's Hospital of PittsburghMaria Carmen Mora - The University of Texas Medical Branch at GalvestonMark Ryan - Children's Medical CenterAlexander Urevick - Children’s Hospital at ErlangerS Dave Bhattacharya - Children’s Hospital at ErlangerRomeo C Ignacio - Rady Children's Hospital-San DiegoBethany J Slater - University of ChicagoBrian C Gulack - Rush University Medical CenterJason O Robertson - Cleveland ClinicPediatric Surgery Research Collaborative
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric surgery, Vol.61(1), 162535
- DOI
- 10.1016/j.jpedsurg.2025.162535
- PMID
- 40812405
- NLM abbreviation
- J Pediatr Surg
- ISSN
- 0022-3468
- eISSN
- 1531-5037
- Publisher
- W B SAUNDERS CO-ELSEVIER INC; PHILADELPHIA
- Language
- English
- Electronic publication date
- 08/12/2025
- Date published
- 01/2026
- Academic Unit
- Stead Family Department of Pediatrics; Surgery
- Record Identifier
- 9984946704602771
Metrics
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