If your child comes to Children’s Mercy Hospital with appendicitis, you’re probably going to be asked whether you want to participate in a clinical trial that could change how the common illness is treated worldwide — and how insurance covers those treatments.
“Guaranteed,” said Shawn St. Peter, the surgeon leading the study, which includes researchers in Sweden, Finland and Canada.
Appendicitis traditionally has had one of medicine’s clearest courses of treatment: Get in there and remove the appendix.
But there’s growing evidence that surgery might not be necessary for adults with nonperforated appendicitis, because antibiotics are just as effective. St. Peter and Children’s Mercy are on the cutting edge of research to determine whether the same is true for children.
It’s a straightforward question, but it’s fraught with cultural baggage from generations of routine appendix removal, surgeons’ preference for a quick, clean solution, and some parents’ outsized fear of surgery and anesthesia in general.
“Frankly, they shouldn’t be afraid of” appendectomies, St. Peter said. They’re “overwhelmingly safe. Far safer than having gotten to the hospital in the first place. Having said that, now that we are treating with antibiotics, it’s remarkable that those kids really are normal immediately. As soon as that pain subsides, then they’re fine. They can all go to school the next day.”
The complicating factor that looms over the whole study is cost. Appendectomies are affordable as surgeries go, but a course of antibiotics is much cheaper.
Depending on how the study turns out, St. Peter said, it could lead insurance companies to cover appendectomies for nonperforated cases only after antibiotic treatments had failed.
“That would be possible,” he said.
The plan is to enroll about 1,000 kids with appendicitis who will be randomly assigned to either an antibiotics-only group or an antibiotics and appendectomy group, and then follow up with them after six weeks and again after one year to see how they fared.
The object of the study, St. Peter said, is not to determine whether one method is better than the other. It’s to determine what percentage of cases treated with only antibiotics end up with a recurrence of appendicitis and surgery anyway. With that information, each patient — or parent — would then have to make their own decision.