Implementing Nonoperative Treatment Strategy for Simple Pediatric Appendicitis: A Qualitative Study

Introduction: A nonoperative treatment strategy (NOT) with antibiotics for children with simple appendicitis could reduce anesthesia and surgery-related complications. As the implementation of a new treatment in routine clinical practice may take years, this study aims to identify barriers and facilitators for implementation of NOT for children with simple appendicitis. Materials and methods: To identify barriers and facilitators for its implementation, we conducted 14 semistructured interviews and a focus group with health insurance/hospital policymakers, surgical clinicians, and young peopledtogether with their parentsdwho have been treated surgically or with antibiotics. Transcripts were open coded and categorized as per the framework for healthcare innovations by Fleuren et al. Results: We identified four main themes: (1) Appendicitis is a well-known disease. Children, parents, and clinicians regard appendectomy as routine and safe, making them reluctant toward other treatment options. (2) Clinicians regard uptake of NOT in the national appendicitis guideline necessary for its implementation. (3) For identification of patients best suited for NOT more experience and scientific evidence is needed. (4) Appendectomy and NOT have different risk and benefits making the treatment choice depended on individual patient preferences.

Automated summary

This study aims to identify barriers and facilitators for the implementation of nonoperative treatment (NOT) with antibiotics for children with simple appendicitis. The results revealed that appendectomy is considered routine and safe, making individuals hesitant towards alternative treatment options. The implementation of NOT requires inclusion in national appendicitis guidelines, as well as more experience and scientific evidence. Treatment choice depends on individual patient preferences.