Sarah Tracy | Harvard Medical School (original) (raw)

Papers by Sarah Tracy

Community partnerships Eat Walk Sleep Discuss: Building a Multi-Dimensional Participatory Relatio... more Community partnerships Eat Walk Sleep Discuss: Building a Multi-Dimensional Participatory Relationship Heather-Lyn Haley1, Suzanne Cashman1, Mick Godkin1, Meredith Walsh2,3, Nang Maung2,4, Toy Lim3, Sarah Tracy5, Clara Savage6, James Madson II6 1 UMass Medical School Dept of Family Medicine and Community Health, 2 Worcester Refugee Assistance Project, 3 UMass Graduate School of Nursing, 4 UMass Graduate School of Biomedical Sciences, 5 UMass Medical School Class of 2014, 6 Common Pathways

American Journal of Medical Genetics Part A, 2020

Esophageal atresia (EA) is a congenital anomaly occurring in 2.3 per 10,000 live births. Due to a... more Esophageal atresia (EA) is a congenital anomaly occurring in 2.3 per 10,000 live births. Due to advances in prenatal imaging, EA is more readily diagnosed, but data on the associated genetic diagnoses, other anomalies, and postnatal outcome for fetuses diagnosed prenatally with EA are scarce. We collected data from two academic medical centers (n = 61). Our data included fetuses with suspected EA on prenatal imaging that was confirmed postnatally and had at least one genetic test. In our cohort of 61 cases, 29 (49%) were born prematurely and 19% of those born alive died in the first 9 years of life. The most commonly associated birth defects were cardiac anomalies (67%) and spine anomalies (50%). A diagnosis was made in 61% of the cases; the most common diagnoses were vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula with esophageal atresia, radial or renal dysplasia, and limb anomalies association (43%, although 12% met only 2 of the criteria), trisomy 21 (5%), and CHARGE syndrome (5%). Our findings suggest that most fetuses with prenatally diagnosed EA have one or more additional major anomaly that warrants a more comprehensive clinical genetics evaluation. Fetuses diagnosed prenatally appear to represent a cohort with a worse outcome.

Journal of pediatric surgery, 2018

Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neona... more Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neonates are not identified until after birth. The distended hypopharynx (DHP) has been suggested as a novel prenatal sign for EA. We assess its diagnostic accuracy and predictive value on ultrasound (US) and magnetic resonance imaging (MRI), both alone and in combination with the esophageal pouch (EP) and secondary signs of EA (polyhydramnios and a small or absent fetal stomach). We retrospectively reviewed fetal US and MRI reports and medical records of 88 pregnant women evaluated for possible EA from 2000 to 2016. Seventy-five had postnatal follow-up that confirmed or disproved the diagnosis of EA and were included in our analysis. Seventy-five women had 107 study visits (range 1-4). DHP and/or EP were seen on US and/or MRI in 36% of patients, and 78% of those patients had EA. DHP was 24% more sensitive for EA than EP, while EP was 30% more specific. After 28weeks of gestation, DHP had a p...

Journal of Neurosurgery: Pediatrics, 2012

Object The authors have previously reported on the overall improved efficacy of endoscopic third ... more Object The authors have previously reported on the overall improved efficacy of endoscopic third ventriculostomy (ETV) combined with choroid plexus cauterization (CPC) for infants younger than 1 year of age. In the present study they specifically examined the long-term efficacy of ETV with or without CPC in 35 infants with congenital aqueduct stenosis treated at CURE Children's Hospital of Uganda during the years 2001–2006. Methods Infants with congenital aqueductal stenosis were treated during 2 distinct treatment epochs: all underwent ETV alone, and subsequently all underwent ETV-CPC. Prospectively collected data in the clinical database were reviewed for all infants with an age < 1 year who had been treated for hydrocephalus due to congenital aqueductal stenosis. Study exclusion criteria included: 1) a history or findings on imaging or at the time of ventriculoscopy that suggested a possible infectious cause of the hydrocephalus, including scarred choroid plexus; 2) an ope...

Seminars in fetal & neonatal medicine, 2014

This literature review discusses the growing trend toward multidisciplinary long term follow-up f... more This literature review discusses the growing trend toward multidisciplinary long term follow-up for congenital diaphragmatic hernia.

JAMA Surgery, 2013

IMPORTANCE Regional anesthetic techniques can be used to alleviate postoperative pain in children... more IMPORTANCE Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU). OBJECTIVE To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical hernia repair. DESIGN Prospective, observer-blinded, randomized clinical trial. SETTING Tertiary-referral urban children's hospital.

selections today, with 318 student-athletes that participated in a fall sport earning All-Academi... more selections today, with 318 student-athletes that participated in a fall sport earning All-Academic recognition. To be honored, a student-athlete must have reached junior academic standing and be a varsity letter winner with a cumulative grade point average of at least 3.35. A transfer student must have completed one year of study at the institution. Of the 318 student-athletes that received Fall All-Academic accolades, a total of 109, more than one-third, had the honor bestowed upon them last autumn. 49 student-athletes on the 2006 Fall All-Academic squad also received NESCAC All-Conference recognition this past season. Of note in the Fall All-Academic group are a pair of senior soccer players and a junior runner that earned individual NESCAC honors this fall. Amherst senior forward Amy Armstrong (Avon, Conn.) received All-Academic recognition for the second year in a row after being named the 2006 NESCAC Women's Soccer Player of the Year only a week ago. Armstrong, a psychology and pre-med major at Amherst, is in the midst of a career year with the Jeffs, scoring a team-leading 12 goals while adding in four assists for 28 points through 17 outings. Armstrong has more than doubled her career points total while helping her club reach the sectional round of the 2006 NCAA Women's Soccer Tournament this weekend. Williams senior midfielder Patrick Huffer (Boulder, Colo.) also earned All-Academic honors for the second year in a row while coming away as the 2006 NESCAC Men's Soccer Player of the Year. Huffer, a biology major, helped lead the Ephs to their third NESCAC Men's Soccer crown in the past four years this fall with a league-best 14 goals. He enters this weekend's NCAA Men's Soccer Tournament sectional already ahead of last year's team-leading points total with 30 points through 16 appearances this season. Making her first appearance on the Fall All-Academic squad is Tufts junior Katy O'Brien (North Easton, Mass.), the 2006 Women's Cross Country Most Outstanding Performer. O'Brien's first-place showing at the NESCAC Women's Cross Country Championship was the first of her career at Tufts, as the Jumbos placed just five points behind NESCAC champ Amherst in what was the second-closest finish to the event in the past 10 years. It was also the second-best finish for Tufts ever, as the 1987 squad won the race 19 years ago. O'Brien will look to help her team garner its best finish ever at the NCAA Championship this weekend at Wilmington College in West Chester, Ohio. Founded in 1971, the New England Small College Athletic Conference (NESCAC) consists of 11 liberal arts colleges and has consistently reflected its commitment to the values of athletics and academic achievement. The member colleges of the conference are Amherst College,

Journal of Pediatric Surgery, 2010

Journal of Pediatric Surgery, 2012

Background/Purpose: The purpose of this study was to examine the impact on the family of immediat... more Background/Purpose: The purpose of this study was to examine the impact on the family of immediate appendectomy compared with initial nonoperative management for perforated appendicitis in children. Methods: Sixty-six prospectively identified families of children with perforated appendicitis completed a daily activity journal and the Impact on Family Scale at presentation and at completion of therapy. Results: There were no significant differences in postoperative surgical site infections or number of missed school or employment days between the immediate appendectomy group (n = 40) and the initial nonoperative management group (n = 26). Impact on Family Scale total scores decreased over time for both groups, but this improvement over time was significant only in the initial nonoperative management group (P b .01). Conclusions: Immediate appendectomy or initial nonoperative management can effectively manage perforated appendicitis in children with no statistically significant differences in the number of missed school or employment days. Greater improvements in family impact are associated with initial nonoperative management as measured by the Impact on Family Scale at completion of therapy.

Journal of Pediatric Surgery, 2014

Background/Purpose: The purpose of this paper was to examine the effect of prenatal counseling in... more Background/Purpose: The purpose of this paper was to examine the effect of prenatal counseling in the Advanced Fetal Care Center (AFCC) on the well-being of parents of infants with congenital diaphragmatic hernia (CDH). Methods: From 2008 through 2012, 26 mothers and fathers of surgically repaired CDH patients who received prenatal counseling at our institution, and 15 who received no prenatal counseling, each completed the Short-Form 36 version 1 (SF-36v1) at the appropriate time points: prenatal, two weeks, and six months postsurgery. Results: Parents in both groups did not differ by demographic characteristics. Patients who received prenatal counseling had significantly longer ventilatory time and length of stay (LOS) in the ICU and in the hospital compared to those who did not receive prenatal counseling (all P b .01). Mothers and fathers had similar SF-36v1 mental and physical component summary (MCS, PCS) post-surgery scores when compared by counseling status. Prenatal MCS scores for mothers and fathers (47 vs. 41; P = .24) were similar to those at six months post-surgery (47 vs. 47; P = .90). Conclusions: When hospital LOS was controlled between groups stratified by AFCC counseling status, MCS scores were comparable prenatally and were sustained at six months post-surgery for both parents. These findings may reflect the support services parents received beginning in the prenatal period.

Journal of Pediatric Surgery, 2014

Background/Purpose: Optimal central venous catheter (CVC) tip location is necessary to decrease t... more Background/Purpose: Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children. Methods: We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/ superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA). Results: Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5*BSA + 7 cm, and for the right subclavian vein approach it was 5*BSA + 6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children. Conclusion: The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.

Journal of Pediatric Surgery, 2014

Background/Purpose: We determined the incidence of sensorineural hearing loss (SNHL; >20 dB at an... more Background/Purpose: We determined the incidence of sensorineural hearing loss (SNHL; >20 dB at any frequency) in a contemporary cohort of congenital diaphragmatic hernia (CDH) survivors at a single tertiary care center and identified potential risk factors for SNHL. Methods: From 2000 through 2011, clinical and audiologic data were collected on 122 surgically-repaired Bochdalek CDH patients. CDH defect size, duration of ventilation, and cumulative aminoglycoside treatment were used for multivariate logistic regression.

Journal of Pediatric Surgery, 2012

Background/Purpose: We compared direct hospital costs and indirect costs to the family associated... more Background/Purpose: We compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children. Methods: From June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy. Results: Patients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies. Conclusions: Patients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy.

Community partnerships Eat Walk Sleep Discuss: Building a Multi-Dimensional Participatory Relatio... more Community partnerships Eat Walk Sleep Discuss: Building a Multi-Dimensional Participatory Relationship Heather-Lyn Haley1, Suzanne Cashman1, Mick Godkin1, Meredith Walsh2,3, Nang Maung2,4, Toy Lim3, Sarah Tracy5, Clara Savage6, James Madson II6 1 UMass Medical School Dept of Family Medicine and Community Health, 2 Worcester Refugee Assistance Project, 3 UMass Graduate School of Nursing, 4 UMass Graduate School of Biomedical Sciences, 5 UMass Medical School Class of 2014, 6 Common Pathways

American Journal of Medical Genetics Part A, 2020

Esophageal atresia (EA) is a congenital anomaly occurring in 2.3 per 10,000 live births. Due to a... more Esophageal atresia (EA) is a congenital anomaly occurring in 2.3 per 10,000 live births. Due to advances in prenatal imaging, EA is more readily diagnosed, but data on the associated genetic diagnoses, other anomalies, and postnatal outcome for fetuses diagnosed prenatally with EA are scarce. We collected data from two academic medical centers (n = 61). Our data included fetuses with suspected EA on prenatal imaging that was confirmed postnatally and had at least one genetic test. In our cohort of 61 cases, 29 (49%) were born prematurely and 19% of those born alive died in the first 9 years of life. The most commonly associated birth defects were cardiac anomalies (67%) and spine anomalies (50%). A diagnosis was made in 61% of the cases; the most common diagnoses were vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula with esophageal atresia, radial or renal dysplasia, and limb anomalies association (43%, although 12% met only 2 of the criteria), trisomy 21 (5%), and CHARGE syndrome (5%). Our findings suggest that most fetuses with prenatally diagnosed EA have one or more additional major anomaly that warrants a more comprehensive clinical genetics evaluation. Fetuses diagnosed prenatally appear to represent a cohort with a worse outcome.

Journal of pediatric surgery, 2018

Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neona... more Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neonates are not identified until after birth. The distended hypopharynx (DHP) has been suggested as a novel prenatal sign for EA. We assess its diagnostic accuracy and predictive value on ultrasound (US) and magnetic resonance imaging (MRI), both alone and in combination with the esophageal pouch (EP) and secondary signs of EA (polyhydramnios and a small or absent fetal stomach). We retrospectively reviewed fetal US and MRI reports and medical records of 88 pregnant women evaluated for possible EA from 2000 to 2016. Seventy-five had postnatal follow-up that confirmed or disproved the diagnosis of EA and were included in our analysis. Seventy-five women had 107 study visits (range 1-4). DHP and/or EP were seen on US and/or MRI in 36% of patients, and 78% of those patients had EA. DHP was 24% more sensitive for EA than EP, while EP was 30% more specific. After 28weeks of gestation, DHP had a p...

Journal of Neurosurgery: Pediatrics, 2012

Object The authors have previously reported on the overall improved efficacy of endoscopic third ... more Object The authors have previously reported on the overall improved efficacy of endoscopic third ventriculostomy (ETV) combined with choroid plexus cauterization (CPC) for infants younger than 1 year of age. In the present study they specifically examined the long-term efficacy of ETV with or without CPC in 35 infants with congenital aqueduct stenosis treated at CURE Children's Hospital of Uganda during the years 2001–2006. Methods Infants with congenital aqueductal stenosis were treated during 2 distinct treatment epochs: all underwent ETV alone, and subsequently all underwent ETV-CPC. Prospectively collected data in the clinical database were reviewed for all infants with an age < 1 year who had been treated for hydrocephalus due to congenital aqueductal stenosis. Study exclusion criteria included: 1) a history or findings on imaging or at the time of ventriculoscopy that suggested a possible infectious cause of the hydrocephalus, including scarred choroid plexus; 2) an ope...

Seminars in fetal & neonatal medicine, 2014

This literature review discusses the growing trend toward multidisciplinary long term follow-up f... more This literature review discusses the growing trend toward multidisciplinary long term follow-up for congenital diaphragmatic hernia.

JAMA Surgery, 2013

IMPORTANCE Regional anesthetic techniques can be used to alleviate postoperative pain in children... more IMPORTANCE Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU). OBJECTIVE To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical hernia repair. DESIGN Prospective, observer-blinded, randomized clinical trial. SETTING Tertiary-referral urban children's hospital.

selections today, with 318 student-athletes that participated in a fall sport earning All-Academi... more selections today, with 318 student-athletes that participated in a fall sport earning All-Academic recognition. To be honored, a student-athlete must have reached junior academic standing and be a varsity letter winner with a cumulative grade point average of at least 3.35. A transfer student must have completed one year of study at the institution. Of the 318 student-athletes that received Fall All-Academic accolades, a total of 109, more than one-third, had the honor bestowed upon them last autumn. 49 student-athletes on the 2006 Fall All-Academic squad also received NESCAC All-Conference recognition this past season. Of note in the Fall All-Academic group are a pair of senior soccer players and a junior runner that earned individual NESCAC honors this fall. Amherst senior forward Amy Armstrong (Avon, Conn.) received All-Academic recognition for the second year in a row after being named the 2006 NESCAC Women's Soccer Player of the Year only a week ago. Armstrong, a psychology and pre-med major at Amherst, is in the midst of a career year with the Jeffs, scoring a team-leading 12 goals while adding in four assists for 28 points through 17 outings. Armstrong has more than doubled her career points total while helping her club reach the sectional round of the 2006 NCAA Women's Soccer Tournament this weekend. Williams senior midfielder Patrick Huffer (Boulder, Colo.) also earned All-Academic honors for the second year in a row while coming away as the 2006 NESCAC Men's Soccer Player of the Year. Huffer, a biology major, helped lead the Ephs to their third NESCAC Men's Soccer crown in the past four years this fall with a league-best 14 goals. He enters this weekend's NCAA Men's Soccer Tournament sectional already ahead of last year's team-leading points total with 30 points through 16 appearances this season. Making her first appearance on the Fall All-Academic squad is Tufts junior Katy O'Brien (North Easton, Mass.), the 2006 Women's Cross Country Most Outstanding Performer. O'Brien's first-place showing at the NESCAC Women's Cross Country Championship was the first of her career at Tufts, as the Jumbos placed just five points behind NESCAC champ Amherst in what was the second-closest finish to the event in the past 10 years. It was also the second-best finish for Tufts ever, as the 1987 squad won the race 19 years ago. O'Brien will look to help her team garner its best finish ever at the NCAA Championship this weekend at Wilmington College in West Chester, Ohio. Founded in 1971, the New England Small College Athletic Conference (NESCAC) consists of 11 liberal arts colleges and has consistently reflected its commitment to the values of athletics and academic achievement. The member colleges of the conference are Amherst College,

Journal of Pediatric Surgery, 2010

Journal of Pediatric Surgery, 2012

Background/Purpose: The purpose of this study was to examine the impact on the family of immediat... more Background/Purpose: The purpose of this study was to examine the impact on the family of immediate appendectomy compared with initial nonoperative management for perforated appendicitis in children. Methods: Sixty-six prospectively identified families of children with perforated appendicitis completed a daily activity journal and the Impact on Family Scale at presentation and at completion of therapy. Results: There were no significant differences in postoperative surgical site infections or number of missed school or employment days between the immediate appendectomy group (n = 40) and the initial nonoperative management group (n = 26). Impact on Family Scale total scores decreased over time for both groups, but this improvement over time was significant only in the initial nonoperative management group (P b .01). Conclusions: Immediate appendectomy or initial nonoperative management can effectively manage perforated appendicitis in children with no statistically significant differences in the number of missed school or employment days. Greater improvements in family impact are associated with initial nonoperative management as measured by the Impact on Family Scale at completion of therapy.

Journal of Pediatric Surgery, 2014

Background/Purpose: The purpose of this paper was to examine the effect of prenatal counseling in... more Background/Purpose: The purpose of this paper was to examine the effect of prenatal counseling in the Advanced Fetal Care Center (AFCC) on the well-being of parents of infants with congenital diaphragmatic hernia (CDH). Methods: From 2008 through 2012, 26 mothers and fathers of surgically repaired CDH patients who received prenatal counseling at our institution, and 15 who received no prenatal counseling, each completed the Short-Form 36 version 1 (SF-36v1) at the appropriate time points: prenatal, two weeks, and six months postsurgery. Results: Parents in both groups did not differ by demographic characteristics. Patients who received prenatal counseling had significantly longer ventilatory time and length of stay (LOS) in the ICU and in the hospital compared to those who did not receive prenatal counseling (all P b .01). Mothers and fathers had similar SF-36v1 mental and physical component summary (MCS, PCS) post-surgery scores when compared by counseling status. Prenatal MCS scores for mothers and fathers (47 vs. 41; P = .24) were similar to those at six months post-surgery (47 vs. 47; P = .90). Conclusions: When hospital LOS was controlled between groups stratified by AFCC counseling status, MCS scores were comparable prenatally and were sustained at six months post-surgery for both parents. These findings may reflect the support services parents received beginning in the prenatal period.

Journal of Pediatric Surgery, 2014

Background/Purpose: Optimal central venous catheter (CVC) tip location is necessary to decrease t... more Background/Purpose: Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children. Methods: We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/ superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA). Results: Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5*BSA + 7 cm, and for the right subclavian vein approach it was 5*BSA + 6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children. Conclusion: The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.

Journal of Pediatric Surgery, 2014

Background/Purpose: We determined the incidence of sensorineural hearing loss (SNHL; >20 dB at an... more Background/Purpose: We determined the incidence of sensorineural hearing loss (SNHL; >20 dB at any frequency) in a contemporary cohort of congenital diaphragmatic hernia (CDH) survivors at a single tertiary care center and identified potential risk factors for SNHL. Methods: From 2000 through 2011, clinical and audiologic data were collected on 122 surgically-repaired Bochdalek CDH patients. CDH defect size, duration of ventilation, and cumulative aminoglycoside treatment were used for multivariate logistic regression.

Journal of Pediatric Surgery, 2012

Background/Purpose: We compared direct hospital costs and indirect costs to the family associated... more Background/Purpose: We compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children. Methods: From June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy. Results: Patients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies. Conclusions: Patients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy.