Long-Term Outcomes of Patients with Nonsurgically Managed Uncomplicated Appendicitis

Abstract

Background Emerging literature has supported the safety of non-operative management of uncomplicated appendicitis. Study Design Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development (OSHPD) database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation following non-surgical management were calculated. Factors associated with treatment failure, recurrence, and perforation were identified using multivariable logistic regression. Mortality, length of stay, and total charges were compared between treatment cohorts using matched propensity score analysis. Results Among 231,678 patients with uncomplicated appendicitis, the majority (98.5%) were managed operatively. Among the 3,236 non-surgically managed patients who survived to discharge without an interval appendectomy, 5.9% and 4.4% experienced treatment failure or recurrence, respectively, over a median duration of follow up of greater than seven years. There were no mortalities associated with treatment failure or recurrence. The risk of perforation after discharge was approximately 3%. Using multivariable analysis, race and age were significantly associated with the odds of treatment failure. Gender, age, and hospital teaching status were significantly associated with the odds of recurrence. Age and hospital teaching status were significantly associated with the odds of perforation. Matched propensity score analysis indicated that after risk adjustment mortality rates (0.1% vs. 0.3%, p=0.65) and total charges ($23,243 vs. $24,793, p=0.70) were not statistically different between operative and non-operative patients, however, length of stay was significantly greater amongst the non-operative treatment group (2.1 vs. 3.2 days, p<0.001). Conclusions This study suggests that non-operative management of uncomplicated appendicitis may be safe, and prompts further investigations. Comparative effectiveness research using prospective randomized studies may be particularly useful.

Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis

“…One-year of follow-up data was included in two of these reports, and recurrence occurred in 13.3% (2 out of 15) and 10% (1 out of 10) of the patients [7,8]. According to meta-analyses of randomized, controlled trials in adults, nonoperative treatment for uncomplicated appendicitis is successful in 68-95% of patients and recurrence occurs in 4.4%-35% within 1 year [1][2][3][4][5][6].…”

“…Nonoperative treatment for uncomplicated appendicitis is now an accepted approach, and there are meta-analyses of randomized, controlled trials in adults [1][2][3][4][5][6]. However, there are few reports concerning nonoperative treatment for uncomplicated appendicitis in children [7][8][9].…”

Outpatient Laparoscopic Appendectomy: Feasible in a Public County Hospital?

“…Options include surgical management with postoperative admission for observation, surgical management with same-day discharge after surgery, 7,8,10-13 and nonoperative management. [14][15][16][17][18][19] Although there is interest in treating acute appendicitis with antibiotics alone, the current data are unclear, and the standard of care remains appendectomy at this time. 16 Laparoscopic surgery has many advantages over open surgery; studies over time have consistently shown decreased length of stay, earlier tolerance of oral diet, and decreased pain.…”

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

“…In a 2014 retrospective review of 231,678 patients with uncomplicated appendicitis, over 3 thousand of these patients were managed non-operatively; and of those patients, approximately 6% required appendectomy at that admission and 4.4% experienced recurrence of appendicitis after discharge during 7 year follow up. Of note, total charges were not statistically different between operative and non-operative patients, but length of stay was significantly longer in the non-operative group [146].…”