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. 2014 May;218(5):905-13.
doi: 10.1016/j.jamcollsurg.2014.01.003. Epub 2014 Jan 18.

Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis

Brandon A McCutcheon  1 , David C Chang  2 , Logan P Marcus  2 , Tazo Inui  2 , Abraham Noorbakhsh  2 , Craig Schallhorn  2 , Ralitza Parina  2 , Francesca R Salazar  2 , Mark A Talamini  2
Affiliations

Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis

Brandon A McCutcheon et al. J Am Coll Surg. 2014 May.

Abstract

Background: Emerging literature has supported the safety of nonoperative 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 database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation after nonsurgical 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: Of 231,678 patients with uncomplicated appendicitis, the majority (98.5%) were managed operatively. Of the 3,236 nonsurgically managed patients who survived to discharge without an interval appendectomy, 5.9% and 4.4% experienced treatment failure or recurrence, respectively, during a median follow-up of more than 7 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. Sex, 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 nonoperative patients; however, length of stay was significantly longer in the nonoperative treatment group (2.1 days vs 3.2 days; p < 0.001).

Conclusions: This study suggests that nonoperative management of uncomplicated appendicitis can be safe and prompts additional investigations. Comparative effectiveness research using prospective randomized studies can be particularly useful.

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Figures

Figure 1
Figure 1
Flow diagram of the number of patients meeting inclusion and exclusion criteria.
Figure 2
Figure 2
Flow diagram of recurrence and perforation in non-operatively managed uncomplicated appendicitis for patients admitted from 1997–2008 with follow-up through 2010.
See this image and copyright information in PMC

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