Acute Appendicitis: Trends in Surgical Treatment—A Population-Based Study of Over 800 000 Patients

Abstract

Background: Appendectomy is the gold standard for treatment of acute appendicitis. However, recent studies favor primary antibiotic therapy. The aim of this observational study was to explore changes in the numbers of operations for acute appendicitis in the period 2010-2017, paying special attention to disease severity.

Methods: Data from diagnosis-related group statistics were used to analyze the trends, mortality, and complication rates in the surgical treatment of appendicitis in Germany between 2010 and 2017. All cases of appendectomy after a diagnosis of appendicitis were included.

Results: Altogether, 865 688 inpatient cases were analyzed. The number of appendectomies went down by 9,8%, from 113 614 in 2010 to 102 464 in 2017, while the incidence fell from 139/100 000 in 2010 to 123/100 000 in 2017 (standardized by age group). This decrease is due to the lower number of operations for uncomplicated appendicitis (79 906 in 2017 versus 93 135 in 2010). Hospital mortality decreased both in patients who underwent surgical treatment of complicated appendicitis (0.62% in 2010 versus 0.42% in 2017) and in those with a complicated clinical course (5.4% in 2010 versus 3.4% in 2017).

Conclusion: Decisions on the treatment of acute appendicitis in German hospitals follow the current trend towards non-surgical management in selected patients. At the same time, the care of acute appendicitis has improved with regard to overall hospital morbidity and hospital mortality.

Figure 1

Number of appendectomies in the period 2010–2017 The overall number of appendectomies fell by 9.8% from 113 614 cases in 2010 to 102 464 cases in 2017. The proportion of all appendectomies accounted for by complicated appendicitis increased to 22%, while that for uncomplicated appendicitis decreased to 78%.

Figure 2

Development of in-hospital mortality and proportion of cases with complicated course, stratified by severity of appendicitis (complicated versus uncomplicated) Mortality is higher for appendectomy cases with complicated appendicitis than for appendectomy cases with uncomplicated appendicitis and shows a declining trend over time (a). The proportion of cases with a complicated course is higher for appendectomy cases with complicated appendicitis than for appendectomy cases with uncomplicated appendicitis. No temporal trend is evident (b).

eFigure

The development of absolute case numbers for appendectomy, stratified by age group.