Outcomes of complicated appendicitis: Is conservative management as smooth as it seems?

American Journal of Surgery
Katelyn A YoungJeffrey L Wild

Abstract

This study characterized the failure rate of non-operative management (NOM) for complicated appendicitis (CA; perforation, abscess, phlegmon), and compared outcomes among patients undergoing acute appendectomy (AA), elective interval appendectomy (EIA), and unplanned appendectomy after failing to improve with NOM. Adults treated at one facility between 2007 and 2014 were retrospectively studied. Ninety-five patients presented with CA. Sixty individuals underwent AA. The remaining 35 patients initially underwent NOM: 14 underwent EIA, nine (25.7%) failed NOM, 12 never underwent surgery. All patients failing NOM had an open operation with most (55.6%) requiring bowel resection. AA and EIA were comparable in surgical approach, bowel resection and post-operative readmission. However, AA demonstrated a lower incidence of bowel resection (3.3% vs 17.1%, P = 0.048) when compared to all patients initially undergoing NOM. Due to the high incidence of failed NOM and the morbidity associated with failure, AA may be appropriate for CA.

Citations

Jan 24, 2019·International Journal of Colorectal Disease·S ShekarrizH Shekarriz
Apr 2, 2019·Surgical Infections·Patrick K McGillenSabrina E Sanchez
Dec 12, 2019·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Yunfei ZhangChunbao Guo
Apr 17, 2020·World Journal of Emergency Surgery : WJES·Salomone Di SaverioFausto Catena
Apr 17, 2021·Annals of Gastroenterological Surgery·Takeshi YamadaYuko Kitagawa
Jun 12, 2021·Cost Effectiveness and Resource Allocation : C/E·César Augusto Guevara-CuellarElizabeth Parody-Rúa
Aug 17, 2021·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Hiroshi TakeyamaYoshio Oka
Sep 1, 2021·JAMA Network Open·Kenneth A MichelsonRichard G Bachur

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