Drain Failure in Intra-Abdominal Abscesses Associated with Appendicitis

Area of Science:

• Surgical Gastroenterology
• Abdominal Imaging
• Health Services Research

Background:

• Percutaneous drainage followed by interval appendectomy is a recognized treatment for appendicitis with abscess.
• Limited research exists on risk factors associated with failed percutaneous drain management for appendiceal abscesses.
• This study investigates patient and treatment-related factors predicting failure of conservative management.

Purpose of the Study:

• To identify risk factors associated with the failure of percutaneous drain management in patients with appendiceal abscesses.
• To determine the impact of drain failure on healthcare charges, hospital stay, and mortality.
• To analyze patient demographics and clinical characteristics associated with successful conservative treatment.

Main Methods:

• Analysis of the 2010-2014 National Inpatient Sample (NIS) database for patients diagnosed with peri-appendiceal abscesses.
• Exclusion of minors and elective admissions; definition of drain failure as subsequent operative intervention during the same inpatient stay.
• Application of univariable and multivariable logistic regression, chi-squared tests, and Student's t-tests to identify independent risk factors.

Main Results:

• 25.4% of 2,209 patients with appendiceal abscesses experienced drain management failure.
• Factors predicting failure included more inpatient diagnoses, female sex, and Hispanic race.
• Older age, specific census regions (West, Midwest), and later drain placement predicted successful drainage alone.

Conclusions:

• Approximately one-quarter of patients undergoing percutaneous drainage for appendiceal abscesses will require operative intervention.
• Patient complexity, female sex, Hispanic race, and earlier drainage are associated with treatment failure.
• Drainage failure increases healthcare charges and hospital length of stay, without affecting mortality rates.