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Risk of emergency surgery for complicated appendicitis: Japanese nationwide study.

Takeshi Yamada1, Hideki Endo2, Hiroshi Hasegawa3

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Summary

Complicated appendicitis (CA) surgery has higher complication rates than uncomplicated appendicitis (UA). Elective appendectomy (EA) shows significantly lower risks for all appendicitis types.

Keywords:
appendicitiscomplicated appendicitismorbiditymortalityuncomplicated appendicitis

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Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Public Health

Background:

  • Appendicitis is classified as complicated (CA) or uncomplicated (UA).
  • Interval appendectomy (IA) reduces complications in pediatric CA cases.
  • The comparative risk of emergency surgery for CA versus UA in adults requires clarification.

Purpose of the Study:

  • To compare complication and mortality rates between emergency surgery for CA and UA in adults.
  • To evaluate the risk associated with elective appendectomy (EA) for chronic/recurrent appendicitis.

Main Methods:

  • Retrospective cohort study of adult appendectomy patients from the National Clinical Database (2014-2016).
  • Groups included: CA (emergency surgery), UA, and EA (elective surgery).
  • Primary outcomes: 30-day all morbidity, serious morbidity, and mortality.

Main Results:

  • The CA group had significantly higher rates of all morbidity, serious morbidity, and mortality compared to the UA group.
  • The EA group demonstrated significantly lower rates of all outcomes compared to both CA and UA groups.
  • Study included 109,256 patients: 14,798 CA, 86,876 UA, and 7,582 EA.

Conclusions:

  • Emergency surgery for complicated appendicitis (CA) presents a higher risk to adult patients.
  • Elective appendectomy (EA) is associated with significantly lower risks compared to emergency surgery for both CA and UA.