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Acute Appendicitis Non-Operative Management Rate Trends Over Two Decades (2000 to 2019): The Israel experience
Doron Carmi1, Ziona Haklai2, Ethel-Sherry Gordon2
1Shoham Community Health Center, Clalit Health Services, Shoham, Israel.
The Israel Medical Association Journal : IMAJ
|February 26, 2023
Summary
Non-operative management (NOM) for acute appendicitis (AA) increased significantly over two decades, particularly since 2015. However, surgical appendectomy remains the predominant treatment for AA.
Area of Science:
- Medical Research
- Surgical Trends
- Public Health
Background:
- Acute appendicitis (AA) is a medical emergency.
- Surgical appendectomy has been the standard treatment.
- Non-operative management (NOM) is increasingly considered for uncomplicated AA.
Purpose of the Study:
- To evaluate trends in non-operative management (NOM) for acute appendicitis (AA) over a 20-year period.
- To compare NOM rates between children and adults.
- To analyze the impact of guidelines on NOM adoption.
Main Methods:
- Retrospective cohort study using Israel's National Hospital Discharges Database (NHDD) from 2000-2019.
- Included patients with primary AA diagnosis or appendectomy procedure.
- Compared data from 2000-2009 with 2010-2019 for pediatric and adult groups.
Main Results:
- Overall AA incidence was 126/100,000/year, higher in children. Surgery predominated (91.9%).
- AA NOM rates increased from 5.6% (2000-2009) to 10.2% (2010-2019), with notable rises in both children and adults.
- Delayed appendectomy after NOM occurred in 19.7% of cases, higher in children (26.3%).
Conclusions:
- AA NOM rates have risen, especially since 2015, possibly influenced by WSES guidelines.
- Despite the upward trend in NOM, surgical appendectomy remains the primary treatment for acute appendicitis.
- Further research may be needed to optimize NOM strategies and outcomes.
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