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Clinical outcomes in patients with complicated appendicitis
Isheeta Madeka1, Keyur Patel2, Peter Altshuler2
1Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA. isheeta.madeka@jefferson.edu.
Surgical Endoscopy
|October 6, 2023
Summary
Complicated appendicitis management can be guided by clinical factors. Larger abscess size predicts non-operative management failure, suggesting a need for tailored treatment algorithms.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Outcomes Research
Background:
- Complicated appendicitis, including abscess, perforation, or peritonitis, has high incidence (28-29%) and lacks consensus on management.
- Current treatments involve antibiotics with or without surgery or drainage, highlighting a need for defined treatment algorithms.
Purpose of the Study:
- To evaluate clinical outcomes in patients with acute complicated appendicitis treated with or without surgery.
- To define treatment algorithms by assessing factors influencing non-operative versus operative management.
Main Methods:
- Retrospective review of 220 adult patients with acute complicated appendicitis (Jan 2017 - June 2022).
- Comparison of outcomes between non-operative management (NOM) and operative management groups.
- Regression modeling to identify predictors of NOM and its failure.
Main Results:
- 26.3% of patients received NOM (antibiotics alone or with drainage), while 73.6% underwent surgery.
- Perforation and phlegmon predicted initial NOM; larger abscess/phlegmon size predicted NOM failure requiring surgery.
Conclusions:
- Clinical factors can help guide the choice between non-operative and operative management for complicated appendicitis.
- Larger abscess and/or phlegmon size is a key predictor of non-operative management failure.
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