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Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

View Article: PubMed Central - PubMed

ABSTRACT

The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively.

We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis.

Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age <18, a (CCI) <2, medical center admission, and a longer time to recurrence were correlated with using laparoscopy to treat recurrence. Neither type of appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach.

In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity.

No MeSH data available.


Flowchart of nonoperatively managed patients.
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Figure 1: Flowchart of nonoperatively managed patients.

Mentions: A total of 239,821 patients hospitalized with acute appendicitis for the first time between 2000 and 2010 were identified from the database. Of note, 71.4% of the patients were between 18 and 65-year old and 54.7% of the patients were men. Most of the patients (91.2%) were healthy with a CCI of 0. The type of appendicitis was coded as generalized peritonitis (19.1%), peritoneal abscess (6.2%), and no abscess or peritonitis (74.7%). For the initial management, 188,162 (78.5%) patients received OA while 39,415 (16.4%) patients received LA. The remaining 12,235 (5.1%) patients were treated nonoperatively (Figure 1).


Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis
Flowchart of nonoperatively managed patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998395&req=5

Figure 1: Flowchart of nonoperatively managed patients.
Mentions: A total of 239,821 patients hospitalized with acute appendicitis for the first time between 2000 and 2010 were identified from the database. Of note, 71.4% of the patients were between 18 and 65-year old and 54.7% of the patients were men. Most of the patients (91.2%) were healthy with a CCI of 0. The type of appendicitis was coded as generalized peritonitis (19.1%), peritoneal abscess (6.2%), and no abscess or peritonitis (74.7%). For the initial management, 188,162 (78.5%) patients received OA while 39,415 (16.4%) patients received LA. The remaining 12,235 (5.1%) patients were treated nonoperatively (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively.

We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis.

Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age <18, a (CCI) <2, medical center admission, and a longer time to recurrence were correlated with using laparoscopy to treat recurrence. Neither type of appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach.

In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity.

No MeSH data available.