WTP2.14 Complicated acute appendicitis: a cohort study

Aims Appendicitis is most common surgical-emergency with incidence 81/100,000, resulting in 50,000 appendicectomies/year (NHS-England). Appendicectomy is accepted as standard-treatment of appendicitis. Complicated-appendicitis is characterized as severe-appendicitis which can result in sepsis. Aim of study is to assess management of complicated-acute-appendicitis at single centre. Methods Cohort study was carried out from Mar'2020 to Jan'2025. Descriptive demography & outcomes were evaluated for all complicated-acute-appendicitis. Uncomplicated-appendicitis & interval-appendicectomy were recruited as controls. Results Complicated(n=484) Uncomplicated(n=469) Interval(n=63) Kruskal-Wallis(p-value) Age(yrs) 41.9±1.0 33.1±0.9 51.9±2.0 <0.0001 Sex(M:F) 250:234 208:261 26:37 NS BMI(kg/m2) 26.8±0.3 25.5±0.3 27.0±0.6 NS WCC(x109/L) 13.8±0.2 12.1±0.2 7.2±0.6 <0.0001 CRP(mg/L) 100.8±4.7 43.3±2.4 18.4±7.0 <0.0001 ASA 2 1 2 0.0009 Conservative(n) 91 173 <0.0001 Surgery(n) 393 296 <0.0001 Clinical(n) 43 62 NS USS-scan(n) 43 92 NS CT-scan(n) 326 269 NS Op-time(mins) 82.0±1.8 66.8±1.6 70.4±4.9 <0.0001 LOS(days) 3±1.5 2 ± 1 0±0.5 <0.0001 Inpatient-AB(days) 3±1.5 2 ± 1 0±0.5 <0.0001 Discharge-AB(days) 5±3.5 3±2.5 0±0 <0.0001 Appendix-HPA(n) Normal 464 430 Appendicitis 18 39 Washout(n) 275 172 20 Drain(n) 114 8 2 Cost(£) 4240±207 2163±124 2212±348 <0.0001 Conclusions Complicated appendicitis accounted for 50.8%, appendicectomy was carried out 81.2%. Grading of acute-appendicitis has allowed targeted-therapy (surgery & antibiotics) especially in complicated-appendicitis. Cummulative-costs of non-operative-management of acute-appendicitis is greater than initial-operative-management (recurrence, readmission, prolonged follow-up & interval-investigations/appendicectomy).