SRS245 - Real-world outcomes of conservative management for uncomplicated appendicitis

Introduction Recent trials suggest that uncomplicated appendicitis can be treated successfully with antibiotics. However, most data are limited to short-term outcomes, and uncertainty remains about the suitability of this approach outside trial settings. Methods Reports of all regional CT scans containing the keyword appendicitis between January 2020 and December 2021 were retrieved from electronic records and filtered using predefined criteria. Demographic, treatment, and outcome data were reviewed retrospectively. The primary outcome was recurrence of appendicitis after conservative treatment at three years. Results Of 3252 scans, 1008 confirmed appendicitis (631 uncomplicated [62.6%], 377 complicated [37.4%]; 544 male; median age 46, range 16–98). Conservative treatment was undertaken in 212 patients (21.0%), including 135 (13.4%) with uncomplicated disease. 796 (79.0%) of the entire study group underwent appendicectomy. Among conservatively managed uncomplicated cases, 17 patients died of unrelated causes during the three-year period and were excluded. Of the remaining, 83 (42.6%) developed recurrence of appendicitis and 57 (29.2%) underwent appendicectomy. Among 534 surgically treated uncomplicated cases, 12 (2.2%) harboured unexpected malignancy. Notably, 7 of 57 recurrent appendicitis cases undergoing delayed surgery (12.3%) had cancer on histology. Conclusions At three years, nearly half of conservatively managed patients with uncomplicated appendicitis had recurrence of appendicitis, and a concerning proportion showed malignancy. Non-operative treatment carries substantial risks of both recurrence of appendicitis and missed cancer. Patients should be advised that while antibiotics may avoid initial surgery, this comes at the cost of high failure rates and potential delay in diagnosing significant pathology.