Background: Optimal management of patients with acute complicated appendicitis remains debated. Traditional management often emphasized nonoperative treatment using antibiotics and, when necessary, percutaneous drainage. Growing evidence indicates that operative management may be safe in select patients. This study aimed to evaluate whether appendiceal stump size ≥2 cm on preoperative CT scan is predictive of intraoperative complexity and postoperative outcomes. Methods: A multicenter retrospective review evaluated operative outcomes in patients with acute complicated appendicitis identified on preoperative imaging that were managed operatively from January 2018 to May 2024. Appendiceal stump length was measured on computed tomography (CT) by an attending acute care surgeon. The primary outcome was the need for extended resection. Secondary outcomes included conversion to open, readmission, length of stay (LOS), postoperative abscess, and mortality. Results: One hundred fifty-two patients met the inclusion criteria: 98 had stump size ≥2 cm, and 54 had stump length <2 cm. Patients with stump size ≥2 cm were more likely to have chronic kidney disease (0.0% vs. 9.9%, p =0.002). There were no other differences in baseline characteristics. Patients with stump size <2 cm had a significantly increased risk of need for extended resection (OR=20.2, 95% CI: 4.43–92.15, p <0.001). They also had a significantly increased odds of conversion to open surgery (OR=5.9, 95% CI: 1.97–17.63, p <0.001). LOS was longer in patients with appendiceal stumps <2 cm (mean 4.6±3.7 d) compared with those with appendiceal stumps ≥2 cm (3.0±2.3 d, p =0.01). There was no difference in readmissions, postoperative abscess, or mortality. Conclusions: Appendiceal stump length ≥2 cm was associated with significantly reduced risk of conversion to open and extended resection. These patients also had shorter LOS. Stump length on preoperative imaging may serve as a useful adjunct in operative planning for patients with acute complicated appendicitis. ( J Trauma Acute Care Surg . 2026;00: 00–00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) Level of Evidence: Original Research—Therapeutic/Care Management; Level III
Gerard et al. (Thu,) studied this question.