Key result
Age >80 years was associated with increased odds of a pathologic appendiceal cancer diagnosis after appendectomy for acute appendicitis.
Why the study?
With changing management practices for acute appendicitis, nonoperative treatment risks missing or delaying a diagnosis of malignancy.
What are the predictors of appendiceal cancer diagnosis after appendectomy for acute appendicitis?
Cohort (n=21,069)
Yes
What are the predictors of appendiceal cancer diagnosis after appendectomy for acute appendicitis?
Increasing age, obesity, normal preoperative WBC, and indeterminate imaging are significant predictors of appendiceal cancer in patients with acute appendicitis, which should be considered when counseling older patients on nonoperative management.
Answers are grounded in this paper and cite their sources.
Older age and select factors may flag higher malignancy risk; leaves open optimal surveillance after nonoperative appendicitis management.
BACKGROUND AND OBJECTIVES: Management practices for acute appendicitis are changing. In cases of nonoperative treatment, the risk of missed or delayed diagnosis of malignancy should be considered. We aimed to identify predictors associated with appendiceal cancer diagnosis after appendectomy for acute appendicitis. MATERIALS AND METHODS: This retrospective cohort study was performed using the National Surgical Quality Improvement Program (NSQIP) appendectomy-targeted data set from 2016 to 2017. A total of 21 069 patients with imaging-confirmed or imaging indeterminate appendicitis who underwent appendectomy were included. Logistic regression was used to identify predictors of cancer diagnosis. RESULTS: Increasing age had an increasing monotonic relationship with the odds of pathologic cancer diagnosis after appendectomy (age 50-59 odds ratio [OR], 2.08, 95% confidence interval [CI], 1.28-3.39, P = .003; age 60-69 OR, 2.89, 95% CI, 1.72-4.83, P < .001; age 70-79 OR, 3.85, 95% CI, 2.08-7.12, P < .001; age >80 OR, 5.32, 95% CI, 2.38-11.9, P < .001). Other significant predictors included obesity, morbid obesity, normal preoperative white blood cell count, and imaging indeterminate for appendicitis. CONCLUSIONS: When counseling patients regarding operative vs nonoperative treatment options for management of acute appendicitis, the rising risk of a delayed or missed cancer diagnosis with increasing age must be discussed.
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Lu et al. (2019) conducted a cohort in acute appendicitis (n=21,069). Age >80 years vs. Reference age group was evaluated on pathologic cancer diagnosis after appendectomy (OR 5.32, 95% CI 2.38-11.9, p=<.001). Age >80 years was associated with increased odds of a pathologic appendiceal cancer diagnosis after appendectomy for acute appendicitis.
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