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January 27, 2022Open Access

Predictors of Nonoperative Management Failure and Recurrence in Adults with Acute Appendicitis: A Single-Center Retrospective Study

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Key result

In adults with acute appendicitis undergoing nonoperative management, the presence of fecal stones with abscess formation was independently associated with treatment failure (OR 5.530).

Why the study?

Failure and recurrence are concerns in nonoperative management for acute appendicitis and interval appendectomy, prompting a search for predictive factors.

What are the predictors of nonoperative management failure and recurrence in adults with acute appendicitis?

Population

337 adults with acute appendicitis who did not undergo emergency surgery

Comparison

Failed vs successful nonoperative management, and recurrence vs non-recurrence

Design

Single-center retrospective study

Authors

YWYusuke WakasaYTYoshikazu ToyokiYKYuma Kameyama

Discussion

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Member takes

Overview

Fecalith with abscess may flag nonoperative failure risk in appendicitis; hypothesis-generating and should not yet change practice.

Study Design

Type

Cohort (n=337)

Multicenter

No

Structured PICO

What are the predictors of nonoperative management failure and recurrence in adults with acute appendicitis?

P
Population
337 adults with acute appendicitis treated with nonoperative management were retrospectively analyzed to identify predictors of treatment failure and recurrence.
E
Exposure
Nonoperative management (NOM) with intravenous fluid support and antibiotics (cefmetazole or piperacillin/tazobactam, with metronidazole added for abscess formation)
O
Outcome
Predictors of nonoperative management (NOM) failure (requiring unplanned appendectomy) and recurrence of appendicitis

Main Result

Odds Ratio: 5.53 (95% CI 2.081–14.691)

p-value: p=0.001

Post-treatment CRP levels and the presence of fecal stones with abscess formation are strong independent predictors of nonoperative management failure in adults with acute appendicitis.

Limitations

  • Small number of patients
  • Retrospective, non-randomized design without a control group
  • Definition of complicated appendicitis has not been established and target cases differ among studies
  • Definition of complicated appendicitis has not been established

Cite This Study

Wakasa et al. (2022) conducted a cohort in Acute appendicitis (n=337). Fecal stones with abscess formation vs. Absence of fecal stones with abscess formation was evaluated on Nonoperative management (NOM) failure (OR 5.530, 95% CI 2.081-14.691, p=0.001). In adults with acute appendicitis undergoing nonoperative management, the presence of fecal stones with abscess formation was independently associated with treatment failure (OR 5.530).

synapsesocial.com/papers/6a7c5273d249c0c91c3be76ahttps://doi.org/10.21203/rs.3.rs-1256996/v1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Randomized controlled trial of appendicectomy <i>versus</i> antibiotic therapy for acute appendicitis1995 · 34 citations
  2. 2Increased Risk of Mucinous Neoplasm of the Appendix in Adults Undergoing Interval Appendectomy2013 · 114 citations
  3. 3Initial nonoperative management for periappendiceal abscess2001 · 140 citations
  4. 4Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult2019 · 112 citations
  5. 5Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis2016 · 18 citations