Composite Criteria for Non-Operative Management of Acute Non-Complicated Appendicitis Result in Low Failure Rates.
World J Surg
; 46(1): 69-75, 2022 01.
Article
em En
| MEDLINE
| ID: mdl-34570268
ABSTRACT
BACKGROUND:
The aim of this study is to investigate the outcomes of conservative management of non-complicated acute appendicitis (AA) using our unique institutional protocol, and to compare between these and the outcomes of operative management.METHODS:
Patients admitted to our institution between March 2016 and October 2019 with non-complicated AA were grouped according to their initial management non-operative versus surgical. Our unique protocol for non-operative management includes pain < 3 days; afebrile upon admission; non-gravid; WBC <15,000 (× 109/L); CRP < 5 mg/dl; appendix diameter < 1 cm; no appendicolith on imaging; no prior episode of AA; no history of Inflammatory Bowel Disease; no evidence of peritonitis on physical examination. The primary outcome measured was failure of non-surgical management during the index admission. Secondary outcomes included recurrence rate, readmissions, complications, length of antibiotic treatment and length of stay (LOS).RESULTS:
A total of 695 patients were included, 436 in the operative group and 259 in the non-surgical treatment group. The mean follow-up time was 1004.9 ± 205.7 days. Patients initially treated conservatively rarely required surgery during their index admission (6.9%). Recurrence rate was 19.1% after a mean follow up of 33.4 months. The overall failure rate of conservative management was documented in 20.8% of the patients. The complication rate was higher in those treated with upfront surgery (1.6% vs. 0.4%, p < 0.001). The overall LOS was not statistically different between the groups.CONCLUSIONS:
Our composite protocol for non-surgical management of non-complicated AA results in a low failure rate. A well calculated patient treatment allocation in non-complicated AA can advocate for wide-spread use of the conservative approach.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Apendicite
/
Apêndice
/
Peritonite
Tipo de estudo:
Guideline
Limite:
Humans
Idioma:
En
Revista:
World J Surg
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Israel