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Nonoperative management increases appendicitis mortality

OCTOBER 26, 2017
Clinical Congress Daily Highlights, Thursday Edition

Nonoperative management of acute appendicitis remains controversial, and both short- and long-term outcomes are poorly understood.

Studies presented Thursday suggest that an increase in nonoperative management has led to an increase in mortality, and patients managed nonoperatively who required readmission should be considered for appendectomy.

A study led by Isaiah R. Turnbull, MD, PhD, FACS, Washington University School of Medicine, St. Louis, MO, found that a rise in nonoperative management of acute appendicitis in the U.S. has led to higher mortality. From 1998–2014, nonoperative management more than doubled from 2.3 percent to 4.9 percent. After controlling for age, comorbidity, number of diagnoses, and gender, nonoperative management was associated with a 5.8-fold increase in mortality versus early operation.

A second study found that one in 10 patients managed nonoperatively are readmitted on a short-term basis, and one in five of those readmitted suffers from recurrent appendicitis. Querying the 2013 Nationwide Readmissions Database, the researchers identified 4,219 patients with acute appendicitis who were managed without surgery. The patients most likely to be readmitted were those who abused drugs, had lost weight, were older, had lower socioeconomic status, had stayed in the hospital more than seven days, or had fluid and electrolyte disorders. The researchers, led by Anam Pal, MBBS, Northwell Health Staten Island University Hospital, Staten Island, NY, conclude that these patients are less suitable for nonoperative treatment and should be considered for appendectomy.

Additional Information:
These Scientific Forum studies were presented on or before October 26 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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