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Interval Appendectomy Increases Odds of Cancer Diagnosis

OCTOBER 29, 2019
Clinical Congress Daily Highlights, Tuesday Second Edition

Appendiceal cancer is relatively common following non-operative management of perforated appendicitis, occurring in 2.5 percent of cases, according to a new study led by Lindsay A. Sceats, MD, Stanford University, Stanford, CA.

Recent data suggests that about 20 percent of patients managed non-operatively for perforated appendicitis are later diagnosed with appendiceal cancer. Since population-level data was lacking to support this figure, the researchers decided to see if it could be established with a commercial claims data set. The team hypothesized that interval appendectomy may increase identification of potential malignancies after perforated appendicitis.

The team assessed index hospitalization cost, length of stay, percutaneous drainage, interval appendectomy rates, abdominal imaging, colonoscopy, and appendiceal malignancy for 1,588 patients with perforated appendicitis and initial non-operative management. After an average of about 3.1 years, 73 percent underwent additional abdominal imaging, 31 percent colonoscopy follow-up, 40 percent interval appendectomy, and 4 percent right hemicolectomy.

“Most patients undergo substantial follow-up after non-operative management of perforated appendicitis,” Dr. Sceats said.

Of the group, 39 patients (2.5 percent) were later diagnosed with an appendiceal cancer after a median time of 68 days. Neither patient characteristics (age, gender, diabetes, obesity) or initial percutaneous drainage were significantly associated with increased odds of appendiceal cancer. Interval appendectomy was associated with increased odds of diagnosing a malignancy.

Additional Information:
The Scientific Forum, Health Services Research IV – Volume-Cost Relationship in Surgery: Nationwide Analysis of 84.6 Million Inpatient Admissions, was held Tuesday, October 29 at the American College of Surgeons Clinical Congress 2019 in San Francisco (program, webcast and audio information).