This large, contemporary, multi-institutional study demonstrated that asymptomatic RAAs rarely rupture (even when >2 cm), growth rate is 0.086 ± 0.08 cm/y, and calcification does not protect against enlargement. RAA open repair is associated with significant minor morbidity, but rarely a major morbidity or mortality. Aneurysm repair cured or improved hypertension in >50% of patients whose RAA was identified during the workup for difficult-to-control hypertension.

Background Emerging literature has supported the safety of non-operative management of uncomplicated appendicitis. Study Design Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development (OSHPD) database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation following non-surgical management were calculated. Factors associated with treatment failure, recurrence, and perforation were identified using multivariable logistic regression. Mortality, length of stay, and total charges were compared between treatment cohorts using matched propensity score analysis. Results Among 231,678 patients with uncomplicated appendicitis, the majority (98.5%) were managed operatively. Among the 3,236 non-surgically managed patients who survived to discharge without an interval appendectomy, 5.9% and 4.4% experienced treatment failure or recurrence, respectively, over a median duration of follow up of greater than seven years. There were no mortalities associated with treatment failure or recurrence. The risk of perforation after discharge was approximately 3%. Using multivariable analysis, race and age were significantly associated with the odds of treatment failure. Gender, age, and hospital teaching status were significantly associated with the odds of recurrence. Age and hospital teaching status were significantly associated with the odds of perforation. Matched propensity score analysis indicated that after risk adjustment mortality rates (0.1% vs. 0.3%, p=0.65) and total charges ($23,243 vs. $24,793, p=0.70) were not statistically different between operative and non-operative patients, however, length of stay was significantly greater amongst the non-operative treatment group (2.1 vs. 3.2 days, p<0.001). Conclusions This study suggests that non-operative management of uncomplicated appendicitis may be safe, and prompts further investigations. Comparative effectiveness research using prospective randomized studies may be particularly useful.

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