Nonoperative Management of Uncomplicated Appendicitis Among Privately Insured Patients

Sceats, Lindsay A.; Trickey, Amber W.; Morris, Arden M.; Kin, Cindy; Staudenmayer, Kristan

doi:10.1001/jamasurg.2018.4282

Cited by 50 publications

(52 citation statements)

References 44 publications

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“…Yet, surgery and perioperative care of children with appendicitis can be both challenging and expensive, and avoiding complications is of the highest priority. 5,[18][19][20] In line with earlier studies, 14,21 our data report a very low mortality and a low overall risk of complications, and we conclude that treatment in general was safe and effective in several aspects. However, since appendicitis is relatively common during childhood and adolescence, even low rates of complications lead to significant disease burden and costs beyond the index hospitalization.…”

Section: Discussionsupporting

confidence: 90%

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

et al. 2020

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Introduction Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. Materials and Methods A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. Results Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18–3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08–5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61–5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62–0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11–0.63], p = 0.002). Conclusion Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.

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Section: Discussionsupporting

confidence: 90%

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

et al. 2020

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“…The majority of appendiceal cancers, however, are not diagnosed preoperatively and present as acute appendicitis, which makes our patient cohort relevant to addressing our clinical question . Finally, the overall incidence of nonoperative management of acute appendicitis has been historically low – a study of privately insured patients in the country reported only 4.5% of patients with acute appendicitis being treated without surgery . However, there has been increasing public awareness on the treatment options for appendicitis; a survey in 2016 showed up to 9.4% of individuals would opt for nonoperative management of their acute appendicitis when presented with treatment options, and in the pediatric population, nonoperative management increased by 20.4% between the years of 2010‐2016 .…”

Section: Discussionmentioning

confidence: 99%

“…10 Finally, the overall incidence of nonoperative management of acute appendicitis has been historically lowa study of privately insured patients in the country reported only 4.5% of patients with acute appendicitis being treated without surgery. 32 However, there has been increasing public awareness on the treatment options for appendicitis; a survey in 2016 showed up to 9.4% of individuals would opt for nonoperative management of their acute appendicitis when presented with treatment options, and in the pediatric population, nonoperative management increased by 20.4% between the years of 2010-2016. 33,34 Despite these limitations, our study has many strengths and provides contemporary, generalizable data, which can be used to help clinicians best educate and counsel patients in a time of changing treatment practices.…”

Section: Discussionmentioning

confidence: 99%

Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management

McCarty

Fields

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Management practices for acute appendicitis are changing. In cases of nonoperative treatment, the risk of missed or delayed diagnosis of malignancy should be considered. We aimed to identify predictors associated with appendiceal cancer diagnosis after appendectomy for acute appendicitis. Materials and Methods This retrospective cohort study was performed using the National Surgical Quality Improvement Program (NSQIP) appendectomy‐targeted data set from 2016 to 2017. A total of 21 069 patients with imaging‐confirmed or imaging indeterminate appendicitis who underwent appendectomy were included. Logistic regression was used to identify predictors of cancer diagnosis. Results Increasing age had an increasing monotonic relationship with the odds of pathologic cancer diagnosis after appendectomy (age 50‐59 odds ratio [OR], 2.08, 95% confidence interval [CI], 1.28‐3.39, P = .003; age 60‐69 OR, 2.89, 95% CI, 1.72‐4.83, P < .001; age 70‐79 OR, 3.85, 95% CI, 2.08‐7.12, P < .001; age >80 OR, 5.32, 95% CI, 2.38‐11.9, P < .001). Other significant predictors included obesity, morbid obesity, normal preoperative white blood cell count, and imaging indeterminate for appendicitis. Conclusions When counseling patients regarding operative vs nonoperative treatment options for management of acute appendicitis, the rising risk of a delayed or missed cancer diagnosis with increasing age must be discussed.

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“…Therefore, ILA is preferred in most pediatric cases of appendicitis. However, some researchers disapprove of the use of ILA because of increased hospital costs, risk of recurrence, and strong in ammatory adhesion [13][14][15]. However, with the recent technical improvements in laparoscopic surgery, ELA has been reported to be equivalent to ILA in terms of the frequency of complications [16][17][18].…”

mentioning

confidence: 99%

Defining treatment strategy for uncomplicated appendicitis based on patient satisfaction feedback: A cross-sectional study

Tatsuta

Miyazaki

Ogiku

et al. 2020

Preprint

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Background Two surgical strategies are available for appendicitis: emergency laparoscopic appendectomy and interval laparoscopic appendectomy. However, timing of surgical intervention remains debatable. This study aimed to compare the surgical outcomes of emergency laparoscopic appendectomy (ELA) and interval laparoscopic appendectomy (ILA) and conduct a questionnaire survey to investigate the use of ELA and patient satisfaction with regard to treatment. Methods We included 162 patients who underwent laparoscopic appendectomy at our hospital. Outcomes were assessed by operation time, blood loss, postoperative fasting time, length of hospital stay, and complication rate. Patient satisfaction was measured by questionnaire addressing degree of satisfaction, pre-surgery anxiety, and length of hospital stay. Continuous variables were compared by Student’s t-test, and discrete variables, expressed as percentages, were analyzed via chi-squared test. Results Of 162 patients, 74 (46%) and 88 (54%) received emergency and ILA, respectively. No significant difference was observed in the operation time, blood loss, length of hospital stay, or complication rate. Among 66 patients who responded to the questionnaire (28 emergency, 38 interval), a significant difference was observed only in the degree of satisfaction regarding the timing of the surgical intervention (p = 0.04). Conclusions Surgical outcomes of emergency and interval appendectomy were equivalent; however, patient satisfaction favored emergency appendectomy, suggesting it is a preferable approach for the treatment of uncomplicated appendicitis. Trial registration: NA

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Nonoperative Management of Uncomplicated Appendicitis Among Privately Insured Patients

Abstract: professionals have shown significant interest in nonoperative management for uncomplicated appendicitis, but long-term population-level data are lacking.

Cited by 50 publications

References 44 publications

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management

Defining treatment strategy for uncomplicated appendicitis based on patient satisfaction feedback: A cross-sectional study

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