Background
Epidemiologic data related to the surgical management of appendicitis are out of date.
As we contemplate the role of nonoperative therapy in uncomplicated appendicitis,
a contemporary profile of the risks and benefits of operative appendectomy is needed.
Methods
This study merged the 2016 National Surgical Quality Improvement Program essential
and appendectomy-targeted participant use files. The appendectomy-targeted file provides
procedure-specific variables related to imaging, approach, and outcomes. Epidemiologic
data were generated across five domains for adults with uncomplicated appendicitis:
patient characteristics/severity, imaging patterns, operative characteristics, pathologic
outcomes, and postoperative morbidity/mortality.
Results
The merged data file contained 12,376 adult appendectomies from 115 National Surgical
Quality Improvement Program sites. After exclusions, 7,778 cases were analyzed. Almost
all patients (96.1%) received preoperative imaging, with most (79.2%) receiving a
computed tomography scan only. Only 2.6% of appendectomies were performed open, and
the laparoscopic to open conversion rate was 0.5%. Most patients (87.3%) were discharged
the day of or the day after their operation. The rate of finding an incidental tumor
was 1.1%, with greater rates in the elderly (2.7% among patients aged ≥65 years).
The overall rate of a negative appendectomy (NA) was 3.8%; the negative appendectomy
rate was 1.7% for patients with any positive imaging study and 19.4% for patients
with no imaging. The 30-day mortality was 0.04%; 30-day rates of any complication
and serious complications were 3.0% and 2.2%, respectively.
Conclusion
Preoperative imaging, a laparoscopic approach, and excellent clinical outcomes have
become the norm for the surgical management of uncomplicated appendicitis. As surgeons
contemplate the role of nonoperative therapy for uncomplicated appendicitis, the data
presented here should be used to inform the ongoing debate.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Laparoscopic versus open appendectomy: Outcomes comparison based on a large administrative database.Ann Surg. 2004; 239: 43-52
- Has misdiagnosis of appendicitis decreased over time? A population-based analysis.JAMA. 2001; 286: 1748-1753
- Laparoscopic appendectomy—Is it worth the cost? Trend analysis in the US from 2000 to 2005.J Am Coll Surg. 2009; 208 (e2): 179-185
- Trends in utilization and outcomes of laparoscopic versus open appendectomy.Am J Surg. 2004; 188: 813-820
- Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program.Ann Surg. 2008; 248: 557-563
- Antibiotic therapy vs appendectomy for treatment of acute uncomplicated appendicitis: The APPAC randomized clinical trial.JAMA. 2015; 313: 2340-2348
- Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial.Lancet. 2011; 377: 1573-1579
- Appendectomy versus antibiotic treatment for acute appendicitis.Cochrane Database Syst Rev. 2011; CD008359
- Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis.Surgery. 2015; 158: 712-721
- Patient preferences for surgery or antibiotics for the treatment of acute appendicitis.JAMA Surg. 2018; 153: 471-478
- Effectiveness of patient choice in nonoperative vs surgical management of pediatric acute uncomplicated appendicitis.JAMA Surg. 2016; 151: 408-415
- Outpatient laparoscopic appendectomy: Is it time to end the discussion?.J Am Coll Surg. 2016; 222: 473-477
- Cancers of the appendix: review of the literatures.ISRN Oncol. 2011; 2011728579
- Development and evaluation of the universal ACS NSQIP surgical risk calculator: A decision aid and informed consent tool for patients and surgeons.J Am Coll Surg. 2013; 217 (e1–3): 833-842
- Acute appendicitis: Meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease.Radiology. 2008; 249: 97-106
- ACR Appropriateness Criteria® right lower quadrant pain—Suspected appendicitis.Ultrasound Q. 2015; 31: 85-91
- Laparoscopic versus open appendectomy in patients with suspected appendicitis: A systematic review of meta-analyses of randomised controlled trials.BMC Gastroenterol. 2015; 15: 48
- Laparoscopic vs open appendectomy in obese patients: Outcomes using the American College of Surgeons National Surgical Quality Improvement Program database.J Am Coll Surg. 2012; 215 (discussion 99–100): 88-99
- Advantages of laparoscopic appendectomy in the elderly.Am Surg. 2006; 72: 474-480
- Results of yet another antibiotics vs appendectomy randomized trial: Still not enough to change my practice.JAMA Surg. 2016; 151: 191-192
- Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: A systematic review of the literature.World J Emerg Surg. 2017; 12: 12
- Croft CA, Smith RS, Efron PA, et al. Predicting appendiceal tumors among patients with appendicitis.J Trauma Acute Care Surg. 2017; 82: 771-775
- Increased risk of mucinous tumor of the appendix in adults undergoing interval appendectomy.JAMA Surg. 2013; 148: 703-706
- Increased risk of tumor in appendicitis treated with interval appendectomy: Single-institution experience and literature review.Am Surg. 2012; 78: 339-343
- Comparison of outcomes of laparoscopic versus open appendectomy in adults: Data from the Nationwide Inpatient Sample (NIS), 2006–2008.J Gastrointest Surg. 2011; 15: 2226-2231
- Laparoscopic appendectomy trends and outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004-2011.Am Surg. 2014; 80: 1074-1077
Article info
Publication history
Published online: October 29, 2018
Accepted:
September 9,
2018
Received in revised form:
August 31,
2018
Received:
July 25,
2018
Footnotes
Christopher Childers is funded by AHRQ# F32HS025079
A portion of this manuscript was presented at the 2018 Annual Clinical Congress of the American College of Surgeons
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
