Anesthesia Staffing: Two Studies Offer More Support for Nonoperative Management of Uncomplicated Appendicitis

Authors: Minneci PC et al., J Am Coll Surg 2014 Apr 12; 218:905

The studies show that antibiotics are effective for uncomplicated appendicitis in adult and pediatric patients.

Two studies offer additional evidence to support the nonoperative management of uncomplicated appendicitis.

One study evaluated 230,000 California patients of all ages admitted between 1997 and 2008. Those undergoing appendectomy were compared with a small, propensity-matched, nonoperatively managed cohort (3236 patients; 1.5%). The nonoperative-treatment failure rate was 5.9%, occurring at an average of 6 days; the recurrence rate was 4.2%, occurring around 2 years. Nonoperative patients had longer lengths of stay (mean, 3.2 vs. 2.1 days). Mean total charges and in-hospital and 30-day mortality rates were similar between groups.

The second study evaluated 77 Ohio patients between ages 7 and 17 years; patients and their families chose operative or nonoperative management. All had abdominal pain for 48 hours or less and underwent imaging confirming uncomplicated appendicitis. Thirty patients chose nonoperative therapy. Of the three nonoperative treatment failures (10%), one had an enlarged, nonperforated appendix intra-operatively. The nonoperative group returned to school more quickly (3 vs. 5 days) and had fewer disability days (3 vs. 17) and higher quality-of-life scores — but longer lengths of stay (38 vs. 20 hours). In the operative group, 10.5% of patients returned with wound complications.

Comment

Although appendectomy is curative for acute appendicitis, the complication rate ranges from 8% to 11%, which is similar to the nonoperative-treatment failure rate. Selection bias limits both of these studies’ generalizability, but in conjunction with other recent research, antibiotics alone appear to be a reasonable treatment option for acute uncomplicated appendicitis in adults and children.