Factors associated with recurrent appendicitis after nonoperative management

Abstract

Background: The objective of this study is to identify predictors for recurrent appendicitis in patients with appendicitis previously treated nonoperatively.

Methods: This is a prospective cohort study of all adult patients with appendicitis treated at a tertiary care hospital. Patient demographics, radiographic information, management, and clinical outcomes were recorded. The primary outcome was recurrent appendicitis within 6 months after discharge from the index admission. Given the competing risk of interval appendectomy, a time-to-event competing-risk analysis was performed.

Results: Of the 699 patients presenting with appendicitis, 74 were treated nonoperatively (35 [47%] were women; median [IQR] age, 48 [33,64] years), and 21 patients (29%) had recurrent appendicitis. On univariate and multivariate analysis, presence of an appendicolith on imaging was the only factor associated with a higher risk of recurrent appendicitis (p = 0.02).

Conclusions: The presence of appendicolith was associated with an increased risk of developing recurrent appendicitis within 6 months.

Keywords: Antibiotics; Appendicitis; Appendicolith; Nonoperative management; Recurrent appendicitis.