The benefits of interval appendectomy and risk factors for nonoperative management failure in the therapeutic strategy for complicated appendicitis

Kohki Takeda; Takeshi Yamada; Kay Uehara; Akihisa Matsuda; Seiichi Shinji; Yasuyuki Yokoyama; Goro Takahashi; Takuma Iwai; Sho Kuriyama; Toshimitsu Miyasaka; Shintaro Kanaka; Hiroshi Yoshida

doi:10.1007/s00595-024-02842-w

The benefits of interval appendectomy and risk factors for nonoperative management failure in the therapeutic strategy for complicated appendicitis

Surg Today. 2024 Apr 10. doi: 10.1007/s00595-024-02842-w. Online ahead of print.

Affiliations

¹ Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan. take-yokohama@nms.ac.jp.
² Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.

PMID: 38598170
DOI: 10.1007/s00595-024-02842-w

Abstract

Purpose: Emergency surgery (ES) for complicated appendicitis (CA) is associated with high morbidity. Interval appendectomy (IA) decreases this rate; however, nonoperative management (NOM) is not always successful. Some patients require unplanned ES due to NOM failure (IA failure: IA-F). This study aimed to verify the benefits of IA and to evaluate the risk factors for NOM failure.

Methods: Patients diagnosed with CA who underwent surgery between January 2012 and December 2021 were included in this study. We compared the surgical outcomes of the ES group with those of the IA success (IA-S) and IA-F groups. We also analyzed 14 factors that predicted NOM failure.

Results: Among 302 patients, the rate of severe complications (Clavien-Dindo grade ≥ III) was significantly higher in the ES group (N = 165) than in the IA-S group (N = 102). The rates were equal between the ES (N = 165) and IA-F (N = 35) groups. NOM was successful in 110 patients and failed in 27. Lack of abscesses, comorbidities, high WBC count, and free air were independent risk factors for NOM failure.

Conclusions: Considering the benefits of IA and the non-inferior surgical outcomes of IA-F compared to ES, IA is a good therapeutic strategy for CA. However, in patients exhibiting four independent risk factors for NOM failure, careful monitoring of unplanned ES is necessary.

Keywords: Appendicitis; Complicated appendicitis; Interval appendectomy; Non operative management; Postoperative complications.