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The following is a summary of “Long-term Outcomes Following Non-operative Management of Acute Appendicitis: A Population-based Analysis,” published in the October 2024 issue of Surgery by Telesnicki et al.     

Non-operative management (NOM) of acute appendicitis (AA) is increasingly offered despite the risk of subsequent appendectomy. Understanding the long-term outcomes of the approach is essential.  

Researchers conducted a retrospective study to describe long-term re-presentations and interventions following NOM of AA.  

They included all adult patients who presented with AA (n = 156,362) to ED in Ontario, Canada (2004 to 2019). Patients who did not undergo a procedure during the index ED presentation or hospital admission were defined as NOM and followed for 5 years. The cumulative incidence of composite re-presentation or intervention (ED re-presentation, readmission, emergency, or scheduled appendicitis procedure) was calculated while accounting for the competing risk of death.  

The results showed that among the patients who have previously undergone NOM, the cumulative incidence of composite re-presentation or intervention was 33% at one year (95% CI 32-33%) and 36% at 5 years (95% CI 36-37%). At 5 years, the incidence of AA-specific ED re-presentation or hospital readmission was 16% (95% CI 15-16%), the incidence of ED procedures for AA was 12% (95% CI 12-13%), and the incidence of scheduled surgery was 21% (95% CI 20-21%). In patients with uncomplicated AA, the composite re-presentation or intervention was 28% at 1 year (95% CI 27-29%) and 32% at 5 years (95% CI 32-33%).  

They concluded that the real-world estimate of ED re-presentation and the need for urgent surgery following NOM of AA were lower than previously reported, with scheduled appendectomy representing a significant portion of long-term interventions.  

Source: journals.lww.com/annalsofsurgery/abstract/9900/long_term_outcomes_following_non_operative.1106.aspx