The role of interval appendectomy after an episode of acute appendicitis is debated.
Patients treated nonoperatively for acute appendicitis do not require routine interval appendectomy.
Dr Anna Kaminski and colleagues from California designed a retrospective cohort study using discharge abstract data.
The investigators assessed data from 12 regional Kaiser Permanente hospitals in Southern California.
The investigative team reported that a total of 32,938 patients were hospitalized with acute appendicitis.
The interventions included appendectomy or nonoperative treatment with or without abscess drainage.
The team's main outcome measure was hospitalization for recurrent appendicitis or interval appendectomy.
|5% recurred after a median follow-up of 4 years |
|Archives of Surgery|
The type of appendicitis was abscess in 7% of patients, peritonitis in 18%, and no peritonitis or abscess in 75%.
The investigators found that emergency appendectomy was performed in 97% of patients.
Nonoperative treatment was used initially in 3% of patients, and of these, 15% had an interval appendectomy while the remaining 85% did not.
The investigative team noted that 5% recurred after a median follow-up of 4 years.
Using Cox regression, the team observed that sex had a slight influence on recurrent appendicitis.
The investigators found that Charlson comorbidity index, type of appendicitis, or percutaneous abscess drainage had no influence on recurrence.
Median length of hospital stay was 4 days for the admission for recurrent appendicitis compared with 6 days for the interval appendectomy admission.
Dr Kaminski's team commented, “Most patients with acute appendicitis undergo appendectomy initially.”
“For those treated nonoperatively, the recurrence rate is low.”
“Routine interval appendectomy after initial successful nonoperative treatment is not justified and should be abandoned.”