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Readmission after antibiotic management of uncomplicated acute appendicitis in adults: prospective study

Abstract

Background

Acute appendicitis is the most common surgical cause of acute abdomen. Many randomized studies compare between antibiotic and surgery, and such studies indicated that antibiotics might treat acute appendicitis. However, there are concerns about selection bias in previous studies. Hence, to overcome this worry; we used in this study a full-scale population-based application.

Patients and methods

We identified 327 adult patients who were admitted to surgical ward with diagnosis of uncomplicated acute appendicitis between March 2013 and February 2016. All patients received antibiotic therapy after confirming the diagnosis by computed tomography. Endpoints were treatment efficacy, readmission, and complications in 1 year of follow-up.

Results

Of the 327 patients include in this study, 8 (2.5%) patients failed initial non-operative (antibiotic) management and underwent operation during their initial hospitalization. Of 319 available for 1-year follow-up, 280 patients (87.8%) did not require appendectomy; while 39 patients (12.2%) need readmission within 1 year.

Conclusions

Antibiotics are a safe and visible option in acute appendicitis management. This approach needs careful assessment and evaluation for each individual patient before it is used as the first-line therapy.

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References

  1. Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333:530–4.

    CAS  Article  Google Scholar 

  2. Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP. Appendectomy: a contemporary appraisal. Ann Surg. 1997;225:252–61.

    CAS  Article  Google Scholar 

  3. Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Oprian CA, Henderson WG, Daley J, Khuri SF. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg. 2003;238:59–66.

    PubMed  PubMed Central  Google Scholar 

  4. Tevis SE, Kohlnhofer BM, Weber SM, Kennedy GD. Postdischarge complications are an important predictor of postoperative readmissions. Am J Surg. 2014;208(4):505–10.

    Article  Google Scholar 

  5. Moghadamyeghaneh Z, Hwang G, Hanna MH, Carmichael JC, Mills S, Pigazzi A, Stamos MJ. Unplanned readmission after appendectomy. Am J Surg. 2015 Oct 22.

  6. Harrison PW. Appendicitis and antibiotics. Am J Surg. 1953;85:160–3.

    CAS  Article  Google Scholar 

  7. Coldrey E. Five years of conservative treatment of acute appendicitis. J Int Coll Surg. 1959;32:255–61.

    Google Scholar 

  8. Ehlers AP, Talan DA, Moran GJ, Flum DR, Davidson GH. Evidence for an antibiotics-first strategy for uncomplicated appendicitis in adults: a systematic review and gap analysis. J Am Coll Surg. 2016; 222(3):309–14.

    Article  Google Scholar 

  9. Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomized controlled trial. Lancet. 2011; 377(9777):1573–9.

    CAS  Article  Google Scholar 

  10. Fitz RH. Perforating inflammation of the vermiform appendix; with special reference to its early diagnosis and treatment. Am J Med Sci. 1886: 92:321–346.

  11. McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. NY Med J. 1889;50:676–684.

    Google Scholar 

  12. Ingraham AM, Cohen ME, Bilimoria KY, Pritts T1A, Ko CY, Esposito TJ. Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery. 2010;148:625–35.

    Article  Google Scholar 

  13. Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg. 2011;201(4):433–7.

    Article  Google Scholar 

  14. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg, 2002;137:799–804.

    Article  Google Scholar 

  15. Liu K, Fogg L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery. 2011;150(4):673–83.

    Article  Google Scholar 

  16. Horikoshi H, Moteki T. New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid. AJR. 2007;188(5):1313–1319.

    Article  Google Scholar 

  17. Benjamin DG, Frederick TD, Vlad VS, Jabi ES, Daniel SH, Manjiri D, et al. A novel reporting system to improve accuracy in appendicitis imaging. AJR. 2015;204(6):1212–1219.

    Article  Google Scholar 

  18. Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T,et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313(23):2340–8.

    CAS  Article  Google Scholar 

  19. Andersson REB. Small bowel obstruction after appendicectomy. Brit J Surg. 2001;88:1387–91.

    CAS  Article  Google Scholar 

  20. Eriksson S, Granström L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg. 1995;82(2):166–9.

    CAS  Article  Google Scholar 

  21. Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius, et al. Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg. 2006;30:1033–7.

    Article  Google Scholar 

  22. Hansson J, Korner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009;96:473–81.

    CAS  Article  Google Scholar 

  23. McCutcheon BA, Chang DC, Marcus LP, Inui T, Noorbakhsh A, Schallhorn C, et al. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg. 2014;218(5):905–13.

    Article  Google Scholar 

  24. Di Saverio S, Sibilio A, Giorgini E, Biscardi A, Villani S, Coccolini F, et al. The NOTA Study (non operative treatment for acute appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260(1):109–17.

    Article  Google Scholar 

  25. Dixon M, Haukoos J, Park I, Oliak D, Kumar R, Arnell T, et al. An assessment of the severity of recurrent appendicitis. Am J Surg. 2003;186(6):718–22.

    Article  Google Scholar 

  26. Wangensteen O, Dennis C. Experimental proof of the obstructive origin of appendicitis in man. Ann Surg. 1939;110:629–47.

    CAS  Article  Google Scholar 

  27. Malt A. The perforated appendix. N Engl J Med. 1986;315:1546–7.

    CAS  Article  Google Scholar 

  28. Wangensteen O, Bowers W. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg. 1937;34:496–504.

    Article  Google Scholar 

  29. Arnbjornsson E, Bengmark S. Role of obstruction in the pathogenesis of acute appendicitis. Am J Surg. 1984;147:390–392.

    CAS  Article  Google Scholar 

  30. Andersson R, Hugander A, Thulin A, Nystrom P, Olaison G. Clusters of acute appendicitis: further evidence for an infectious aetiology. Int J Epidemiol. 1995;24:829–33.

    CAS  Article  Google Scholar 

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Correspondence to Abdulrahman Saleh Al-Mulhim.

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Conflict of interest

Abdulrahman Saleh Al-Mulhim declares that this work complies with ethical standards, and there is no conflict of interest.

Ethical approval

The research ethics committees of the medical college approved the study protocol, and all patients gave written informed consent.

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Al-Mulhim, A.S. Readmission after antibiotic management of uncomplicated acute appendicitis in adults: prospective study. Eur J Trauma Emerg Surg 46, 841–846 (2020). https://doi.org/10.1007/s00068-018-1038-0

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  • DOI: https://doi.org/10.1007/s00068-018-1038-0

Keywords

  • Appendicitis
  • Antibiotic
  • Complications