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Prediction Model for Failure of Nonoperative Management of Uncomplicated Appendicitis in Adults

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Abstract

Background

Prediction of failure of nonoperative management (NOM) in uncomplicated appendicitis (UA) is difficult. This study aimed to establish a new prediction model for NOM failure in UA.

Methods

We included 141 adults with UA who received NOM as initial treatment. NOM failure was defined as conversion to operation during hospitalization. Independent predictors of NOM failure were identified using logistic regression analysis. A prediction model was established based on these independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer–Lemeshow test were used to assess the discrimination and calibration of the model, respectively, and risk stratification using the model was performed.

Results

Among 141 patients, NOM was successful in 120 and unsuccessful in 21. Male sex, maximal diameter of the appendix, and the presence of fecalith were identified as independent predictors of NOM failure for UA. A prediction model with scores ranging from 0 to 3 was established using the three variables (male sex, maximal diameter of the appendix ≥ 15 mm, and the presence of fecalith). The area under the ROC curve for the new prediction model was 0.778, and the model had good calibration (P = 0.476). A score of 2 yielded a sensitivity of 71.4% and a specificity of 90.8%. Patients were stratified into low (0–1), moderate (2), and high (3) risk categories, which had NOM rates of 5.2%, 47.1%, and 77.8%, respectively.

Conclusions

Our prediction model may predict NOM failure in UA with good diagnostic accuracy and help surgeons select appropriate treatments.

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Acknowledgements

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Funding

No specific funding was received for this research.

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Authors and Affiliations

  1. Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan

    Toshimichi Kobayashi, Eiji Hidaka, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Sigeto Ochiai, Takahiro Gunji, Yosuke Ozawa, Kosuke Hikita, Toru Sano, Koichi Tomita, Satoshi Tabuchi, Naokazu Chiba & Sigeyuki Kawachi

Authors
  1. Toshimichi Kobayashi
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  2. Eiji Hidaka
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  3. Itsuki Koganezawa
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  4. Masashi Nakagawa
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  5. Kei Yokozuka
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  6. Sigeto Ochiai
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  7. Takahiro Gunji
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  8. Yosuke Ozawa
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  9. Kosuke Hikita
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  10. Toru Sano
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  11. Koichi Tomita
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  12. Satoshi Tabuchi
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  13. Naokazu Chiba
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  14. Sigeyuki Kawachi
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Correspondence to Sigeyuki Kawachi.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

Statement of human and animal rights

This study was approved by the Tokyo Medical University Hachioji Medical Center Ethics Committee.

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Kobayashi, T., Hidaka, E., Koganezawa, I. et al. Prediction Model for Failure of Nonoperative Management of Uncomplicated Appendicitis in Adults. World J Surg 45, 3041–3047 (2021). https://doi.org/10.1007/s00268-021-06213-1

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  • DOI: https://doi.org/10.1007/s00268-021-06213-1

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