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Long-term impacts of appendectomy associated with increased incidence of inflammatory bowel disease, infection, and colorectal cancer

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Abstract

Purpose

Although the appendix has been suggested to play a role in maintaining the gut microbiome and immune system, the ramifications of appendectomy on the development inflammatory bowel disease, sepsis, and colorectal cancer are yet to be determined. The purpose of this study was to evaluate the potential long-term impacts of appendectomy, with a focus on inflammatory bowel disease, infection, and colorectal cancer, using the National Healthcare Insurance Service (NHIS) database of Korea.

Methods

The National Healthcare Insurance Service database in Korea was used for analysis. Adult patients who received appendectomy between 2005 and 2013 were identified. The control group consisted of patients who did not receive appendectomy were matched by baseline characteristics including comorbidities and frequency of healthcare resource utilization. The primary outcome was the incidence-rate ratio (IRR) of Crohn’s disease, ulcerative colitis, Clostridium difficile infection, sepsis, and colorectal cancer after appendectomy or the index date.

Results

We identified 914,208 patients who underwent appendectomy, and after matching with control patients, a total of 486,844 patients were included for analysis. Patients who underwent appendectomy showed a significantly higher incidence of Crohn’s disease (IRR 4.40, 95% confidence interval (CI) 3.78–5.13) and ulcerative colitis (IRR 1.78, 95% CI 1.63–1.93) compared to the control group during the 5-year follow-up period. The associations between appendectomy and Clostridium difficile infection, sepsis, and colorectal cancer were all found to be significant.

Conclusion

Patients who underwent appendectomy may be at increased risk for developing Crohn’s disease, ulcerative colitis, Clostridium difficile infection, sepsis, and colorectal cancer.

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Data Availability

Dr. Lee, Ms. Jang, and Dr. Ryu had full access to the study data and take responsibility for the integrity of the analysis.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea, 03080

    Seohee Lee, So Jung Park & Ho Geol Ryu

  2. Department of Information Statistics, Andong National University, 1375 Gyeongdong-Ro, Andong, Gyeongsangbuk-do, 36729, South Korea

    Eun Jin Jang

  3. Department of Statistics, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea

    Junwoo Jo

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  1. Seohee Lee
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Seohee Lee, Eun Jin Jang, Junwoo Jo, So Jung Park, and Ho Geol Ryu meet all the criteria for the definition of authorship and contributed substantially to the manuscript. Ho Geol Ryu is the correspondent author.

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Correspondence to Ho Geol Ryu.

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This study was approved by the Ethics Committee of the Seoul National University Hospital.

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Lee, S., Jang, E.J., Jo, J. et al. Long-term impacts of appendectomy associated with increased incidence of inflammatory bowel disease, infection, and colorectal cancer. Int J Colorectal Dis 36, 1643–1652 (2021). https://doi.org/10.1007/s00384-021-03886-x

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