Abstract
Purpose
Appendicectomy is the primary treatment for acute appendicitis. However, extended resection (ER) may be required in difficult cases. Preoperative prediction of ER may identify challenging cases but remains difficult. We aimed to establish a preoperative scoring system for ER prediction during emergency surgery for acute appendicitis.
Methods
This was a single-center retrospective study. Patients who underwent emergency surgery for acute appendicitis between January 2014 and December 2022 were included and divided into ER and appendicectomy groups. Independent variables associated with ER were identified using multivariate logistic regression analysis. A new scoring system was established based on these independent variables. The discrimination of the new scoring system was assessed using the area under the receiver operating characteristic curve (AUC). The risk categorization of the scoring system was also analyzed.
Results
Of the 179 patients in this study, 12 (6.7%) underwent ER. The time interval from symptom onset to surgery ≥ 4 days, a retrocecal or retrocolic appendix, and the presence of an abscess were identified as independent preoperative predictive factors for ER. The new scoring system was established based on these three variables, and the scores ranged from 0 to 6. The AUC of the scoring system was 0.877, and the rates of ER among patients in the low- (score, 0–2), medium- (score, 4), and high- (score, 6) risk groups were estimated to be 2.5%, 28.6%, and 80%, respectively.
Conclusion
Our scoring system may help surgeons identify patients with acute appendicitis requiring ER and facilitate decision-making regarding treatment options.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.
References
Moris D, Paulson EK, Pappas TN (2021) Diagnosis and management of acute appendicitis in adults: a review. JAMA 326:2299–2311. https://doi.org/10.1001/jama.2021.20502
Téoule P, Laffolie J, Rolle U, Reissfelder C (2020) Acute appendicitis in childhood and adulthood. Dtsch Ärztebl Int 117:764–774. https://doi.org/10.3238/arztebl.2020.0764
Saida F, Matsumoto S, Kitano M (2018) Preoperative predictor of extensive resection for acute appendicitis. Am J Surg 215:599–602. https://doi.org/10.1016/j.amjsurg.2017.06.033
Takeyama H, Ikeda K, Shinomiya S, Nishigaki T, Yamashita M, Danno K, Taniguchi H, Sugimoto K, Oka Y (2021) Comparison of clinical outcomes between laparoscopic and open extensive resection for complicated appendicitis: retrospective observational study. Surg Laparosc Endosc Percutan Tech 31:448–452. https://doi.org/10.1097/SLE.0000000000000903
Waki Y, Hotchi M, Utsunomiya D, Inoue T, Obatake M (2021) Preoperative predictors of extended resection in patients with complicated acute appendicitis undergoing surgery. J Med Invest 68:334–341. https://doi.org/10.2152/jmi.68.334
Olsen J, Skovdal J, Qvist N, Bisgaard T (2014) Treatment of appendiceal mass–a qualitative systematic review. Dan Med J 61:A4881
Deelder JD, Richir MC, Schoorl T, Schreurs WH (2014) How to treat an appendiceal inflammatory mass: operatively or nonoperatively? J Gastrointest Surg 18:641–645. https://doi.org/10.1007/s11605-014-2460-1
Andersson RE, Petzold MG (2007) Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 246:741–748. https://doi.org/10.1097/SLA.0b013e31811f3f9f
de Jonge J, Bolmers MDM, Musters GD, van Rossem CC, Bemelman WA, van Geloven AAW (2019) Predictors for interval appendectomy in non-operatively treated complicated appendicitis. Int J Colorectal Dis 34:1325–1332. https://doi.org/10.1007/s00384-019-03303-4
Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Hurme S, Mecklin JP, Sand J, Virtanen J, Jartti A, Grönroos JM (2018) Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA 320:1259–1265. https://doi.org/10.1001/jama.2018.13201
Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A, Mulliri A, Davies RJ, Di Saverio S (2019) Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis. Ann Surg 270:1028–1040. https://doi.org/10.1097/SLA.0000000000003225
Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP (2010) A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 147:818–829. https://doi.org/10.1016/j.surg.2009.11.013
Luo CC, Cheng KF, Huang CS, Lo HC, Wu SM, Huang HC, Chien WK, Chen RJ (2016) Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess. BMC Surg 16:72. https://doi.org/10.1186/s12893-016-0188-4
Papandria D, Goldstein SD, Rhee D, Salazar JH, Arlikar J, Gorgy A, Ortega G, Zhang Y, Abdullah F (2013) Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res 184:723–729. https://doi.org/10.1016/j.jss.2012.12.008
Jiang L, Liu Z, Tong X, Deng Y, Liu J, Yang X, Chan FSY, Fan JKM (2021) Does the time from symptom onset to surgery affect the outcomes of patients with acute appendicitis? A prospective cohort study of 255 patients. Asian J Endosc Surg 14:361–367. https://doi.org/10.1111/ases.12870
Hosokawa T, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E (2021) Association between the computed tomography findings and operative time for interval appendectomy in children. Afr J Paediatr Surg 18:73–78. https://doi.org/10.4103/ajps.AJPS_94_20
Funding
No specific funding was received for this research.
Author information
Authors and Affiliations
Contributions
Toshimichi Kobayashi, Eiji Hidaka, and Shigeyuki Kawachi contributed to the study conception and design, and all authors contributed to the acquisition of data. Toshimichi Kobayashi wrote the main manuscript and prepared the figure. All authors critically reviewed the manuscript.
Corresponding author
Ethics declarations
Ethics approval and informed consent
This study was approved by the ethics committee of Tokyo Medical University Hachioji Medical Center (approval number TS2022-0405). The need for informed consent was waived in view of the retrospective study design.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kobayashi, T., Hidaka, E., Ando, A. et al. Preoperative scoring system for prediction of extended resection during emergency surgery for acute appendicitis. Langenbecks Arch Surg 408, 443 (2023). https://doi.org/10.1007/s00423-023-03183-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00423-023-03183-x