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Emergency appendectomy versus elective appendectomy following conservative treatment for acute appendicitis: a multicenter retrospective clinical study by the Japanese Society for Abdominal Emergency Medicine

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Abstract

Purpose

To establish the best treatment strategy for acute appendicitis.

Methods

We collected data on 2142 appendectomies performed in 2017 and compared the backgrounds and surgical outcomes of patients who underwent early surgery (ES) (< 48 h) with those managed with non-ES (> 48 h). We performed a risk factor analysis to predict postoperative complications and subgroup analysis to propose a standard treatment strategy.

Results

The incidence of postoperative complications was significantly higher in the ES group than in the non-ES group, and significantly lower in the laparoscopic surgery group than in the laparotomy group. Surgical outcomes, including the incidence of postoperative complications, were comparable after acute surgery (< 12 h) and subacute surgery (12–48 h), following antibiotic treatment. The risk factors for postoperative complications in the ES group were a higher age, history of abdominal surgery, perforation, high C-reactive protein level, histological evidence of gangrenous or perforated appendicitis, a long operation time, and intraoperative complications. The risk factors for postoperative complications in the non-ES group were perforation and unsuccessful conservative treatment.

Conclusions

Non-early appendectomy is feasible for acute appendicitis but should be applied with care in patients with risk factors for postoperative complications or failure of pretreatment, including diabetes mellitus, abscess formation, and perforation.

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References

  1. Perez KS, Allen SR. Complicated appendicitis and considerations for interval appendectomy. J Am Acad PAs. 2018;31(9):35–41.

    Google Scholar 

  2. Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH. Is there truly an oncologic indication for interval appendectomy? Am J Surg. 2015;209(3):442–6.

    Article  Google Scholar 

  3. Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246(5):741–8.

    Article  Google Scholar 

  4. Ahmed I, Deakin D, Parsons S. Appendix mass: do we know how to treat it? Ann R Coll Surg Engl. 2005;87(3):191.

    Article  CAS  Google Scholar 

  5. Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F, et al. Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg. 2015;10(1):1–6.

    Article  Google Scholar 

  6. Miyo M, Urabe S, Hyuga S, Nakagawa T, Michiura T, Hatashi N, et al. Clinical outcomes of single-site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy. Ann Gastroenterol Surg. 2019;3(5):561–7.

    Article  Google Scholar 

  7. Yamada T, Endo H, Hasegawa H, Kimura T, Kakeji Y, Koda K, et al. Risk of emergency surgery for complicated appendicitis: Japanese nationwide study. Ann Gastroenterol Surg. 2021;5(2):236–42.

    Article  Google Scholar 

  8. Blakely ML, Williams R, Dassinger MS, Eubanks JW 3rd, Fischer P, Huang EY, et al. Early vs interval appendectomy for children with perforated appendicitis. Arch Surg. 2011;146(6):660–5.

    Article  Google Scholar 

  9. Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H, et al. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today. 2014;44(8):1400–5.

    Article  Google Scholar 

  10. Flum DR. Acute appendicitis—appendectomy or the “antibiotics first” strategy. N Engl J Med. 2015;372(20):1937–43.

    Article  Google Scholar 

  11. National Clinical Database Home Page [internet]. https://www.ncd.or.jp/.

  12. Seto Y, Kakeji Y, Miyata H, Iwanaka T. National Clinical Database (NCD) in Japan for gastroenterological surgery: Brief introduction. Ann Gastroenterol Surg. 2017;1(2):80–1.

    Article  Google Scholar 

  13. Kakeji Y, Takahashi A, Udagawa H, Unno M, Endo I, Kunisaki C, et al. Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016. Ann Gastroenterol Surg. 2018;2(1):37–54.

    Article  Google Scholar 

  14. Kakeji Y, Takahashi A, Hasegawa H, Ueno H, Uguchi S, Endo I, et al. Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011–2018. Ann Gastroenterol Surg. 2020;4(3):250–74.

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205.

    Article  Google Scholar 

  16. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010;147(6):818–829.

  17. Wullstein C, Barkhausen S, Gross E. Results of laparoscopic vs conventional appendectomy in complicated appendicitis. Dis Colon Rectum. 2001;44(11):1700–5.

    Article  CAS  Google Scholar 

  18. Frazee RC, Bohannon WT. Laparoscopic appendectomy for complicated appendicitis. Arch Surg. 1996;131(5):509–12.

    Article  CAS  Google Scholar 

  19. Kobayashi T, Watanabe K, Yano H, Murata Y, Igari T, Nakada-Tsukui K, et al. Underestimated amoebic appendicitis among HIV-1-infected individuals in Japan. J Clin Microbiol. 2017;55(1):313–20.

    Article  Google Scholar 

  20. Browder W, Smith JW, Vivoda LM, Nichols RL. Nonperforative appendicitis: a continuing surgical dilemma. J Infect Dis. 1989;159(6):1088–94.

    Article  CAS  Google Scholar 

  21. Taylor M, Emil S, Nguyen N, Ndiforchu F. Emergent vs urgent appendectomy in children: a study of outcomes. J Pediatr Surg. 2005;40(12):1912–5.

    Article  Google Scholar 

  22. Canal C, Lempert M, Birrer DL, Neuhaus V, Turina M. Short-term outcome after appendectomy is related to preoperative delay but not to the time of day of the procedure: a nationwide retrospective cohort study of 9224 patients. Int J Surg. 2020;76:16–24.

    Article  Google Scholar 

  23. Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M, et al. Diagnosis and management of acute appendicitis EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668–90.

    Article  Google Scholar 

  24. Trejo-Ávila ME, Romero-Loera S, Cárdenas-Lailson E, Blas-Franco M, Delano-Alonso R, Valenzuela-Salazar C, et al. Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial. Surg Endosc. 2019;33(2):429–36.

    Article  Google Scholar 

  25. Kotaluoto S, Ukkonen M, Pauniaho S-L, Helminen M, Sand J, Rantanen T. Mortality related to appendectomy; a population based analysis over two decades in Finland. World J Surg. 2017;41(1):64–9.

    Article  Google Scholar 

  26. Scarborough JE, Bennett KM, Pappas TN. Defining the impact of resident participation on outcomes after appendectomy. Ann Surg. 2012;255(3):577–82.

    Article  Google Scholar 

  27. Marjanović V, Budić I, Slavković A, Radlović V, Simić D. C-reactive protein and procalcitonin as a predictive factors on appearance of postoperative complications after open appendectomy in children. Srp Arh Celok Lek. 2017;145(5–6):265–70.

    Article  Google Scholar 

  28. Ceresoli M, Zucchi A, Allievi N, Harbi A, Pisano M, Montori G, et al. Acute appendicitis: epidemiology, treatment and outcomes-analysis of 16544 consecutive cases. World J Gastrointest Surg. 2016;8(10):693.

    Article  Google Scholar 

  29. Cao JG, Tao F, Zhou XJ, Wang XG, Wang SS, Zhang H, et al. Trends and outcomes of laparoscopic appendectomy in C hina: a multicenter, retrospective cohort study. Surg Pract. 2015;19(4):166–72.

    Article  Google Scholar 

  30. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004;239(1):43.

    Article  Google Scholar 

  31. Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ. Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery. 2010;148(4):625–37.

    Article  Google Scholar 

  32. Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, et al. Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006–2008. J Gastrointest Surg. 2011;15(12):2226–31.

    Article  Google Scholar 

  33. Yeh C-C, Wu S-C, Liao C-C, Su L-T, Hsieh C-H, Li T-C. Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc. 2011;25(9):2932–42.

    Article  Google Scholar 

  34. Yang Z, Sun F, Ai S, Wang J, Guan W, Liu S. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg. 2019;19(1):1–10.

    Article  Google Scholar 

  35. Rosado P, Cheng HT, Wu CM, Wei FC. Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck. 2015;37(4):615–8.

    Article  Google Scholar 

  36. MacKenzie C, Charlson M. Assessment of perioperative risk in the patient with diabetes mellitus. Surg Gynecol Obstet. 1988;167(4):293–9.

    CAS  PubMed  Google Scholar 

  37. Sivrikoz E, Karamanos E, Beale E, Teixeira P, Inaba K, Demetriades D. The effect of diabetes on outcomes following emergency appendectomy in patients without comorbidities: a propensity score-matched analysis of National Surgical Quality Improvement Program database. Am J Surg. 2015;209(1):206–11.

    Article  Google Scholar 

  38. Andersson MN, Andersson RE. Causes of short-term mortality after appendectomy: a population-based case-controlled study. Ann Surg. 2011;254(1):103–7.

    Article  Google Scholar 

  39. Joshi N, Caputo GM, Weitekamp MR, Karchmer A. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341(25):1906–12.

    Article  CAS  Google Scholar 

  40. Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. J Br Surg. 2009;96(5):473–81.

    Article  CAS  Google Scholar 

  41. Collaborative C. A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med. 2020;383(20):1907–19.

    Article  Google Scholar 

  42. Charfi S, Sellami A, Affes A, Yaïch K, Mzali R, Boudawara TS. Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Colorectal Dis. 2014;29(8):1009–12.

    Article  Google Scholar 

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Acknowledgements

We thank the 55 leading Japanese institutions where the surgery took place. The order of these institutions in the list below was based on the number of patients who underwent appendectomy. Department of Surgery, Higashi-Sapporo Hospital. Department of Gastroenterological Surgery, Hakodate Municipal. Department of Surgery, Honjo Daiichi Hospital. Department of Gastroenterological Surgery, Nakadori General Hospital; Department of Gastroenterological Surgery Hirosaki University Graduate School of Medicine; Department of Surgery, Itabashi Chuo Medical Center; Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University; Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital; Department of Surgery, Sagamihara Kyodo Hospital; Department of Surgery, Tsukuba Gakuen Hospital; Department of Surgery, Tama-nambu Regional Hospital; Department of Surgery, Social Insurance Funabashi Central Hospital; Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center; Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital; Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University; Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School; Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital; Department of General Surgery, Juntendo University Nerima Hospital; Department of Surgery, Saiseikai Utsunomiya Hospital; Department of Surgery, Shin-Kuki General Hospital; Department of Surgery, National Hospital Organization Takasaki General Medical Center; Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine; Department of Surgery, Japanese Red Cross Maebashi Hospital; Department of Surgery, Juntendo University Urayasu Hospital; Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital; Department of Surgery, Hiratsuka City Hospital; Department of Surgery, Tochigi Medical Center Shimotsuga; Surgery 2, Dokkyo Medical University Hospital. Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital of Medicine; Department of Gastroenterological surgery, Fujita Health University Bantane Hospital; Department of Surgery, Mie Prefectural Shima Hospital; Department of Surgery, Shimada Municipal Hospital; Department of Surgery, Fukui-ken Saiseikai Hospital; Department of Digestive Surgery, Hyogo Prefectural Awaji Medical Center; Department of Surgery, Osaka City Juso Hospital; Department of Gastrointestinal Surgery, Minami Osaka Hospital; Department of Surgery, Shiga University of Medical Science; Department of Gastroenterological Surgery, Higashiosaka City Medical Center; Department of Surgery, Konan Medical Center. Department of Surgery, Soseikai General Hospital; Department of Surgery, Kohnan Hospital. Department of Acute Care Surgery, Shimane University Faculty of Medicine; Department of Surgery, Chugoku Central Hospital. Department of Surgery, Okayama City Hospital. Department of Digestive Surgery, Kawasaki Medical School; Department of Gastroenterological Surgery, Sanuki Municipal Hospital; Department of Surgery, Kochi University; Department of Surgery, Saiseikai Fukuoka, General Hospital; Department of Gastroenterological and Pediatric Surgery, Oita University; Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital; Department of Surgery, Iizuka Hospital; Department of Digestive Surgery, Imamura General Hospital; Department of Surgery, Saiseikai Futsukaichi Hospital; Department of Cardiovascular Surgery, Chubu Tokushukai Hospital; Division of surgery, Kenwakai Otemachi Hospital.

Funding

We declare that this study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan

    Satoshi Arakawa, Hiroyuki Kato, Yukio Asano & Akihiko Horiguchi

  2. Utsunomiya Memorial Hospital, Utsunomiya, Japan

    Masakazu Yamamoto

  3. Department of Surgery, Teikyo University Hospital, Mizonokuchi, Tokyo, Japan

    Fumihiko Miura

  4. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata, Hospital, Kitakyushu, Japan

    Kohji Okamoto

  5. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan

    Yasutoshi Kimura

  6. Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Japan

    Takanori Sakaguchi

  7. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan

    Masahiro Yoshida

Authors
  1. Satoshi Arakawa
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  2. Hiroyuki Kato
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  3. Yukio Asano
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  8. Yasutoshi Kimura
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  10. Masahiro Yoshida
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Corresponding author

Correspondence to Satoshi Arakawa.

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We have no conflicts of interest to declare in relation to this article.

Ethical statement

The study protocol was approved by the institutional review board of Fujita Health University (approval no. HM19-381). Signed informed consent was not required, as this was a retrospective study with de-identified data. Details of the study were published on the institutional website, and the patients were guaranteed the right to decline participation in the study. It conforms to the provisions of the Declaration of Helsinki established in 1995 (as revised in Brazil in 2013). A total of 55 hospitals in Japan participated in this study, and patients who underwent surgical appendectomy in 2017 were registered.

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Arakawa, S., Kato, H., Asano, Y. et al. Emergency appendectomy versus elective appendectomy following conservative treatment for acute appendicitis: a multicenter retrospective clinical study by the Japanese Society for Abdominal Emergency Medicine. Surg Today 52, 1607–1619 (2022). https://doi.org/10.1007/s00595-022-02526-3

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  • DOI: https://doi.org/10.1007/s00595-022-02526-3

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