Harms ID'd With Nonoperative Management of Appendicitis
THURSDAY, Nov. 15, 2018 -- Patients with uncomplicated appendicitis undergoing nonoperative management are more likely to have an appendicitis-associated readmission and to develop an abscess, although index hospitalization costs are lower compared with appendectomy, according to a study published online Nov. 14 in JAMA Surgery.
Lindsay A. Sceats, M.D., from Stanford University in California, and colleagues used claims data from a private insurance database to compare outcomes for 58,329 patients admitted with uncomplicated appendicitis undergoing appendectomy (95.5 percent) versus nonoperative management (4.5 percent).
The researchers found an increased likelihood of appendicitis-associated readmissions and abscess development among patients in the nonoperative management group (adjusted odds ratios, 2.13 and 1.42, respectively). More follow-up visits were required in the year after index admission by patients in the nonoperative management group (unadjusted mean, 1.6 versus 0.3), and they had a lower index hospitalization cost (unadjusted mean, $11,502 versus $13,551); when follow-up was considered, the total cost of appendicitis care was higher (unadjusted, $14,934 versus $14,186). Failure of nonoperative management occurred in 101 patients during a mean follow-up of 3.2 years, with a median time to recurrence of 42 days.
"Taken together, these data do not support the use of nonoperative management as first-line therapy for uncomplicated appendicitis until more conclusive randomized clinical trial data become available," the authors write.
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Posted: November 2018
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