AI Article Synopsis
- Emergency surgery for complicated appendicitis has high risks, and interval appendectomy (IA) can reduce complications, though some patients still need emergency surgery if nonoperative management fails.
- A study analyzed the surgical outcomes of patients over nearly a decade, revealing that emergency surgery had more severe complications than successful interval appendectomy, with nonoperative management succeeding in about 76% of cases.
- Certain factors like lack of abscesses, existing health issues, high white blood cell count, and presence of free air were linked to nonoperative management failure, suggesting that while IA is generally effective, patients with these risk factors need close monitoring for potential surgery.
Article Abstract
Purpose: Emergency surgery (ES) for complicated appendicitis (CA) is associated with high morbidity. Interval appendectomy (IA) decreases this rate; however, nonoperative management (NOM) is not always successful. Some patients require unplanned ES due to NOM failure (IA failure: IA-F). This study aimed to verify the benefits of IA and to evaluate the risk factors for NOM failure.
Methods: Patients diagnosed with CA who underwent surgery between January 2012 and December 2021 were included in this study. We compared the surgical outcomes of the ES group with those of the IA success (IA-S) and IA-F groups. We also analyzed 14 factors that predicted NOM failure.
Results: Among 302 patients, the rate of severe complications (Clavien-Dindo grade ≥ III) was significantly higher in the ES group (N = 165) than in the IA-S group (N = 102). The rates were equal between the ES (N = 165) and IA-F (N = 35) groups. NOM was successful in 110 patients and failed in 27. Lack of abscesses, comorbidities, high WBC count, and free air were independent risk factors for NOM failure.
Conclusions: Considering the benefits of IA and the non-inferior surgical outcomes of IA-F compared to ES, IA is a good therapeutic strategy for CA. However, in patients exhibiting four independent risk factors for NOM failure, careful monitoring of unplanned ES is necessary.
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Source |
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| http://dx.doi.org/10.1007/s00595-024-02842-w | DOI Listing |
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