Successful nonoperative management of uncomplicated appendicitis: predictors and outcomes

Our objective was to identify predictors of successful nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that the absence of diabetes, absence of an appendicolith, short duration of symptoms, absence of systemic inflammation, and low modified Alvarado score would predict s...

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Bibliographic Details
Published in:The Journal of surgical research 2018-02, Vol.222, p.212-218.e2
Main Authors: Loftus, Tyler J., Brakenridge, Scott C., Croft, Chasen A., Stephen Smith, R., Efron, Philip A., Moore, Frederick A., Mohr, Alicia M., Jordan, Janeen R.
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotics
Appendectomy
Appendicitis
Appendicitis - drug therapy
Appendicitis - epidemiology
Female
Florida - epidemiology
Humans
Male
Middle Aged
Nonoperative management
Recurrent appendicitis
Retrospective Studies
Treatment Failure
Young Adult
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Summary:Our objective was to identify predictors of successful nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that the absence of diabetes, absence of an appendicolith, short duration of symptoms, absence of systemic inflammation, and low modified Alvarado score would predict successful NOM. We performed a retrospective cohort analysis of 81 consecutive patients who underwent NOM of uncomplicated appendicitis. Successful NOM was defined as resolution of appendicitis with antibiotics alone and no recurrent appendicitis within 180 days. Patients with successful NOM (n = 36) were compared with patients who failed NOM (n = 45). Multivariable logistic regression was used to identify predictors of successful NOM, expressed as odds ratios (ORs) with 95% confidence intervals. Model strength was assessed by calculating area under the receiver operating characteristic curve (AUC). Patient age (35 years), the American Society of Anesthesiologists class (2.0), and Charlson comorbidity index (0.0) were similar between groups. Independent predictors of successful NOM were duration of symptoms prior to admission >25 hours: OR 4.17 (1.42-12.24), maximum temperature within 6 hours of admission
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2017.10.006