Increasingly, clinicians are treating appendicitis nonoperatively, and this practice is associated with a higher mortality rate, according to a study presented at the American College of Surgeons Clinical Congress 2017, which took place Oct. 22 to Oct. 26 in San Diego.
Researchers used the National Inpatient Sample for the study. They examined the type of treatment 477,680 adults with a primary diagnosis of appendicitis received between 1998 and 2014.
Researchers also investigated patient characteristics and outcomes for 135,856 patients with appendicitis from 2010 to 2014. Around 131,162 patients underwent an early operation, primarily an appendectomy, and 4,694 patients underwent nonoperative management.
The study shows that the proportion of patients who underwent an early operation decreased from 94.6 percent in 1998 to 92.1 percent in 2014. The proportion of patients receiving nonoperative treatment increased from 2.3 percent to 4.9 percent over the study period.
In the subgroup of 135,856 patients, those receiving nonoperative treatment had a significantly higher comorbidity index and were approximately eight years older than patients in the early operation group. The study shows that the likelihood of dying, of any cause, during the hospitalization was 2.4 times higher for the nonoperative treatment group than the early operation group. Even after matching cases in both groups, researchers found a nearly sixfold increase in death rate in the nonoperative care group.