Prediction of the outcome of nonoperative management of uncomplicated acute appendicitis in adults

Abstract

Background: Antibiotic treatment may be an effective treatment modality for adult patients with acute appendicitis (AA) and ~75% of those patients may not need appendectomy at all, either during initial illness or during the first year of follow-up. Aim: This clinical trial aimed to investigate the outcome (success/failure) of nonoperative management (NOM) of uncomplicated AA in adults and to identify the independent predictors of this outcome. Patients and Methods: A prospective cohort study was conducted at Tanta University Hospitals during the period from July 2021 to July 2022 on 160 adult patients diagnosed with uncomplicated AA. Included patients received IV levofloxacin and metronidazole for 72 h. Daily clinical, laboratory, and ultrasound evaluation was performed. Patients responding successfully to NOM were discharged home while those who failed NOM were subjected to appendectomy. Results: The study included 81 males and 79 females with a mean age of 27.6 years and a mean BMI of 23.3 kg/m 2 . Total 137 (85.6%) patients showed successful outcomes of NOM during the initial admission. Multivariate analysis identified diabetes mellitus and longer duration of symptoms before admission as independent predictors of failure of NOM. During the 6 months follow-up, only two (1.5%) patients in the successful NOM group showed recurrent AA. Conclusion: NOM with antibiotics in adult patients with uncomplicated AA is associated with a high success rate. diabetes mellitus and longer duration of symptoms before admission were identified as independent predictors of failure of NOM.