Long-term Outcomes Following Non-operative Management of Acute Appendicitis: A Population-based Analysis.

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-10-16 DOI:10.1097/sla.0000000000006555
Teagan Telesnicki,Jordan Nantais,Charles De Mestral,Anthony de Buck van Overstraeten,David Gomez
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Abstract

OBJECTIVE To describe long-term re-presentations and interventions following non-operative management (NOM) of acute appendicitis (AA). SUMMARY BACKGROUND DATA Trial data suggest NOM of AA carries a substantial risk of subsequent appendectomy, although NOM is increasingly offered to patients. Population-based data is required to understand the real-world long-term course of patients undergoing NOM of AA. METHODS This population-based cohort study included all adult patients in Ontario, Canada who presented to any emergency department (ED) with AA between 2004-2019. Patients who did not undergo a procedure on index ED presentation or hospital admission were defined as NOM and followed for five years. The cumulative incidence of composite re-presentation or intervention (ED re-presentation, re-admission, emergency, or scheduled appendicitis procedure) was calculated accounting for competing risk of death. RESULTS Of 156,362 patients identified with AA, 13,200 underwent NOM. The cumulative incidence of composite re-presentation or intervention was 33% at 1-year (95%CI 32-33%) and 36% at 5-years (95%CI 36-37%). At 5-years, the incidence of appendicitis-specific ED re-presentation or hospital re-admission was 16% (95%CI 15-16%), the incidence of an emergency procedure for AA was 12% (95%CI 12-13%), and the incidence of scheduled surgery was 21% (95%CI 20-21%). In a subgroup of patients with uncomplicated AA, composite re-presentation or intervention was 28% at 1-year (95%CI 27-29%) and 32% at 5-years (95%CI 32-33%). CONCLUSIONS Real-world estimates of emergency re-presentation with or without urgent surgery following NOM of AA were lower than previously described. Scheduled appendectomy made up an important proportion of long-term interventions following NOM.
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急性阑尾炎非手术治疗的长期效果:基于人群的分析
目的描述急性阑尾炎(AA)非手术治疗(NOM)后的长期再就诊情况和干预措施。这项基于人群的队列研究纳入了加拿大安大略省 2004-2019 年间因 AA 到急诊科(ED)就诊的所有成年患者。在急诊科就诊或入院时未接受手术的患者被定义为NOM,并随访五年。计算再次就诊或干预(ED 再次就诊、再次入院、急诊或计划阑尾炎手术)的累积发生率,并考虑死亡竞争风险。结果 在 156362 名被确诊为 AA 的患者中,13200 人接受了 NOM。1年后复合再就诊或干预的累计发生率为33%(95%CI 32-33%),5年后为36%(95%CI 36-37%)。5年后,阑尾炎特异性急诊室再次就诊或再次入院的发生率为16%(95%CI 15-16%),AA急诊手术的发生率为12%(95%CI 12-13%),计划手术的发生率为21%(95%CI 20-21%)。在无并发症的 AA 患者亚组中,1 年后再次就诊或干预的复合发生率为 28%(95%CI 27-29%),5 年后为 32%(95%CI 32-33%)。在NOM后的长期干预中,计划中的阑尾切除术占了很大比例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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