Predictors of Nonoperative Management Failure and Recurrence in Adults with Acute Appendicitis: A Single-Center Retrospective Study

Q4 Medicine

Surgery, Gastroenterology and Oncology Pub Date : 2022-01-27 DOI:10.21203/rs.3.rs-1256996/v1

Y. Wakasa, Y. Toyoki, Yuma Kameyama, Tadashi Odagiri, Hiroyuki Jin, M. Nakai, K. Aoki, H. Kawashima, M. Endo

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Abstract

[Purpose] Failure and recurrence are concerns in nonoperative management (NOM) for acute appendicitis (AA) and interval appendectomy (IA). The goal of the study was to identify predictors of failure and recurrence in patients with AA who underwent NOM. [Methods] A total of 348 adults with appendicitis were treated in our department from April 2016 to October 2021. Among these patients, 337 who did not undergo emergency surgery were divided into those with failed NOM and unplanned surgery (n=28) and successful NOM (n=309). These groups were compared to identify predictive factors for NOM failure. In the NOM-success group, 195 patients were divided into non-recurrence (n=166) and recurrence (n=29) groups to identify predictive factors for recurrence of appendicitis. [Results] In multivariate analysis, post-treatment CRP level (odds ratio (OR)=1.126, 95% confidence interval (CI) 1.076-1.179, P=0.000) and fecal stones with abscess formation (OR=5.530, 95% CI 2.081-14.691, P=0.001) were independently associated with NOM failure. Receiver operating characteristic curve analysis showed an optimum cutoff CRP level of 10.46 mg/dl for failure appendicitis. The initial CRP level was significantly lower and the % CRP decrease was significantly higher in the recurrence group than in the non-recurrence group. [Conclusions] These findings suggest that the post-treatment CRP level and fecal stones with abscess formation are predictors of NOM failure, but that recurrence may not be affected by the severity of previous appendicitis.

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成人急性阑尾炎非手术治疗失败和复发的预测因素:单中心回顾性研究

【目的】急性阑尾炎(AA)和间隔期阑尾切除术(IA)非手术治疗(NOM)的失败和复发是值得关注的问题。[方法]2016年4月至2021年10月，我科共收治了348例成年阑尾炎患者。其中337例未进行紧急手术的患者分为手术失败和计划外手术(n=28)和手术成功(n=309)。将这些组进行比较，以确定NOM失败的预测因素。非手术成功组195例患者分为未复发组(n=166)和复发组(n=29)，确定阑尾炎复发的预测因素。[结果]在多因素分析中，治疗后CRP水平(优势比(OR)=1.126, 95%可信区间(CI) 1.076 ~ 1.179, P=0.000)和粪便结石合并脓肿形成(OR=5.530, 95% CI 2.081 ~ 14.691, P=0.001)与NOM失败独立相关。受试者工作特征曲线分析显示，失效阑尾炎的最佳CRP临界值为10.46 mg/dl。与未复发组相比，复发组CRP初始水平明显降低，CRP下降百分比明显升高。【结论】这些发现提示治疗后CRP水平和粪便结石伴脓肿形成是NOM失败的预测因素，但复发可能不受既往阑尾炎严重程度的影响。

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来源期刊

Surgery, Gastroenterology and Oncology Medicine-Gastroenterology

CiteScore

0.30

自引率

0.00%

发文量

期刊介绍： Starting with this issue "Annals of Fundeni Hospital", founded in 1996 as the scientific journal of the prestigious hospital Fundeni becomes "Journal of Translational Medicine and Research" (JTMR), an Journal of the Academy of Medical Sciences of Romania. Therefore, an 18 years old Journal, attested and indexed in Elsevier Bibliographic Databases, Amsterdam and also indexed in SCOPUS, is continuing a tradition of excellence that lasted almost two decades. The new title of the Journal is inspired first of all from the important developments of translational research In Fundeni Clinical Institute and the "C.C Iliescu Institute for Cardio-Vascular Diseases", in parallel with the national and international trend to promote and develop this important area or medical research. Although devoted mainly to translational research, JTMR will continue to promote both basic and clinical research.