Teagan Telesnicki,Jordan Nantais,Charles De Mestral,Anthony de Buck van Overstraeten,David Gomez
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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.\r\n\r\nRESULTS\r\nOf 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%).\r\n\r\nCONCLUSIONS\r\nReal-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.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term Outcomes Following Non-operative Management of Acute Appendicitis: A Population-based Analysis.\",\"authors\":\"Teagan Telesnicki,Jordan Nantais,Charles De Mestral,Anthony de Buck van Overstraeten,David Gomez\",\"doi\":\"10.1097/sla.0000000000006555\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVE\\r\\nTo describe long-term re-presentations and interventions following non-operative management (NOM) of acute appendicitis (AA).\\r\\n\\r\\nSUMMARY BACKGROUND DATA\\r\\nTrial 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.\\r\\n\\r\\nMETHODS\\r\\nThis 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.\\r\\n\\r\\nRESULTS\\r\\nOf 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%).\\r\\n\\r\\nCONCLUSIONS\\r\\nReal-world estimates of emergency re-presentation with or without urgent surgery following NOM of AA were lower than previously described. 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引用次数: 0
摘要
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。
Long-term Outcomes Following Non-operative Management of Acute Appendicitis: A Population-based Analysis.
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.
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.