Disease Burden Following Non-Operative Treatment of Appendicitis in the Adult Population.
Andrew Felber1, Deven Catalano1, Caitlin Stafford1, Todd Francone1, Pat Roberts2,Rocco Ricciardi1
1Massachusetts General Hospital, Boston, MA USA; 2Lahey Clinic, Burlington, MA USA
Background: In this study, we determine outcomes following non-operative treatment of subacute or perforated appendicitis.
Methods: We abstracted data for all patients discharged with a diagnosis of appendicitis during the period of 8/1/2007 through 3/31/2015. Next, we collected demographics, imaging results, and method of treatment. For those patients treated non-operatively, we also collected additional treatment for appendicitis and the date of last follow-up. Last, we identified factors related to need for additional treatment.
Results: We identified 488 patients treated for subacute or perforated appendicitis. From this group, 66 patients were successfully treated non-operatively. Eight patients (12%) went on to have interval appendectomy within 2 months. Of the 58 remaining patients, 21 (36%) did not have any further appendicitis related issues over a mean follow-up period of 26 months. A total of 37 (64%) had recurring or additional concerns requiring further treatment or emergent surgery over a mean follow-up of 11.6 months (Figure 1). A large proportion, 65% (n=24), required emergent appendectomy after a future unplanned admission to the hospital. We noted no difference in age, sex, or length of initial hospital stay between the group with no further appendicitis related issues as compared to the group that required further care. However, there were proportionately more patients treated with percutaneous drains during their index stay (24%) in the group that had further appendicitis issues as compared to the group that had no further issues (0%; p<0.05).
Conclusion: Successful non-operative treatment of subacute or perforated appendicitis is associated with significant likelihood of future appendicitis related issues or emergency surgery (63%) within 12 months of index hospitalization. Furthermore, patients treated with percutaneous drains are at particularly high risk of future appendicitis related issues and should be counseled to the high likelihood of recurrence and additional need for operative treatment. 
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