Study Explores Unplanned Readmission Rate before Interval Appendectomy

Hellmann ZJ, Shahyan R, Hornick M, et al. Unplanned Readmission Rate before Interval Appendectomy after Nonoperative Management of Complicated Appendicitis. J Am Coll Surg. 2024, in press

A considerable proportion of children with complicated appendicitis, defined as late presentation with phlegmon or abscess formation, are initially treated with antibiotics with planned interval appendectomy later. Available evidence has shown that the risk of unplanned, early appendectomy prior to the planned interval appendectomy can be as high as 20%.

The study reported in this article sought to determine the relationship of readmission with early appendectomy to the time interval from initial treatment.

The authors used a national database to identify patients (n = 2,826) younger than 18 years of age who were admitted for complicated appendicitis, received at least 3 days of antibiotics, and were discharged without appendectomy. The primary outcome of interest was readmission for appendicitis prior to interval appendectomy.

The data showed that the largest proportion of early readmissions occurred in the first 50 days after initial treatment. Of interest was the finding that 810 patients were never readmitted for appendectomy.

The authors concluded that readmission risk was highest in the first 50 days after treatment and that there may be a group of patients who will never require appendectomy. These findings can be used to facilitate shared decision-making. Additional studies are needed to identify characteristics that might help predict which patients will not require appendectomy following initial treatment.