Nonoperative Management of Appendicitis in High-Risk Patients Shows Significant Increase in Mortality

Lunardi N, Thornton M, Zarzaur BL, et al. Potential Risks of Nonoperative Management of Appendicitis in High-Risk Patients. Surgery. 2024.

Talan DA, Minneci PC. Interval Appendectomy After Successful Antibiotic Treatment? JAMA Surg. 2024;159:600-601.

The study and viewpoint article discussed in this commentary deal with important aspects of nonoperative management of appendicitis.

Lunardi and coauthors reported outcomes of a retrospective cohort study (n = 21,342) of patients who were estimated to be at high risk for mortality and complications following appendectomy using an accepted risk assessment scale. Data on the patients included in the cohort were obtained from the National Inpatient Sample. Median age of included patients was 68 years and 31% were managed nonoperatively.

The data analysis showed that nonoperative management was associated with a significant 2% increase in mortality risk versus operative management and a significant decrease in rates of complications. Hospital costs, length of stay, and rates of discharge to an extended care facility were significantly higher in the nonoperative group.

The authors concluded that surgeons should use caution when choosing nonoperative therapy for high-risk patients with uncomplicated appendicitis. 

In the viewpoint article by Talan, the author reviewed data on the risks and benefits of interval appendectomy following successful nonoperative management of appendicitis.

Available long-term follow-up data showed that recurrence rates of appendicitis were low and that risks of complications following interval appendectomy were significant. Concern over missed appendiceal carcinoma was noted to be a frequent reason for recommending interval appendectomy.

Evidence supported the conclusion that cross-sectional imaging can dependably provide evidence of appendiceal carcinoma, and that interval appendectomy should not routinely be performed as a means of prevention of this condition.

The author concluded that routine interval appendectomy was not beneficial following successful nonoperative management of appendicitis.