Background Emerging literature has supported the safety of nonoperative management of uncomplicated appendicitis. Study Design Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation after nonsurgical management were calculated. Factors associated with treatment failure, recurrence, and perforation were identified using multivariable logistic regression. Mortality, length of stay, and total charges were compared between treatment cohorts using matched propensity score analysis. Results Of 231,678 patients with uncomplicated appendicitis, the majority (98.5%) were managed operatively. Of the 3,236 nonsurgically managed patients who survived to discharge without an interval appendectomy, 5.9% and 4.4% experienced treatment failure or recurrence, respectively, during a median follow-up of more than 7 years. There were no mortalities associated with treatment failure or recurrence. The risk of perforation after discharge was approximately 3%. Using multivariable analysis, race and age were significantly associated with the odds of treatment failure. Sex, age, and hospital teaching status were significantly associated with the odds of recurrence. Age and hospital teaching status were significantly associated with the odds of perforation. Matched propensity score analysis indicated that after risk adjustment, mortality rates (0.1% vs 0.3%; p = 0.65) and total charges ($23,243 vs $24,793; p = 0.70) were not statistically different between operative and nonoperative patients; however, length of stay was significantly longer in the nonoperative treatment group (2.1 days vs 3.2 days; p < 0.001). Conclusions This study suggests that nonoperative management of uncomplicated appendicitis can be safe and prompts additional investigations. Comparative effectiveness research using prospective randomized studies can be particularly useful.
展开▼
机译：背景技术新兴文献支持非手术治疗阑尾炎的安全性。研究设计1997年至2008年间，在加利福尼亚州州立卫生规划与发展办公室的数据库中，通过适当的ICD-9诊断代码确定了急诊，无并发症阑尾炎的患者。计算了非手术治疗后的治疗失败率，复发率和穿孔率。使用多变量逻辑回归分析确定与治疗失败，复发和穿孔相关的因素。使用匹配的倾向评分分析比较治疗队列中的死亡率，住院时间和总费用。结果在231,678例单纯性阑尾炎患者中，大部分（98.5％）接受了手术治疗。在3,236名未经手术的存活患者中，没有进行间隔阑尾切除术就可以生存，在中位随访7年以上时，分别有5.9％和4.4％的患者经历了治疗失败或复发。没有死亡与治疗失败或复发相关。出院后穿孔的风险约为3％。使用多变量分析，种族和年龄与治疗失败的几率显着相关。性别，年龄和医院教学状况与复发几率显着相关。年龄和医院教学状况与穿孔几率显着相关。匹配的倾向得分分析表明，风险调整后，手术患者和非手术患者的死亡率（0.1％比0.3％; p = 0.65）和总费用（23,243美元比24,793美元; p = 0.70）在统计学上无差异。但是，非手术治疗组的住院时间明显更长（2.1天vs 3.2天; p <0.001）。结论这项研究表明，非手术性阑尾炎的非手术治疗是安全的，并提示进行其他检查。使用前瞻性随机研究进行的比较有效性研究可能特别有用。
展开▼
