Antibiotics for appendicitis! Not so fast

Mazhar Khalil, Peter Rhee, Tahereh Orouji Jokar, Narong Kulvatunyou, Terence OKeeffe, Andrew Tang, Ahmed Hassan, Lynn Gries, Rifat Latifi, Bellal Joseph

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes. Methods: We did an 8-year (2004-2011) retrospective analysis of the National Inpatient Sample database. We included all inpatients with the diagnosis of acute appendicitis. Patients with a diagnosis of appendiceal abscess or patients who underwent surgery for any other pathology were excluded from the analysis. Jonckheere-Terpstra trend analysis was performed for operative versus nonoperative management and outcomes. Results: A total of 436,400 cases of acute appendicitis were identified. Mean age of the population was 33 ± 19.5 years, and 54.5% were male. There was no significant change in the number of acute appendicitis diagnosed over the study period (p = 0.2). During the study period, nonoperative management of acute appendicitis increased significantly from 4.5% in 2004 to 6% in 2011 (p < 0.001). When compared with operatively managed patients, conservatively managed patients had a significantly longer hospital length of stay (3 [2-6] vs. 2 [1-3] days, p < 0.001), and in-hospital complications (27.8% vs. 7%, p < 0.001). On comparison of open and laparoscopic appendectomy, both had shorter hospital length of stay and rate of in-hospital complications. Overall hospital charges were lower in patients managed conservatively (15,441 [8,070-31,688] vs. 20,062 [13,672-29,928] USD, p < 0.001). Conclusions: Nonoperative management of appendicitis has increased over time; however, outcomes of nonoperative management did not improve over the study period. A more in-depth analysis of patient and system demographics may reveal this disparity in trends.

Original languageEnglish (US)
Pages (from-to)923-932
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Appendicitis
Anti-Bacterial Agents
Length of Stay
Inpatients
Hospital Charges
Appendectomy
Systems Analysis
Abscess
Demography
Databases
Pathology
Population

Keywords

  • Acute appendicitis
  • antibiotics
  • appendectomy
  • conservative management
  • nonoperative management

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Khalil, M., Rhee, P., Jokar, T. O., Kulvatunyou, N., OKeeffe, T., Tang, A., ... Joseph, B. (2016). Antibiotics for appendicitis! Not so fast. Journal of Trauma and Acute Care Surgery, 80(6), 923-932. https://doi.org/10.1097/TA.0000000000001030

Antibiotics for appendicitis! Not so fast. / Khalil, Mazhar; Rhee, Peter; Jokar, Tahereh Orouji; Kulvatunyou, Narong; OKeeffe, Terence; Tang, Andrew; Hassan, Ahmed; Gries, Lynn; Latifi, Rifat; Joseph, Bellal.

In: Journal of Trauma and Acute Care Surgery, Vol. 80, No. 6, 01.06.2016, p. 923-932.

Research output: Contribution to journalArticle

Khalil, M, Rhee, P, Jokar, TO, Kulvatunyou, N, OKeeffe, T, Tang, A, Hassan, A, Gries, L, Latifi, R & Joseph, B 2016, 'Antibiotics for appendicitis! Not so fast', Journal of Trauma and Acute Care Surgery, vol. 80, no. 6, pp. 923-932. https://doi.org/10.1097/TA.0000000000001030
Khalil, Mazhar ; Rhee, Peter ; Jokar, Tahereh Orouji ; Kulvatunyou, Narong ; OKeeffe, Terence ; Tang, Andrew ; Hassan, Ahmed ; Gries, Lynn ; Latifi, Rifat ; Joseph, Bellal. / Antibiotics for appendicitis! Not so fast. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 80, No. 6. pp. 923-932.
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