Rashid Rahel, Abuahmed Mohamed Y, Khalabazyane Baidar, Inteti Kamalesh, Kadhmawi Israa, Awakhti Ahmed, Wilson Jeremy, Magee Conor
General and Colorectal Surgery, Arrowe Park Hospital, Wirral, GBR.
Upper Gastrointestinal Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR.
Cureus. 2024 Nov 7;16(11):e73196. doi: 10.7759/cureus.73196. eCollection 2024 Nov.
Background The COVID-19 pandemic led many units to increase their utilization of nonoperative management (NOM) of acute appendicitis, with the literature showing its non-inferiority when compared to operative management (OM). Therefore, we compared NOM to OM against standard guidelines in order to ascertain the effectiveness of NOM. Primary outcomes were rates of admission, complications, hospital length of stay (LOS), and the incidence of colonic malignancy following NOM upon subsequent bowel evaluation using colonoscopy and/or computed tomography (CT) scan. Methods This was a retrospective observational study done on patients who were admitted with acute appendicitis from January 2020 to January 2022 at Wirral University Teaching Hospital, UK. Data was electronically collected from medical records. Inclusion criteria were patients aged 40 years and above, admitted with a diagnosis of acute appendicitis using a CT scan, and who underwent either OM or NOM. Exclusion criteria were patients below 40 years old or not diagnosed with acute appendicitis. Results This study included 211 cases of acute appendicitis (female to male: 110:101), with a median age of 60. One hundred and twenty-five (60%) patients were managed operatively, while 86 cases (40%) were managed by NOM. All of the cases were diagnosed using a CT scan. The mean LOS for operative and non-operative cases were 4.77 and 4.89 days, respectively. When readmission days were added over the following three years, adjusted LOS was 5.35 days for operative cases, in comparison to 10.86 days for NOM. Forty-five percent of NOM cases had at least one episode of readmission, with 37% of them being in the first year. We found six cases of malignancy in the NOM cohort, none of which were detected on colonoscopy following discharge. Conclusion NOM is associated with increased LOS and increased readmission rates, and 44% of cases eventually required appendicectomy.
新冠疫情导致许多科室增加了对急性阑尾炎非手术治疗（NOM）的应用，文献表明与手术治疗（OM）相比，其疗效并不逊色。因此，我们将NOM与OM对照标准指南进行比较，以确定NOM的有效性。主要结局指标为入院率、并发症发生率、住院时间（LOS）以及在后续使用结肠镜检查和/或计算机断层扫描（CT）进行肠道评估时NOM后结肠恶性肿瘤的发生率。
这是一项回顾性观察研究，对象为2020年1月至2022年1月在英国威尔拉尔大学教学医院因急性阑尾炎入院的患者。数据通过电子方式从病历中收集。纳入标准为年龄40岁及以上、经CT扫描诊断为急性阑尾炎且接受了OM或NOM的患者。排除标准为年龄低于40岁或未诊断为急性阑尾炎的患者。
本研究纳入211例急性阑尾炎病例（女性与男性比例为110:101），中位年龄为60岁。125例（60%）患者接受了手术治疗，而86例（40%）患者接受了NOM治疗。所有病例均通过CT扫描诊断。手术和非手术病例的平均住院时间分别为4.77天和4.89天。在接下来的三年中加上再次入院天数后，手术病例的调整后住院时间为5.35天，而NOM为10.86天。45%的NOM病例至少有一次再次入院，其中37%发生在第一年。我们在NOM队列中发现6例恶性肿瘤病例，出院后结肠镜检查均未发现。
NOM与住院时间延长和再入院率增加相关，44%的病例最终需要阑尾切除术。
