title: Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis.
abstract: BACKGROUND
  Emerging literature has supported the safety of nonoperative management of uncomplicated appendicitis.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, University of California, San Diego, CA. Electronic address: bmccutch@ucsd.edu.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: McCutcheon
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Logan P
authors.initials: LP
authors.lastname: Marcus
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Tazo
authors.initials: T
authors.lastname: Inui
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Noorbakhsh
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Craig
authors.initials: C
authors.lastname: Schallhorn
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Parina
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Francesca R
authors.initials: FR
authors.lastname: Salazar
authors.affiliation: Department of Surgery, University of California, San Diego, CA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
mesh_terms: D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome