title: Antibiotics for appendicitis! Not so fast.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  Epidemiologic/prognostic study, level III.
authors.affiliation: From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Tahereh Orouji
authors.initials: TO
authors.lastname: Jokar
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hassan
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D005260:Female; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents