Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases.
OBJECTIVE
To investigate the epidemiology, treatment and outcomes of acute appendicitis (AA) in a large population study.


METHODS
This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system (more than 1 million inhabitants) from 1997 to 2013. Data about treatment, surgery, length of stay were collected. Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.


RESULTS
From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA, with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17, 54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92. Mortality was < 0.0001%. Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion. Laparoscopic appendectomy was performed in 48% of cases. Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.


CONCLUSIONS
The treatment of acute appendicitis in Northern Italy is slowly changing, with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option, but rich of promising results.
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Marco
M
Ceresoli
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Alberto
A
Zucchi
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Niccolò
N
Allievi
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Asaf
A
Harbi
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Michele
M
Pisano
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Giulia
G
Montori
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Arianna
A
Heyer
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Gabriela E
GE
Nita
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Luca
L
Ansaloni
Marco Ceresoli, Niccolò Allievi, Asaf Harbi, Michele Pisano, Giulia Montori, Gabriela E Nita, Luca Ansaloni, Federico Coccolini, General Surgery Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Federico
F
Coccolini
Acute appendicitis; Conservative treatment; Epidemiology; Intestinal obstruction; Laparoscopic appendectomy