Predictive factors for failure of nonoperative management in perforated appendicitis

Authors

Mark W. Maxfield, From the Departments of Surgery (M.W.M., K.M.S., E.A.M., K.A.D.), and Radiology (J.B.), Yale School of Medicine, New Haven, Connecticut.Follow
Kevin M. SchusterFollow
Jamal Bokhari
Edward A. McGillicuddyFollow
Kimberly A. DavisFollow

Document Type

Article

Publication Title

The journal of trauma and acute care surgery

Abstract

BACKGROUND: Identifying patients on admission with perforated appendicitis who have phlegmon or abscess initially selected for but likely to fail nonoperative management may avoid delays in definitive treatment. METHODS: Patients older than 15 years presenting to a university tertiary care hospital with perforated appendicitis and abscess or phlegmon and planned nonoperative management were reviewed. Comorbidities, clinical findings, laboratory markers, radiographic findings, and nonsurgical treatments associated with failure of nonoperative management were recorded. RESULTS: Eighty-nine patients were identified, and 69 were managed successfully to discharge without operation. Length of stay was greater in the failure group (11 days vs. 5 days, p = 0.001), and intensive care unit care was more common (10% vs. 0%, p = 0.049). On univariate and multivariate analyses, smoking (odds ratio [OR], 13.20; 95% confidence interval [CI], 1.13-142; p = 0.039), tachycardia (OR, 4.93; 95% CI, 1.21-20.06; p = 0.026), and generalized abdominal tenderness (OR, 5.52; 95% CI, 1.40-21.73; p = 0.015) were associated with failure of nonoperative management. On computed tomographic scan, the failure group had higher rates of abscess (75% vs. 55%, p = 0.110), and their abscesses were more likely smaller than 50 mm (OR, 2.83; 95% CI, 1.01-7.92; p = 0.043). CONCLUSION: Patients with perforated appendicitis and phlegmon or abscess who smoke or present with tachycardia, generalized abdominal tenderness, and abscesses smaller than 50 mm are more likely to fail nonoperative management and should be considered for early operation. These findings should be validated prospectively. LEVEL OF EVIDENCE: Therapeutic study, level III.

First Page

976

Last Page

81

DOI

10.1097/TA.0000000000000187

Publication Date

4-1-2014

Recommended Citation

Maxfield, Mark W.; Schuster, Kevin M.; Bokhari, Jamal; McGillicuddy, Edward A.; and Davis, Kimberly A., "Predictive factors for failure of nonoperative management in perforated appendicitis" (2014). Surgery. 75.
https://scholar.bridgeporthospital.org/surgery/75

Identifier

24662860 (pubmed); 10.1097/TA.0000000000000187 (doi); 01586154-201404000-00010 (pii)