Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2538-2545
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2538
Indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis
Yuichi Hosokawa, Masato Moritani, Yosuke Makuuchi, Yuichi Nagakawa
Yuichi Hosokawa, Masato Moritani, Yosuke Makuuchi, Department of Surgery, Nishitokyo Central General Hospital, Tokyo 188-0014, Japan
Yuichi Hosokawa, Masato Moritani, Yosuke Makuuchi, Yuichi Nagakawa, Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 166-0023, Japan
Author contributions: Hosokawa Y designed and performed the research and wrote the paper; Moritani M designed the research and supervised the report; Makuuchi Y designed the research and contributed to the analysis; Nagakawa Y provided clinical advice.
Institutional review board statement: Nishitokyo Central General Hospital has its own Institutional Review Board. This study was approved by the Ethics Committee of the Nishitokyo Central General Hospital, No. 2018-004.
Informed consent statement: This specific study, the ethical committee approved the lack of informed consent from the patients because of the low risk of identification due to the presented data are anonymized.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ryu37072002@yahoo.co.jp. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yuichi Hosokawa, MD, PhD, Surgeon, Department of Surgery, Nishitokyo Central General Hospital, 2-4-19 Shibakubo-tyo, Nishitokyo-shi, Tokyo 188-0014, Japan. ryu37072002@yahoo.co.jp
Received: April 12, 2024
Revised: June 27, 2024
Accepted: June 28, 2024
Published online: August 27, 2024
Processing time: 126 Days and 12.1 Hours
Abstract
BACKGROUND

Acute appendicitis is one of the most common emergency abdominal disease, and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis. Although the efficacy of conservative treatment for uncomplicated appendicitis is known, its efficacy for complicated appendicitis remains unknown, so are risk factors for the conservative treatment of appendicitis. In our institution, conservative treatment has long been the first choice for most appendicitis cases, except for perforation. Therefore, this novel study investigated the outcomes of conservative treatment for uncomplicated and complicated acute appendicitis and the risk factors associated with conservative treatment.

AIM

To investigate the indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis

METHODS

We investigated 270 patients who received conservative treatment for acute appendicitis at the Nishitokyo Central General Hospital, between April 2011 and February 2022. Twenty-eight (10.3%) patients were resistant to conservative treatment and underwent surgery. We retrospectively investigated the outcomes of conservative treatment for appendicitis and the risk factors for resistance to conservative treatment using the receiver operating characteristic curves and Cox hazard model.

RESULTS

Two hundred and forty-two (89.7%) patients improved with conservative treatment. The significant and independent predictors of resistance to conservative treatment were body temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid visible on computed tomography (CT). The rate of resistance to conservative treatment was 66.7% (6/9) for patients with the above three factors, 22.9% (8/35) for patients with two factors (appendicolith and body temperature ≥ 37.3 °C), 16.7% (2/12) for patients with two factors (Douglas sinus fluid and appendicolith) and 11.1% (1/9) for patients with two factors (Douglas sinus fluid and body temperature ≥ 37.3 °C).

CONCLUSION

A temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.

Keywords: Acute appendicitis; Conservative treatment; Antibiotics; Appendicolith; Uncomplicated appendicitis

Core Tip: This is a retrospective study to investigate the outcomes of conservative treatment for uncomplicated and complicated acute appendicitis. The success rate of conservative treatment of acute appendicitis was 89.7%. The significant and independent predictors of resistance to conservative treatment were body temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid. The rate of resistance to conservative treatment was 66.7% for patients with the above three factors, therefore, surgical treatment should be recommended at the first visit. Body temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid might be clinical risk factors for resistance to conservative treatment for acute appendicitis.