Satoshi Arakawa1, Hiroyuki Kato2, Yukio Asano2, Akihiko Horiguchi2, Masakazu Yamamoto3, Fumihiko Miura4, Kohji Okamoto5, Yasutoshi Kimura6, Takanori Sakaguchi7, Masahiro Yoshida8. 1. Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan. sarakawa@fujita-hu.ac.jp. 2. Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan. 3. Utsunomiya Memorial Hospital, Utsunomiya, Japan. 4. Department of Surgery, Teikyo University Hospital, Mizonokuchi, Tokyo, Japan. 5. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata, Hospital, Kitakyushu, Japan. 6. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. 7. Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Japan. 8. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan.
Abstract
PURPOSE: To establish the best treatment strategy for acute appendicitis. METHODS: We collected data on 2142 appendectomies performed in 2017 and compared the backgrounds and surgical outcomes of patients who underwent early surgery (ES) (< 48 h) with those managed with non-ES (> 48 h). We performed a risk factor analysis to predict postoperative complications and subgroup analysis to propose a standard treatment strategy. RESULTS: The incidence of postoperative complications was significantly higher in the ES group than in the non-ES group, and significantly lower in the laparoscopic surgery group than in the laparotomy group. Surgical outcomes, including the incidence of postoperative complications, were comparable after acute surgery (< 12 h) and subacute surgery (12-48 h), following antibiotic treatment. The risk factors for postoperative complications in the ES group were a higher age, history of abdominal surgery, perforation, high C-reactive protein level, histological evidence of gangrenous or perforated appendicitis, a long operation time, and intraoperative complications. The risk factors for postoperative complications in the non-ES group were perforation and unsuccessful conservative treatment. CONCLUSIONS: Non-early appendectomy is feasible for acute appendicitis but should be applied with care in patients with risk factors for postoperative complications or failure of pretreatment, including diabetes mellitus, abscess formation, and perforation.
PURPOSE: To establish the best treatment strategy for acute appendicitis. METHODS: We collected data on 2142 appendectomies performed in 2017 and compared the backgrounds and surgical outcomes of patients who underwent early surgery (ES) (< 48 h) with those managed with non-ES (> 48 h). We performed a risk factor analysis to predict postoperative complications and subgroup analysis to propose a standard treatment strategy. RESULTS: The incidence of postoperative complications was significantly higher in the ES group than in the non-ES group, and significantly lower in the laparoscopic surgery group than in the laparotomy group. Surgical outcomes, including the incidence of postoperative complications, were comparable after acute surgery (< 12 h) and subacute surgery (12-48 h), following antibiotic treatment. The risk factors for postoperative complications in the ES group were a higher age, history of abdominal surgery, perforation, high C-reactive protein level, histological evidence of gangrenous or perforated appendicitis, a long operation time, and intraoperative complications. The risk factors for postoperative complications in the non-ES group were perforation and unsuccessful conservative treatment. CONCLUSIONS: Non-early appendectomy is feasible for acute appendicitis but should be applied with care in patients with risk factors for postoperative complications or failure of pretreatment, including diabetes mellitus, abscess formation, and perforation.