More than half of patients treated nonoperatively avoided surgery for longer than two decades.

The longest follow up of patients with acute appendicitis treated nonoperatively has been five years in the published literature. Now, Swedish researchers report 25-year outcomes for 137 patients who were treated nonoperatively in two early randomised trials – conducted in the 1990s – that compared appendectomy with nonoperative antibiotic treatment.

Nonoperative treatment failed during the index hospital admission in 15% of the patients, and another 25% underwent appendectomy at some later time (typically during the first year after the initial clinical presentation). Thus, 60% of these patients had not undergone appendectomy by the end of the 25-year follow up. No patients underwent surgery for bowel obstruction, and no appendiceal tumours were reported among the non-operative patients who underwent appendectomy during follow up. 

Comment: This study has certain limitations (e.g. radiographic imaging was less accurate in the 1990s, compared with current diagnostic standards). Nevertheless, its results suggest that more than half of patients with acute appendicitis treated with a medical approach can likely avoid surgery, as well as subsequent complications.

Neil H. Winawer, MD, SFHM, Director, Hospital Medicine Unit, Grady Memorial Hospital; Professor of Medicine, Emory University School of Medicine, Atlanta, USA.

Pátková B, et al. Long-term outcome of nonoperative treatment of appendicitis. JAMA Surg 2023 Aug 9; e-pub (https://doi.org/10.1001/jamasurg.2023.2756).

This summary is taken from the following Journal Watch titles: Hospital Medicine, General Medicine, Gastroenterology.