O. Renteria1, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2VA North Texas Health Care System,Surgery,Dallas, TX, USA
Introduction: Some studies indicate that non-complicated acute appendicitis might be treated exclusively with antibiotics instead of an appendectomy. We hypothesize that conservative treatment might not be appropriate for veteran patients.
Methods: This a retrospective, single institution analysis at the VA North Texas Health Care system between 7/05 to 6/17 for all patients who underwent an appendectomy (n=345). Patients who had an appendectomy for cancer, or incidentally for other reasons were excluded (n=35) as were patients with interval appendectomies (n=16) as well as patients with perforated appendicitis (n=14). Using postoperative complications as a dependent variable, univariate analysis was performed using Fisher’s Exact Test for categorical and Student’s T-Test for continuous variables. Significant variables were included in a multiple logistic regression model with postoperative complications as the dependent variable. Data are expressed as means ± SD and significance was established at a p≤0.05 (two-sided).
Results: Of patients who underwent an appendectomy for acute appendicitis (n=280; male=90%; age=46.0±15.7 y.o.; BMI=31.2±18.3 Kg/m2), seven had a malignancy in the specimen (2.5%), one had endometriosis and five had been previously treated conservatively. Without major complications, minor complications occurred in 20 patients (7.1%) and 30-day mortality was zero. LOS was 3.7±4.3 days. On presentation, 91% of patients had a CT scan and 92% underwent a laparoscopic appendectomy. Conversion rate was 5%. Age (57.4±13.1 vs. 45.4±15.6 y.o); blood loss (75.6±95.1 vs. 18.4±27.7 cc); ASA (2.6±0.9 vs. 2.2±0.8); tachycardia on initial presentation (95.2±20.6 vs. 85.8±17.1 bpm); and leukocytosis (16.1±4.8 vs. 13.2±4.4 cc/U) [all p’s <0.05] were associated with complications. Patients with a gangrenous appendix and history of cardiovascular disease were also more likely to have complications. Blood loss (OR=1.1; 95% CI 1.0 to 1.1) and a history of cardiovascular disease (OR=4.8; 95% CI 1.2 to 19.9) were independent predictors of complications.
Conclusion: In Veteran patients, the low rate of complications, the risk of harboring malignancy and failure to conservative management argue against managing acute appendicitis with antibiotics compared to an appendectomy.