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Objective: Determine factors, on presentation, associated with failure of non-operative management of perforated appendicitis with phlegmon or abscess.
Design: Retrospective review of patients (≥15yo) with acute appendicitis and abscess or phlegmon and planned non-operative management that persisted for at least 48 hours. We performed Univariate analysis with Chi-square and t-tests and multivariate analysis with logistic regression.
Setting: University tertiary care hospital
Patients: With acute perforated appendicitis and abscess or phlegmon
Interventions: None
Main Outcome Measure: Co-morbidities, clinical findings, laboratory markers, radiographic findings, and non-surgical treatments associated with failure of non-operative management. Outcomes were also recorded.
Results: Eighty-nine patients over 5 years were identified. Sixty-nine were managed successfully to discharge without operation and 20 required operation. The failure group had longer lengths of stay (15 days vs. 6 days, p=0.001) and were more likely to require ICU care with mechanical ventilation (10% vs 0%, p=0.049). On univariate and multivariate analysis smoking [OR 13.20 95% CI (1.13 – 153.64), 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. On CT scan, the failure group had higher rates of abscess (75% vs. 55%, p=0.110), however their abscesses were more likely to be less than 50cm³ [OR 2.83 95% CI (1.01 – 7.92), p=0.043]. Rates of percutaneous abscess drainage between groups were similar (control 41%, failure 35%, p=0.653).
Conclusions: Patients with perforated appendicitis and phlegmon or abscess who smoke or present with tachycardia, generalized abdominal tenderness, or abscesses smaller than 50cm³ are more likely to fail non-operative management and should be considered for early operation. These findings should be validated prospectively.