Factors identified for eventual surgery in patients with appendicitis

Presence of an appendicolith is associated with a nearly twofold increased risk for undergoing appendectomy within 30 days of initiating antibiotics for appendicitis, according to a study published online Jan. 12 in JAMA Surgery.

David R. Flum, M.D., from the University of Washington in Seattle, and colleagues from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy Collaborative assessed patient factors associated with undergoing appendectomy within 30 days of initiating antibiotics for appendicitis. The analysis included 1,552 participants with acute appendicitis presenting at 25 U.S. medical centers (May 3, 2016, to Feb. 5, 2020) who were randomly assigned to antibiotics (776 participants) or appendectomy (776 participants).

The researchers found that in an adjusted analysis, female sex (odds ratio [OR], 1.53; 95 percent confidence interval [CI], 1.01 to 2.31), a radiographic finding of wider appendiceal diameter (OR per 1-mm increase, 1.09; 95 percent CI, 1.00 to 1.18), and the presence of appendicolith (OR, 1.99; 95 percent CI, 1.28 to 3.10) were associated with increased odds of undergoing appendectomy within 30 days. There was no association seen between odds of 30-day appendectomy and characteristics that are often associated with an increased risk for complications (e.g., advanced age, comorbid conditions) and characteristics clinicians often use to describe appendicitis severity (e.g., fever; OR, 1.28; 95 percent CI, 0.82 to 1.98).

"This information may help guide more individualized decision making for people with appendicitis," the authors write.

Several authors disclosed financial ties to the pharmaceutical, biotechnology, medical technology, and clinical resource industries.

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