Yasmin Arda, Riley B Brackin, John F Jachimiak, Ikemsinachi C Nzenwa, Charudutt N Paranjape, Matthew A Bartek, Joshua S Ng-Kamstra, John O Hwabejire, Haytham M A Kaafarani, George C Velmahos, Michael P DeWane
In patients with perforated appendicitis, interval appendectomy is associated with worse clinical outcomes, including complex resection, infectious complications, and nonroutine discharge. These findings support the safety and potential benefits of early appendectomy in the management of perforated appendicitis.
BACKGROUND: The optimal timing of appendectomy in adult patients with perforated appendicitis remains unclear. This study aimed to evaluate the rate of ileocecal resection and patient outcomes associated with early versus interval appendectomy in the management of perforated appendicitis.
METHODS: We retrospectively analyzed the 2019 Nationwide Readmissions Database to identify patients aged ≥18 years with perforated appendicitis who underwent appendectomy. Patients were stratified into early (index admission), failed interval (emergency readmission within 90 days), and elective interval (elective readmission within 90 days) appendectomy. Multivariable logistic regression was used to examine the effect of timing of appendectomy on the risk of ileocecal resection and patient outcomes, including discharge disposition and postoperative complications.
RESULTS: A total of 4,433 patients were included: 3,958 (89%) early, 229 (5%) failed interval, and 246 (6%) elective interval appendectomy. On univariate analysis, the rate of ileocecal resection was highest in patients undergoing elective interval appendectomy (15% vs 8.3% vs 8.0%, P < .001). On multivariable analyses, elective interval appendectomy was independently associated with increased risk of ileocecal resection compared with early appendectomy (adjusted odds ratio, 1.92; confidence interval, 1.32-2.81). Both failed and elective interval appendectomies were associated with increased risk of infectious complications (adjusted odds ratio, 2.09; confidence interval, 1.07-4.09; adjusted odds ratio, 3.14; confidence interval, 1.58-4.26, respectively) and nonroutine discharge (adjusted odds ratio, 1.69; confidence interval, 1.14-2.49; adjusted odds ratio, 1.49; confidence interval, 1.05-2.12, respectively) compared with early appendectomy.
CONCLUSION: In patients with perforated appendicitis, interval appendectomy is associated with worse clinical outcomes, including complex resection, infectious complications, and nonroutine discharge. These findings support the safety and potential benefits of early appendectomy in the management of perforated appendicitis.