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Antibiotics for appendicitis! Not so fast

Khalil, Mazhar MD; Rhee, Peter MD; Jokar, Tahereh Orouji MD; Kulvatunyou, Narong MD; O’Keeffe, Terence MD; Tang, Andrew MD; Hassan, Ahmed MD; Gries, Lynn MD; Latifi, Rifat MD; Joseph, Bellal MD

Journal of Trauma and Acute Care Surgery: June 2016 - Volume 80 - Issue 6 - p 923–932
doi: 10.1097/TA.0000000000001030
AAST 2015 Plenary Papers

Background Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes.

Methods We did an 8-year (2004–2011) retrospective analysis of the National Inpatient Sample database. We included all inpatients with the diagnosis of acute appendicitis. Patients with a diagnosis of appendiceal abscess or patients who underwent surgery for any other pathology were excluded from the analysis. Jonckheere-Terpstra trend analysis was performed for operative versus nonoperative management and outcomes.

Results A total of 436,400 cases of acute appendicitis were identified. Mean age of the population was 33 ± 19.5 years, and 54.5% were male. There was no significant change in the number of acute appendicitis diagnosed over the study period (p = 0.2). During the study period, nonoperative management of acute appendicitis increased significantly from 4.5% in 2004 to 6% in 2011 (p < 0.001). When compared with operatively managed patients, conservatively managed patients had a significantly longer hospital length of stay (3 [2–6] vs. 2 [1–3] days, p < 0.001), and in-hospital complications (27.8% vs. 7%, p < 0.001). On comparison of open and laparoscopic appendectomy, both had shorter hospital length of stay and rate of in-hospital complications. Overall hospital charges were lower in patients managed conservatively (15,441 [8,070–31,688] vs. 20,062 [13,672–29,928] USD, p < 0.001).

Conclusions Nonoperative management of appendicitis has increased over time; however, outcomes of nonoperative management did not improve over the study period. A more in-depth analysis of patient and system demographics may reveal this disparity in trends.

Level of Evidence Epidemiologic/prognostic study, level III.

Supplemental digital content is available in the text.

From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.

Submitted: September 14, 2015, Revised: February 9, 2016, Accepted: February 22, 2016, Published online: March 8, 2016.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Bellal Joseph, MD, Division of Trauma, Critical Care, Emergency Surgery, and Trauma, Department of Surgery, University of Arizona, 1501 N Campbell Ave, Room 5411, PO Box 245063, Tucson, AZ 85724; email:

© 2016 Lippincott Williams & Wilkins, Inc.