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Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG), an EAST Multicenter Study
- Source :
- Annals of surgery. 273(3)
- Publication Year :
- 2019
-
Abstract
- Objective We sought to describe contemporary presentation, treatment, and outcomes of patients presenting with acute (A), perforated (P), and gangrenous (G) appendicitis in the United States. Summary background data Recent European trials have reported that medical (antibiotics only) treatment of acute appendicitis is an acceptable alternative to surgical appendectomy. However, the type of operation (open appendectomy) and average duration of stay are not consistent with current American practice and therefore their conclusions do not apply to modern American surgeons. Methods This multicenter prospective observational study enrolled adults with appendicitis from January 2017 to June 2018. Descriptive statistics were performed. P and G were combined into a "complicated" outcome variable and risk factors were assessed using multivariable logistic regression. Results A total 3597 subjects were enrolled across 28 sites: median age was 37 (27-52) years, 1918 (53%) were male, 90% underwent computed tomography (CT) imaging, 91% were initially treated by appendectomy (98% laparoscopic), and median hospital stay was 1 (1-2) day. The 30-day rates of Emergency Department (ED) visit and readmission were 10% and 6%. Of 219 initially treated with antibiotics, 35 (16%) required appendectomy during index hospitalization and 12 (5%) underwent appendectomy within 30 days, for a cumulative failure rate of 21%. Overall, 2403 (77%) patients had A, whereas 487 (16%) and 218 (7%) patients had P and G, respectively. On regression analysis, age, symptoms >48 hours, temperature, WBC, Alvarado score, and appendicolith were predictive of "complicated" appendicitis, whereas co-morbidities, smoking, and ED triage to appendectomy >6 hours or >12 hours were not. Conclusion In the United States, the majority of patients presenting with appendicitis receive CT imaging, undergo laparoscopic appendectomy, and stay in the hospital for 1 day. One in five patients selected for initial non-operative management required appendectomy within 30 days. In-hospital delay to appendectomy is not a risk factor for "complicated" appendicitis.
- Subjects :
- Adult
Male
medicine.medical_specialty
Logistic regression
Gangrene
03 medical and health sciences
0302 clinical medicine
Risk Factors
medicine
Appendectomy
Humans
Prospective Studies
Risk factor
Practice Patterns, Physicians'
business.industry
General surgery
Emergency department
Length of Stay
Middle Aged
medicine.disease
Appendicitis
Triage
United States
Anti-Bacterial Agents
Multicenter study
Alvarado score
Intestinal Perforation
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Surgery
Observational study
Female
business
Subjects
Details
- ISSN :
- 15281140
- Volume :
- 273
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Annals of surgery
- Accession number :
- edsair.doi.dedup.....19e3f913541111df6fd77999c0093e6c