Outcomes of complicated appendicitis: Is conservative management as smooth as it seems?

Abstract Background This study characterized the failure rate of non-operative management (NOM) for complicated appendicitis (CA; perforation, abscess, phlegmon), and compared outcomes among patients undergoing acute appendectomy (AA), elective interval appendectomy (EIA), and unplanned appendectomy after failing to improve with NOM. Methods Adults treated at one facility between 2007 and 2014 were retrospectively studied. Results Ninety-five patients presented with CA. Sixty individuals underwent AA. The remaining 35 patients initially underwent NOM: 14 underwent EIA, nine (25.7%) failed NOM, 12 never underwent surgery. All patients failing NOM had an open operation with most (55.6%) requiring bowel resection. AA and EIA were comparable in surgical approach, bowel resection and post-operative readmission. However, AA demonstrated a lower incidence of bowel resection (3.3% vs 17.1%, P  = 0.048) when compared to all patients initially undergoing NOM. Conclusions Due to the high incidence of failed NOM and the morbidity associated with failure, AA may be appropriate for CA.