| Peer-Reviewed

Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis

Received: 7 April 2021    Accepted: 28 April 2021    Published: 14 May 2021
Views:       Downloads:
Abstract

Background: The management for abscess-forming appendicitis, including interval appendectomy, is controversial. Emergency surgery for abscess-forming appendicitis may lead to expanded surgery, which is associated with many perioperative complications. To prevent complications, we introduced the Interval Appendectomy protocol (IA protocol), and examined its efficacy compared to emergency appendectomy. Methods: Patients treated for complicated appendicitis at our hospital from January 2010 to January 2018 were consecutively enrolled into this study. They were classified into two groups based on enrollment before and after April 2014: emergency appendectomy group (EA group, before April 2014) and interval appendectomy group (IA group, after April 2014). We compared the perioperative treatment outcomes and examined the necessity for elective surgery, focusing on the postoperative pathological results of the IA group. Results: We enrolled 49 consecutive patients with complicated appendicitis who were treated during this study period. The IA protocol was applied to 38 patients; 32 patients completed this protocol and were assigned to the IA group. Patient characteristics were not significantly different between the IA and EA group. The IA group had significantly less postoperative complications (p=0.002) and medical costs (p=0.01). Residual inflammation in the appendix was observed in 16 cases (50%) pathologically. Conclusions: Interval appendectomy for complicated appendicitis was associated with a low incidence of perioperative complications and was effective in terms of cost. Interval appendectomy seems necessary to prevent recurrent appendicitis, given that inflammation remains on pathological examination.

Published in Journal of Surgery (Volume 9, Issue 3)
DOI 10.11648/j.js.20210903.13
Page(s) 109-113
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Interval Appendectomy, Complicated Appendicitis, Perioperative Complications, Cost-effectiveness

References
[1] Barnes BA, Behringer GE, Wheelock FC, Wilkins EW. Treatment of appendicitis at the Massachusetts General Hospital (1937-1959). JAMA. 1962; 180: 122-6.
[2] Thomas DR. Conservative management of the appendix mass. Surgery 1973; 73: 677-80.
[3] Bradley EL, III, Isaacs J. Appendiceal Abscess Revisited. Arch Surg. 1978; 113: 130-2.
[4] Blakely ML, Williams R, Dassinger MS, Eubanks JW, 3rd, Fischer P, Huang EY, et al. Early vs interval appendectomy for children with perforated appendicitis. Arch Surg. 2011; 146: 660-5.
[5] St Peter SD, Aguayo P, Fraser JD, Keckler SJ, Sharp SW, Leys CM, et al. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg. 2010; 45: 236-40.
[6] Armstrong J, Merritt N, Jones S, Scott L, Butter A. Non-operative management of early, acute appendicitis in children: is it safe and effective? J Pediatr Surg. 2014; 49: 782-5.
[7] Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 2011; 254: 927-32.
[8] Rice-Townsend S, Hall M, Barnes JN, Baxter JK, Rangel SJ. Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications. J Pediatr Surg. 2012; 47: 1170-6.
[9] Cash CL, Frazee RC, Abernathy SW, Childs EW, Davis ML, Hendricks JC, et al. A prospective treatment protocol for outpatient laparoscopic appendectomy for acute appendicitis. J Am Coll Surg. 2012; 215: 101-5; discussion 105-6.
[10] Mosegaard A, Nielsen OS. Interval appendectomy. A retrospective study. Acta Chir Scand. 1979; 145: 109-11.
[11] Paull DL, Bloom GP. Appendiceal abscess. Arch Surg. 1982; 117: 1017-9.
[12] Al-Kurd A, Mizrahi I, Siam B, Kupietzky A, et al. Outcomes of interval appendectomy in comparison with appendectomy for acute appendicitis. The Journal of surgical research 2018; 225: 90-94.
[13] Cheng Y, Xiong X, Lu J, Wu S, Zhou R, Cheng N. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev 2017; 6: Cd011670.
[14] Talan DA, Saltzman DJ, Mower WR, Krishnadasan A, Jude CM, Amii R, et al. Antibiotics-first versus surgery for appendicitis: A US pilot randomized controlled trial allowing outpatient antibiotic management. Ann Emerg Med 2017; 70: 1-11. e19.
[15] Perez KS, Allen SR. Complicated appendicitis and considerations for interval appendectomy. journal of the American Academy of Physician Assistants. 2018; 31 (9): 35-41.
[16] Miyo M, Urabe S, Hyuga S, et al. Clinical outcomes of single-site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy. Annals of gastroenterological surgery 2019; 3 (5): 561-567.
[17] Lai HW, Loong CC, Wu CW, Lui WY. Watchful waiting versus interval appendectomy for patients who recovered from acute appendicitis with tumor formation: a cost-effectiveness analysis. J Chin Med Assoc 2005; 68: 431-4.
[18] Luo CC, Cheng KF, Huang CS, Lo HC, Wu SM, Huang HC, et al. Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess. BMC Surg. 2016; 16: 72.
[19] Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 2013; 19: 3942-50.
[20] Dina Fouad, Jeremy D. Kauffman, Nicole M. Chandler. Pathology findings following interval appendectomy: Should it stay or go? J Pediat Surg. 2020; 55 (4): 737-741.
[21] Rosen M, Chalupka A, Butler K, et al. Pathologic findings suggest long-term abnormality after conservative management of complex acute appendicitis. Am Surg. 2015; 81 (3): 297-299.
Cite This Article
  • APA Style

    Ryosuke Kita, Hiroki Hashida, Daisuke Yamashita, Hiromitsu Kinoshita, Masato Kondo, et al. (2021). Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis. Journal of Surgery, 9(3), 109-113. https://doi.org/10.11648/j.js.20210903.13

    Copy | Download

    ACS Style

    Ryosuke Kita; Hiroki Hashida; Daisuke Yamashita; Hiromitsu Kinoshita; Masato Kondo, et al. Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis. J. Surg. 2021, 9(3), 109-113. doi: 10.11648/j.js.20210903.13

    Copy | Download

    AMA Style

    Ryosuke Kita, Hiroki Hashida, Daisuke Yamashita, Hiromitsu Kinoshita, Masato Kondo, et al. Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis. J Surg. 2021;9(3):109-113. doi: 10.11648/j.js.20210903.13

    Copy | Download

  • @article{10.11648/j.js.20210903.13,
      author = {Ryosuke Kita and Hiroki Hashida and Daisuke Yamashita and Hiromitsu Kinoshita and Masato Kondo and Satoshi Kaihara},
      title = {Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis},
      journal = {Journal of Surgery},
      volume = {9},
      number = {3},
      pages = {109-113},
      doi = {10.11648/j.js.20210903.13},
      url = {https://doi.org/10.11648/j.js.20210903.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210903.13},
      abstract = {Background: The management for abscess-forming appendicitis, including interval appendectomy, is controversial. Emergency surgery for abscess-forming appendicitis may lead to expanded surgery, which is associated with many perioperative complications. To prevent complications, we introduced the Interval Appendectomy protocol (IA protocol), and examined its efficacy compared to emergency appendectomy. Methods: Patients treated for complicated appendicitis at our hospital from January 2010 to January 2018 were consecutively enrolled into this study. They were classified into two groups based on enrollment before and after April 2014: emergency appendectomy group (EA group, before April 2014) and interval appendectomy group (IA group, after April 2014). We compared the perioperative treatment outcomes and examined the necessity for elective surgery, focusing on the postoperative pathological results of the IA group. Results: We enrolled 49 consecutive patients with complicated appendicitis who were treated during this study period. The IA protocol was applied to 38 patients; 32 patients completed this protocol and were assigned to the IA group. Patient characteristics were not significantly different between the IA and EA group. The IA group had significantly less postoperative complications (p=0.002) and medical costs (p=0.01). Residual inflammation in the appendix was observed in 16 cases (50%) pathologically. Conclusions: Interval appendectomy for complicated appendicitis was associated with a low incidence of perioperative complications and was effective in terms of cost. Interval appendectomy seems necessary to prevent recurrent appendicitis, given that inflammation remains on pathological examination.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis
    AU  - Ryosuke Kita
    AU  - Hiroki Hashida
    AU  - Daisuke Yamashita
    AU  - Hiromitsu Kinoshita
    AU  - Masato Kondo
    AU  - Satoshi Kaihara
    Y1  - 2021/05/14
    PY  - 2021
    N1  - https://doi.org/10.11648/j.js.20210903.13
    DO  - 10.11648/j.js.20210903.13
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 109
    EP  - 113
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20210903.13
    AB  - Background: The management for abscess-forming appendicitis, including interval appendectomy, is controversial. Emergency surgery for abscess-forming appendicitis may lead to expanded surgery, which is associated with many perioperative complications. To prevent complications, we introduced the Interval Appendectomy protocol (IA protocol), and examined its efficacy compared to emergency appendectomy. Methods: Patients treated for complicated appendicitis at our hospital from January 2010 to January 2018 were consecutively enrolled into this study. They were classified into two groups based on enrollment before and after April 2014: emergency appendectomy group (EA group, before April 2014) and interval appendectomy group (IA group, after April 2014). We compared the perioperative treatment outcomes and examined the necessity for elective surgery, focusing on the postoperative pathological results of the IA group. Results: We enrolled 49 consecutive patients with complicated appendicitis who were treated during this study period. The IA protocol was applied to 38 patients; 32 patients completed this protocol and were assigned to the IA group. Patient characteristics were not significantly different between the IA and EA group. The IA group had significantly less postoperative complications (p=0.002) and medical costs (p=0.01). Residual inflammation in the appendix was observed in 16 cases (50%) pathologically. Conclusions: Interval appendectomy for complicated appendicitis was associated with a low incidence of perioperative complications and was effective in terms of cost. Interval appendectomy seems necessary to prevent recurrent appendicitis, given that inflammation remains on pathological examination.
    VL  - 9
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

  • Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

  • Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan

  • Department of Gastroenterological Surgery, Kyoto University Hospital, Kyoto, Japan

  • Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

  • Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

  • Sections