Document Detail

Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis.
MedLine Citation:
PMID:  19936849     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Acute appendicitis has been reported to be managed with non-operative therapy at relatively high successful rate. However, risk factors for negative outcome have not been established. METHOD: Three hundred eighty consecutive patients who underwent initial therapy for suspected appendicitis were reviewed. They were divided into three groups: operation group, the group successfully managed with non-operative therapy (success group), and the group required surgical conversion (failure group). Preoperative clinical data were compared among the groups and risk factors for negative outcomes were investigated. RESULT: Thirteen patients were excluded due to contraindication for non-operative therapy. Of the remaining 367 patients, 143 patients (39.0%) were primarily treated with surgery, and 224 patients (61.0%) were initially managed with antibiotics. Among the 224 patients, 91 patients (40.6%) were refractory to antibiotics and converted to surgery after more than 24 h usage of antibiotics. Multivariate analysis revealed that elevated C-reactive protein (CRP) level (>4 mg/dL) and presence of appendicolith were significant risk factors for conversion. Morbidity rate showed no significant difference between the operative and failure groups. CONCLUSION: Elevated CRP concentration and appendicolith may predict the negative outcome in non-operative management. However, immediate appendectomy can possibly be avoided at least 24 h without increasing morbidity under the usage of antibiotics.
Junichi Shindoh; Hirotaka Niwa; Kazushige Kawai; Ko Ohata; Yukio Ishihara; Naoki Takabayashi; Ryo Kobayashi; Takeyuki Hiramatsu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  14     ISSN:  1873-4626     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-29     Completed Date:  2010-05-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  309-14     Citation Subset:  IM    
Department of Surgery, Yaizu City General Hospital, Yaizu City, Japan.
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MeSH Terms
Appendicitis / blood,  drug therapy*,  surgery*
Biological Markers / blood
C-Reactive Protein / analysis*
Middle Aged
Patient Selection
Risk Factors
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Biological Markers; 9007-41-4/C-Reactive Protein

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