EP 099 Uncomplicated Appendicitis: Do we need to take it out?

Background statement

Standard care of management of acute appendicitis has been operative regardless of complexity of inflammation in suitable healthy patients. However, there are several RCTs that describe successful treatment with antibiotics in acute uncomplicated appendicitis.

Aim

This study aims to describe patient outcomes for acute appendicitis. We seek to assess our current practice and determine the factors correlating with successful non-operative treatment.

We also aim to enhance discussions around shared decision making and informed consent in clinically well patients presenting with acute appendicitis.

Study design

Retrospective audit

Methodology

Identified patients who presented to SAC with clinically and/or radiologically confirmed appendicitis from July 2024 to December 2024 and grouped into Operative vs Non-operative based on their initial management. Mapped out clinical progress, unscheduled presentations, outpatient follow up arrangements including delayed surgery.

Findings

71 patients with confirmed appendicitis. 65 patients underwent imaging and 6 were diagnosed clinically. 45 patients managed operatively, 26 patients managed non-operatively. Among the non-operative cohort, 8 underwent delayed surgery. 6 out of 17 managed with antibiotics without requiring admission. 4 patients showed complete resolution of inflammation on follow up scans. Out of the 45 patients managed operatively, 26 had uncomplicated appendicitis on imaging. 53 patients underwent surgery of which 23 had perforated appendicitis intra-operatively. The negative appendicectomy rate was 2.81%

Discussion

Through this project, we aim to propose an ambulatory appendicitis pathway based on the shared decision-making model for patients who present with uncomplicated appendicitis.