OBJECTIVE To describe long-term re-presentations and interventions following non-operative management (NOM) of acute appendicitis (AA). SUMMARY BACKGROUND DATA Trial data suggest NOM of AA carries a substantial risk of subsequent appendectomy, although NOM is increasingly offered to patients. Population-based data is required to understand the real-world long-term course of patients undergoing NOM of AA. METHODS This population-based cohort study included all adult patients in Ontario, Canada who presented to any emergency department (ED) with AA between 2004-2019. Patients who did not undergo a procedure on index ED presentation or hospital admission were defined as NOM and followed for five years. The cumulative incidence of composite re-presentation or intervention (ED re-presentation, re-admission, emergency, or scheduled appendicitis procedure) was calculated accounting for competing risk of death. RESULTS Of 156,362 patients identified with AA, 13,200 underwent NOM. The cumulative incidence of composite re-presentation or intervention was 33% at 1-year (95%CI 32-33%) and 36% at 5-years (95%CI 36-37%). At 5-years, the incidence of appendicitis-specific ED re-presentation or hospital re-admission was 16% (95%CI 15-16%), the incidence of an emergency procedure for AA was 12% (95%CI 12-13%), and the incidence of scheduled surgery was 21% (95%CI 20-21%). In a subgroup of patients with uncomplicated AA, composite re-presentation or intervention was 28% at 1-year (95%CI 27-29%) and 32% at 5-years (95%CI 32-33%). CONCLUSIONS Real-world estimates of emergency re-presentation with or without urgent surgery following NOM of AA were lower than previously described. Scheduled appendectomy made up an important proportion of long-term interventions following NOM.

中文翻译：

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急性阑尾炎非手术治疗后的长期结果：基于人群的分析。


目的 描述急性阑尾炎 （AA） 非手术治疗 （NOM） 后的长期再表现和干预。摘要 背景数据 试验数据表明，AA 的 NOM 具有后续阑尾切除术的很大风险，尽管 NOM 越来越多地提供给患者。需要基于人群的数据来了解接受 AA NOM 的患者的真实世界长期病程。方法 这项基于人群的队列研究包括 2004-2019 年间加拿大安大略省所有因 AA 到任何急诊科 （ED） 就诊的成年患者。未接受指数 ED 表现或住院手术的患者被定义为 NOM 并随访 5 年。计算复合再出现或干预 （ED 再出现、再入院、急诊或预定阑尾炎手术） 的累积发生率，考虑竞争性死亡风险。结果 在 156,362 例确诊为 AA 的患者中，13,200 例接受了 NOM。复合再出现或干预的累积发生率在 1 年时为 33% （95% CI 32-33%），在 5 年时为 36% （95% CI 36-37%）。5 年时，阑尾炎特异性 ED 再就诊或再入院的发生率为 16% （95% CI 15-16%），AA 紧急手术的发生率为 12% （95% CI 12-13%），预定手术的发生率为 21% （95% CI 20-21%）。在单纯性 AA 患者亚组中，复合再出现或干预在 1 年时为 28% （95% CI 27-29%），在 5 年时为 32% （95% CI 32-33%）。结论 AA 型 NOM 后有或没有紧急手术后紧急再见的真实世界估计值低于既往描述。预定的阑尾切除术占 NOM 后长期干预的重要比例。