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Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?

Abstract This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.
PMID
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Authors

Mayor MeshTerms

Patient Selection

Severity of Illness Index

Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29580342
OWN - NLM
STAT- MEDLINE
DCOM- 20180404
LR  - 20180404
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 2
DP  - 2018 Feb 1
TI  - Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?
PG  - 174-180
AB  - This study evaluated nonoperative treatment for mild appendicitis and reviewed
      selection criteria to be used in introducing this option into clinical practice. 
      A retrospective review of 73 consecutive cases of appendicitis treated by a
      single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with 
      mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm
      proposed in this manuscript were considered for nonoperative management. An
      additional 17 patients with mild appendicitis were offered and successfully
      treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73
      patients, 37 had moderate to severe appendicitis and directly underwent
      appendectomy. The remaining patients were diagnosed with mild appendicitis and
      considered eligible for nonoperative management. Of these, 14 patients were
      offered nonoperative therapy. Thirteen responded successfully; one patient
      responded partially, but later opted for surgery. In 2014, this scoring system
      and preliminary results were shared with the other surgeons in our department.
      Nonoperative management was then selectively adopted by a few of the surgeons
      from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being
      offered and successfully managed nonoperatively. Patients with mild or early
      appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS 
      scoring system may provide a helpful mnemonic for successfully selecting patients
      for this option.
FAU - Horattas, Mark C
AU  - Horattas MC
AD  - Clinic Akron General, Akron, Ohio, USA.
FAU - Horattas, Ileana K
AU  - Horattas IK
FAU - Vasiliou, Elya M
AU  - Vasiliou EM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
RN  - 0 (Anti-Bacterial Agents)
RN  - 65DT0ML581 (sultamicillin)
RN  - 74469-00-4 (Amoxicillin-Potassium Clavulanate Combination)
RN  - 7C782967RD (Ampicillin)
RN  - S4TF6I2330 (Sulbactam)
SB  - IM
MH  - Administration, Oral
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Amoxicillin-Potassium Clavulanate Combination/therapeutic use
MH  - Ampicillin/therapeutic use
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Appendectomy
MH  - Appendicitis/diagnosis/*drug therapy/surgery
MH  - Clinical Decision-Making/*methods
MH  - Drug Administration Schedule
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Injections, Intravenous
MH  - Male
MH  - Middle Aged
MH  - *Patient Selection
MH  - Retrospective Studies
MH  - *Severity of Illness Index
MH  - Sulbactam/therapeutic use
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2018/03/28 06:00
MHDA- 2018/04/05 06:00
CRDT- 2018/03/28 06:00
PHST- 2018/03/28 06:00 [entrez]
PHST- 2018/03/28 06:00 [pubmed]
PHST- 2018/04/05 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Feb 1;84(2):174-180.