Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis

doi:10.1016/j.amjsurg.2016.07.026

The American Journal of Surgery

Volume 214, Issue 1, July 2017, Pages 24-28

https://doi.org/10.1016/j.amjsurg.2016.07.026 Get rights and content

Highlights

•
About 27.8% of diabetic patients receiving antibiotics for appendicitis underwent an appendectomy.
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About 19.2% of nondiabetic patients receiving antibiotics for appendicitis underwent an appendectomy.
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Diabetes was related to the increased risk of appendectomy for patients receiving antibiotics.

Abstract

Background

This retrospective cohort study examined whether diabetic patients have a higher risk for recurrent appendicitis during a 1-year follow-up period after successful antibiotic treatment for patients with acute uncomplicated appendicitis than nondiabetic patients using a population-based database.

Methods

We included 541 appendicitis patients who received antibiotic treatment for acute appendicitis. We individually tracked each patient for a 1-year period to identify those who subsequently underwent an appendectomy during the follow–up period.

Results

Cox proportional hazard regressions suggested that the adjusted hazard ratio of an appendectomy during the 1-year follow-up period was 1.75 for appendicitis patients with diabetes than appendicitis patients without diabetes. We found that among females, the adjusted hazard ratio of an appendectomy was 2.18 for acute appendicitis patients with diabetes than their counterparts without diabetes. However, we failed to observe this relationship in males.

Conclusions

We demonstrated a relationship between diabetes and a subsequent appendectomy in females who underwent antibiotic treatment for noncomplicated appendicitis.

Section snippets

Database

We retrieved data for this study from the “Longitudinal Health Insurance Database 2005” (LHID2005). Taiwan began the National Health Insurance (NHI) program in 1995, and the coverage rate has been maintained at about 98.4% since its inception. The LHID2000 covers registration files and original medical claims for 1,000,000 enrollees randomly selected from all enrollees listed in the 2000 Registry of Beneficiaries under the NHI program (n = 25.68 million) by the Taiwan National Health Research

Results

Table 1 presents the distributions of demographic characteristics and the CCI between acute appendicitis patients with and those without diabetes. It shows that there was a significant difference in the mean age (P < .001) and CCI (P < .001) between appendicitis patients with and those without diabetes. Acute appendicitis patients with diabetes were more likely to be older than their counterparts without diabetes (61.5 vs 46.1 year). However, we observed no significant difference in monthly

Comments

This retrospective cohort study shows that among acute uncomplicated appendicitis patients who received antibiotic treatment, diabetic patients were more likely to undergo a subsequent appendectomy during the 1-year follow-up period than those without diabetes (27.8% vs 19.2%, P = .003). Furthermore, the Cox proportional analysis suggested that diabetes was significantly associated with an increased risk of a subsequent appendectomy with recurrent appendicitis (adjusted HR = 1.72, 95% CI 1.01

Conclusions

Despite the previously mentioned limitations, this study demonstrated a relationship between diabetes and a subsequent appendectomy in female patients with antibiotic treatment of noncomplicated appendicitis. We suggest that clinicians be alert to the possibility of recurrent appendicitis in acute uncomplicated appendicitis patients with diabetes even before their successful treatment with antibiotics.

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The objective of this study is to identify predictors for recurrent appendicitis in patients with appendicitis previously treated nonoperatively.
This is a prospective cohort study of all adult patients with appendicitis treated at a tertiary care hospital. Patient demographics, radiographic information, management, and clinical outcomes were recorded. The primary outcome was recurrent appendicitis within 6 months after discharge from the index admission. Given the competing risk of interval appendectomy, a time-to-event competing-risk analysis was performed.
Of the 699 patients presenting with appendicitis, 74 were treated nonoperatively (35 [47%] were women; median [IQR] age, 48 [33,64] years), and 21 patients (29%) had recurrent appendicitis. On univariate and multivariate analysis, presence of an appendicolith on imaging was the only factor associated with a higher risk of recurrent appendicitis (p = 0.02).
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Citation Excerpt :
Therefore, our findings, as well as those from previous studies,8-10 should be validated in a large multicenter data set.
Our objective was to identify predictors of successful nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that the absence of diabetes, absence of an appendicolith, short duration of symptoms, absence of systemic inflammation, and low modified Alvarado score would predict successful NOM.
We performed a retrospective cohort analysis of 81 consecutive patients who underwent NOM of uncomplicated appendicitis. Successful NOM was defined as resolution of appendicitis with antibiotics alone and no recurrent appendicitis within 180 days. Patients with successful NOM (n = 36) were compared with patients who failed NOM (n = 45). Multivariable logistic regression was used to identify predictors of successful NOM, expressed as odds ratios (ORs) with 95% confidence intervals. Model strength was assessed by calculating area under the receiver operating characteristic curve (AUC).
Patient age (35 years), the American Society of Anesthesiologists class (2.0), and Charlson comorbidity index (0.0) were similar between groups. Independent predictors of successful NOM were duration of symptoms prior to admission >25 hours: OR 4.17 (1.42-12.24), maximum temperature within 6 hours of admission <37.3°C: OR 8.07 (1.79-36.38), modified Alvarado score <4: OR 9.06 (1.26-64.93), and appendiceal diameter <13 mm: OR 17.55 (1.30-237.28); model AUC: 0.81 (0.72-0.90).
Patients with a longer duration of symptoms prior to admission were more likely to have successful NOM. Other independent predictors of successful NOM included lower temperature, lower modified Alvarado score, and smaller appendiceal diameter. These findings provide a framework for clinical decision-making and large-scale derivation and validation of a model to predict successful NOM of uncomplicated appendicitis.
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Identifying recurrence risk factors in CT-confirmed acute appendicitis in adults managed non-operatively during the COVID-19 pandemic
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Recommendations on treatment of acute appendicitis: Recommendations of an expert group based on the current literature
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: Ming-Chieh Tsai and Herng-Ching Lin have equal contributions to this study.

: There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

: The authors declare no conflicts of interest.

View full text

Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis

Highlights

Abstract

Background

Methods

Results

Conclusions

Section snippets

Database

Results

Comments

Conclusions

Lancet

Gastroenterology

J Surg Res

Dig Liver Dis

J Am Coll Surg

Am J Surg

Am J Surg

Ann Diagn Pathol

Am J Surg

Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence

Can J Surg

A decade of laparoscopic appendectomy: presentation of 1,026 patients with suspected appendicitis treated in a single surgical department

J Laparoendosc Adv Surg Tech A

Risk factors of postoperative infections in adults with complicated appendicitis

Surg Laparosc Endosc Percutan Tech

Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial

World J Surg

The risk of developing Crohn's disease after an appendectomy: a population-based cohort study in Sweden and Denmark

Gut

Protective role of appendicectomy on onset and severity of ulcerative colitis and Crohn's disease

Gut

Increased risk of pulmonary tuberculosis among subjects with appendectomy in Taiwan

Eur J Clin Microbiol Infect Dis

Does appendectomy reduce the risk of ulcerative colitis?

Epidemiology