Management and Outcomes of Acute Appendicitis in the Presence of Cirrhosis: A Nationwide Analysis

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was qu...

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Published in:The American surgeon 2019-10, Vol.85 (10), p.1129-1133
Main Authors: Garcia, Monika, Gerber, Ari, Zakhary, Bishoy, Finco, Tiago, Kazi, Albert, Zhang, Xiaofei, Brenner, Megan, Coimbra, Raul
Format: Article
Language:English
Subjects:
Appendectomy
Appendicitis
Cirrhosis
Clinical outcomes
Comorbidity
Complications
Laparoscopy
Liver cirrhosis
Management
Mortality
Patients
Regression analysis
Risk analysis
Risk factors
Statistical analysis
Surgery
Urinary tract infections
Variance analysis
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container_end_page 1133
container_issue 10
container_start_page 1129
container_title The American surgeon
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creator Garcia, Monika
Gerber, Ari
Zakhary, Bishoy
Finco, Tiago
Kazi, Albert
Zhang, Xiaofei
Brenner, Megan
Coimbra, Raul
description Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chisquare, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.
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We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chisquare, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P &lt; 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. 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subjects Appendectomy
Appendicitis
Cirrhosis
Clinical outcomes
Comorbidity
Complications
Laparoscopy
Liver cirrhosis
Management
Mortality
Patients
Regression analysis
Risk analysis
Risk factors
Statistical analysis
Surgery
Urinary tract infections
Variance analysis
title Management and Outcomes of Acute Appendicitis in the Presence of Cirrhosis: A Nationwide Analysis
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