Background: Use of nonoperative management for uncomplicated appendicitis is increasing. Recurrent appendicitis is only one measure of successful nonoperative management. We examined health care utilization and exposure to medical imaging between patients postappendectomy and those with an in situ appendix over the year after initial diagnosis. We hypothesized that nonoperative management would result in greater health care utilization than operative management in the year following index diagnosis.

Methods: Using MarketScan, a commercial and fee-for-service Medicare claims database, we extracted patients presenting to the emergency department (ED) with acute appendicitis and without perforation from 2017 to 2021, and either underwent appendectomy during index presentation or nonoperative treatment. We examined differences in abdominal pain related health care utilization within 1-year including ED visits, hospitalizations, and abdominal computed tomography (CT) scans associated with the most common causes of ED presentation for abdominal pain.

Results: Of 26,588 patients presenting with uncomplicated appendicitis (female, 50.4%; mean [SD] age, 37.9 [15.3] years; mean [SD] Elixhauser comorbidity index, 0.8 [1.2]), 24,102 (90.6%) underwent appendectomy. At 1 year, 2,544 (9.6%) represented to the ED with an abdominal pain and/or appendicitis related diagnosis. Of nonoperatively managed patients, 78 (3.1%) underwent appendectomy for recurrent appendicitis at a median of 70 days, and 396 (15.9%) represented to the ED but did not undergo appendectomy. Emergency department visits, subsequent hospitalization, and abdominal CT scans were more common in the nonoperative group. After adjusting for patient sex, age, and Elixhauser comorbidity index, patients managed nonoperatively were approximately twice as likely (relative risk [RR], 2.10 [1.90-2.31]) to represent to the ED, be hospitalized (RR, 2.32 [1.94-2.76]), or undergo a CT scan (RR, 1.87 [1.68-2.08]) within 1 year.

Conclusion: After adjusting for baseline characteristics, nonoperative management of uncomplicated appendicitis was associated with representation to the ED, rehospitalization, and repeat CT imaging.

Level of evidence: Therapeutic/Care Management; Level III.

Keywords: Appendicitis; health care utilization; nonoperative management; operative management.

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背景：

非手术治疗单纯性阑尾炎的使用正在增加。复发性阑尾炎只是非手术管理成功的一个衡量标准。我们研究了在初次诊断后一年内，行阑尾切除术患者与未行手术但保留原位阑尾患者的医疗服务利用和医学影像暴露情况。我们认为，在初次诊断后的第一年内，非手术治疗将导致更高的医疗利用率。

方法：

使用MarketScan数据库（一个商业和医疗保险费用报销数据库），我们提取了2017年至2021年间因急性阑尾炎但未穿孔而到急诊科就诊的患者，并且这些患者在初次就诊时要么接受了阑尾切除术，要么接受了非手术治疗。我们研究了在这之后一年内腹痛相关医疗服务利用情况，包括急诊访问、住院和腹部CT扫描等。

结果：

共有26,588名单纯性阑尾炎患者（女性占50.4%，平均年龄[标准差]37.9岁[15.3]；平均[标准差]Elixhauser合并症指数为0.8[1.2]）在初次诊断时接受治疗。其中，有24,102名患者（占90.6%）接受了阑尾切除术。一年后，有2,544名患者（占9.6%）因腹痛或相关性阑尾炎而再次到急诊科就诊。在非手术管理的患者中，78名患者（3.1%）因复发性阑尾炎在平均70天时接受了阑尾切除术，另外有396名患者（占15.9%）虽未接受手术但因为腹痛再次到急诊科就诊。与手术治疗相比，在非手术治疗组中，急诊访问、后续住院和腹部CT扫描更为常见。调整性别、年龄和Elixhauser合并症指数后，非手术管理的患者在一年内更可能因上述原因再访急诊（相对风险[RR]2.10 [1.90-2.31]）、重新入院（RR, 2.32 [1.94-2.76]）或进行CT扫描（RR，1.87 [1.68-2.08]）。

结论：

调整基线特征后，非手术治疗单纯性阑尾炎与再访急诊、再次入院和重复CT成像相关联。

证据级别：

治疗/护理管理；III级。