Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions

Table 1 Limitations of the Kupietzky et al’s study[1]

Limitation type	Specific issue	Potential impact
Design limitations	Retrospective design prone to selection/information bias; Excluded patients with complicated appendicitis	Recurrence rates in NOM group may be skewed; Findings may not generalize to mixed populations
Sample size/Power	Only 68 patients with appendicoliths (8.5% of cohort); Follow-up duration varied (median 44.2 months)	Underpowered to detect subgroup differences; Long-term recurrence risks underestimated
Clinical Heterogeneity	Multiple surgeons involved in NOM decisions; Non-standardized imaging follow-up protocols	Variability in intervention consistency; Reduced reliability of results
External validity	Single-center study (Hadassah Medical Center, Israel)	Findings may not apply to other healthcare settings or cultural contexts

NOM: Nonoperative management.