Published online Oct 27, 2016. doi: 10.4240/wjgs.v8.i10.693
Peer-review started: June 1, 2016
First decision: July 20, 2016
Revised: August 4, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 27, 2016
To investigate the epidemiology, treatment and outcomes of acute appendicitis (AA) in a large population study.
This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system (more than 1 million inhabitants) from 1997 to 2013. Data about treatment, surgery, length of stay were collected. Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.
From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA, with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17, 54.7% were male and the mean Charlson’s comorbidity index was 0.32 ± 0.92. Mortality was < 0.0001%. Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion. Laparoscopic appendectomy was performed in 48% of cases. Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.
The treatment of acute appendicitis in Northern Italy is slowly changing, with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option, but rich of promising results.
Core tip: Acute appendicitis is the most common surgical emergency around the world. In the Bergamo district, northern Italy its incidence is 89/100000 inhabitants per year with a negative trend during the last years. Percent of 95 patients were treated with appendectomy, 48% of whom laparoscopically; 1.3% of operated patients had an intestinal obstruction during the follow-up. Conservative treatment resulted in a reduced length of stay but 23% of patients had a relapse during follow up. Cumulative length of stays during the study period was similar for the two treatment option.