MSS10: PREDICTING APPENDICEAL NEOPLASMS WITH APPENDICITIS: AN ACS NSQIP ANALYSIS
Elisabeth O Coffin, MD; Dana M Poloni, DO; Marcos C Aranda, MD; Salvatore A Parascandola, MD; Christopher W Mangieri; DDEAMC
Objective: Management of appendicitis has transitioned from primarily surgical to equivalence between surgical and medical management. While exceedingly rare, appendiceal neoplasms are incidental pathologic diagnoses after appendectomies performed for suspected benign appendicitis. With the transition towards more non-operative management of acute appendicitis there is the risk of missing underlying appendiceal neoplasms in suspected benign acute appendicitis that meets criteria for medical management. The aim of this study was to identify clinical risk factors for underlying appendiceal neoplasms which could potentially serve as contraindications for non-operative management of appendicitis.
Methods: A retrospective review of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) main and targeted appendectomy registries was performed for the 2016-2019 data sets. Cases with pathologic diagnoses of appendiceal neoplasms were compared to cases with benign appendicitis findings. Clinical factors suspected or known to be associated with underlying malignancy were analyzed between the cohorts. Multivariate regression analysis was utilized in attempt to identity significant factors predictive of appendiceal neoplasms.
Results: A total of 51,413 cases were available for analysis between the combined registries. There were 900 cases of appendiceal neoplasms identified resulting in an incidence rate of 1.75%. For all the evaluated factors only a pre-operative CT with radiographic findings not consistent with typical appendicitis was significantly associated with appendiceal neoplasms. Abnormal CT imaging was present in 36.4% of cases with appendiceal neoplasms as opposed to 5.7% of cases with benign pathology (OR 6.31, 95%CI 5.39-7.39, P<0.001). There was trend towards cases with SIRS/sepsis present (OR 0.90, 95%CI 0.78-1.04, P=0.15) and perforated appendicitis with abscess (OR 0.84, 95%CI 0.65-1.08, P=0.17) associated with a decreased risk of an underlying appendiceal neoplasm.
Conclusion: Suspicious radiographic findings for appendiceal neoplasm presents a likely contraindication to nonoperative management of acute appendicitis. SIRS/sepsis and perforation with abscess are less associated with appendiceal neoplasm.