TỶ LỆ TÁI PHÁT VÀ YẾU TỐ LIÊN QUAN SAU ĐIỀU TRỊ NỘI KHOA VIÊM RUỘT THỪA CẤP KHÔNG BIẾN CHỨNG

Abstract

Background: Antibiotic therapy for uncomplicated acute appendicitis has increasingly been adopted as an alternative to surgery in selected patients. This study aimed to quantify initial treatment success and long‑term recurrence in routine clinical practice. Methods: We conducted a longitudinal cohort study at Trung Vuong Hospital including patients with CT‑confirmed uncomplicated acute appendicitis treated initially with antibiotics between June 2015 and August 2020. Uncomplicated disease on CT was defined as absence of perforation, abscess, phlegmon, pneumoperitoneum, and significant free fluid; an appendicolith was not an exclusion criterion. The antibiotic regimen was ceftriaxone plus metronidazole; in patients with cephalosporin allergy, ciprofloxacin plus metronidazole was used. Patients were observed as inpatients for at least 48 hours. Surgery was considered for worsening pain, persistent fever, rising leukocyte count, signs of peritonitis, or clinical deterioration. Initial success was defined as discharge without appendectomy; failure as appendectomy during the index admission. Recurrence was confirmed by discharge documentation with appendectomy or by CT in patients managed nonoperatively at recurrence. Post‑discharge follow‑up was performed by scheduled telephone contacts; loss to follow‑up was treated as censoring in survival analyses. Cumulative recurrence was estimated using Kaplan–Meier methods, and associated factors were assessed with the log‑rank test (p<0.05). Results: Among 5,750 patients with acute appendicitis, 222 had uncomplicated disease and received antibiotics; mean age was 39.2±14.1 years and 42.7% were male. Initial treatment success was 95.5% (212/222), with an in‑hospital failure rate requiring appendectomy of 4.5% (10/222); no deaths occurred. Of the 212 initially successful patients, 164 were followed (48 lost), with a median follow‑up of 19 months (maximum 75 months). Thirty‑three recurrences were observed. The cumulative recurrence rates at 12, 24, 36, and 48 months were 13.7%, 17.4%, 21.2%, and 28.6%, respectively. Male sex was significantly associated with recurrence (p=0.013); no other factors showed significant differences. Conclusions: Nonoperative management of CT‑confirmed uncomplicated acute appendicitis with antibiotics was safe and achieved a high initial success rate, but recurrence increased over time. Careful patient selection, inpatient observation for at least 48 hours, and prompt conversion to surgery when treatment fails are warranted. Male sex was associated with recurrence in this cohort.