The treatment strategies for acute appendicitis, such as emergency appendectomy (EA), interval appendectomy (IA), and repeating nonoperative management (NOM), are controversial. In this study, we examined the preoperative factors that can be used to distinguish which patients should undergo IA. We retrospectively identified 902 patients who underwent surgery for appendicitis in our hospital from January 2010 to December 2021. Of these patients, 776 were included in this study. The patients were divided into two groups: those with a periappendiceal fluid collection (PAFC) on preoperative computed tomography (PAFC-positive group, n = 170) and those without a PAFC (PAFC-negative group, n = 606). In each group, we compared patients who underwent EA and IA. In the PAFC-positive group, patients who underwent EA had a significantly higher postoperative complication rate than those who underwent IA (40.5% vs. 24.0%, p = 0.037). In the multivariate analysis, only the presence of PAFC was significantly associated with an increased risk of postoperative complications (odds ratio, 7.11; 95% confidence interval, 2.73–18.60; p < 0.001). The presence of PAFC alone was not significantly associated with an increased risk of IA or NOM failure (odds ratio, 1.48; 95% confidence interval, 0.19–11.7; p = 0.71). The rate of neoplasia on pathologic examination was significantly higher in the PAFC-positive than PAFC-negative group (7.6% vs. 1.5%, p < 0.001); the rate of carcinoma was also higher in the PAFC-positive group (2.4% vs. 0.17%, p = 0.02). The presence of PAFC on preoperative computed tomography was found to be a risk factor for postoperative complications but not IA or NOM failure. It was also correlated with neoplasia as the etiology of appendicitis. Therefore, PAFC positivity is useful as an indication for IA.

中文翻译：

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术前计算机断层扫描发现的阑尾周围积液可作为间歇性阑尾切除术的指征：一项回顾性研究

急性阑尾炎的治疗策略，例如紧急阑尾切除术（EA）、间隔阑尾切除术（IA）和重复非手术治疗（NOM），是有争议的。在这项研究中，我们检查了可用于区分哪些患者应该接受 IA 的术前因素。我们回顾性确定了 2010 年 1 月至 2021 年 12 月在我院接受阑尾炎手术的 902 例患者。其中 776 例患者纳入本研究。患者分为两组：术前计算机断层扫描显示阑尾周围积液（PAFC）的患者（PAFC 阳性组，n = 170）和没有 PAFC 的患者（PAFC 阴性组，n = 606）。在每组中，我们比较了接受 EA 和 IA 的患者。在 PAFC 阳性组中，接受 EA 的患者术后并发症发生率明显高于接受 IA 的患者（40.5% vs. 24.0%，p = 0.037）。在多变量分析中，只有 PAFC 的存在与术后并发症风险增加显着相关（优势比，7.11；95% 置信区间，2.73-18.60；p < 0.001）。单独存在 PAFC 与 IA 或 NOM 失败的风险增加没有显着相关性（优势比，1.48；95% 置信区间，0.19-11.7；p = 0.71）。PAFC 阳性组病理检查的肿瘤发生率显着高于 PAFC 阴性组（7.6% vs. 1.5%，p < 0.001）；PAFC 阳性组的癌症发病率也较高（2.4% 对 0.17%，p = 0.02）。术前计算机断层扫描发现 PAFC 是术后并发症的危险因素，但不是 IA 或 NOM 失败的危险因素。它也与作为阑尾炎病因的肿瘤形成相关。因此，PAFC 阳性可用作 IA 的指征。