Impact of an appendicolith and its characteristics on the severity of acute appendicitis

Sami Sula; Timo Paananen; Ville Tammilehto; Saija Hurme; Anne Mattila; Tuomo Rantanen; Tero Rautio; Tarja Pinta; Suvi Sippola; Jussi M. Haijanen; Paulina Salminen

doi:10.1093/bjsopen/zrae093

Impact of an appendicolith and its characteristics on the severity of acute appendicitis

Sami Sula
, Timo Paananen
, Ville Tammilehto
, Saija Hurme
, Anne Mattila
, Tuomo Rantanen
, Tero Rautio
, Tarja Pinta
, Suvi Sippola
, Jussi M. Haijanen
, Paulina Salminen^*

^*Tämän työn vastaava kirjoittaja

Seinäjoen keskussairaala VA HVA

Tutkimustuotos: Artikkeli › Tieteellinen › vertaisarvioitu

10 Sitaatiot (Scopus)

13 Lataukset (Pure)

Abstrakti

Background: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. Methods: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated - including perforation, gangrene, an abscess, or a tumour) was determined for all patients. Results: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. Conclusion: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.

Alkuperäiskieli	Englanti
Artikkeli	zrae093
Sivumäärä	8
Julkaisu	BJS Open
Vuosikerta	8
Numero	5
DOI - pysyväislinkit	https://doi.org/10.1093/bjsopen/zrae093
Tila	Julkaistu - 2024
OKM-julkaisutyyppi	A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä

Rahoitus

This study was supported by the Academy of Finland, the Sigrid Jus\u00E9lius Foundation, the Finnish Medical Foundation, and the Orion Research Foundation. The funders had no role in the design and conduct of this study. Acknowledgements The authors thank Eeva-Liisa S\u00E4vel\u00E4 (Satasairaala Central Hospital), Imre Ilves (Mikkeli Central Hospital), and the whole APPAC study group for their contribution to patient recruitment. The authors would also like to thank the Academy of Finland (Paulina Salminen), the Sigrid Jus\u00E9lius Foundation (Paulina Salminen), the Finnish Medical Foundation (Sami Sula), and the Orion Research Foundation (Sami Sula) for providing research grants. Timo Paananen and Ville Tammilehto contributed equally as second authors and Jussi M. Haijanen and Paulina Salminen contributed equally as last authors. This study was supported by the Academy of Finland, the Sigrid Jus\u00E9lius Foundation, the Finnish Medical Foundation, and the Orion Research Foundation. The funders had no role in the design and conduct of this study. This study was supported by the Academy of Finland, the Sigrid Jus\u00E9lius Foundation, the Finnish Medical Foundation, and the Orion Research Foundation. The funders had no role in the design and conduct of this study. The authors thank Eeva-Liisa S\u00E4vel\u00E4 (Satasairaala Central Hospital), Imre Ilves (Mikkeli Central Hospital), and the whole APPAC study group for their contribution to patient recruitment. The authors would also like to thank the Academy of Finland (Paulina Salminen), the Sigrid Jus\u00E9lius Foundation (Paulina Salminen), the Finnish Medical Foundation (Sami Sula), and the Orion Research Foundation (Sami Sula) for providing research grants. Timo Paananen and Ville Tammilehto contributed equally as second authors and Jussi M. Haijanen and Paulina Salminen contributed equally as last authors.

Rahoittajat
Strategic Research Council at the Research Council of Finland
Satasairaala Central Hospital
Orionin Tutkimussäätiö
Suomen Lääketieteen Säätiö
Sigrid Juséliuksen Säätiö

Julkaisufoorumi-taso

Jufo-taso 1

!!ASJC Scopus subject areas

Surgery

Pääsy asiakirjaan

10.1093/bjsopen/zrae093Lisenssi: CC BY-NC

zrae093Final published version, 181 KBLisenssi: CC BY-NC

https://urn.fi/URN:NBN:fi:tuni-202410159276Lisenssi: CC BY-NC

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title = "Impact of an appendicolith and its characteristics on the severity of acute appendicitis",

abstract = "Background: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. Methods: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated - including perforation, gangrene, an abscess, or a tumour) was determined for all patients. Results: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7\%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1\%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5\%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95\% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1\% versus 44.9\%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4\% versus 31.6\%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. Conclusion: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.",

author = "Sami Sula and Timo Paananen and Ville Tammilehto and Saija Hurme and Anne Mattila and Tuomo Rantanen and Tero Rautio and Tarja Pinta and Suvi Sippola and Haijanen, \{Jussi M.\} and Paulina Salminen",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s).",

year = "2024",

doi = "10.1093/bjsopen/zrae093",

language = "English",

volume = "8",

journal = "BJS Open",

issn = "2474-9842",

publisher = "Oxford University Press",

number = "5",

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TY - JOUR

T1 - Impact of an appendicolith and its characteristics on the severity of acute appendicitis

AU - Sula, Sami

AU - Paananen, Timo

AU - Tammilehto, Ville

AU - Hurme, Saija

AU - Mattila, Anne

AU - Rantanen, Tuomo

AU - Rautio, Tero

AU - Pinta, Tarja

AU - Sippola, Suvi

AU - Haijanen, Jussi M.

AU - Salminen, Paulina

PY - 2024

Y1 - 2024

N2 - Background: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. Methods: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated - including perforation, gangrene, an abscess, or a tumour) was determined for all patients. Results: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. Conclusion: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.

AB - Background: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. Methods: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated - including perforation, gangrene, an abscess, or a tumour) was determined for all patients. Results: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. Conclusion: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.

U2 - 10.1093/bjsopen/zrae093

DO - 10.1093/bjsopen/zrae093

M3 - Article

AN - SCOPUS:85203178575

SN - 2474-9842

VL - 8

JO - BJS Open

JF - BJS Open

IS - 5

M1 - zrae093

ER -

Impact of an appendicolith and its characteristics on the severity of acute appendicitis

Abstrakti

Rahoitus

Julkaisufoorumi-taso

!!ASJC Scopus subject areas

Pääsy asiakirjaan

Sormenjälki

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