Introduction
Materials and methods
Study design
Outcomes
Site recruitment
Data collection
Statistical analysis
Results
Patient cohort
Event/total (%)* | Total (n = 500) | Operative management (n = 229) | Initial conservative management (n = 271) | |||
---|---|---|---|---|---|---|
Antibiotics and IR drain (n = 271) | P value | Antibiotics alone (n = 263) | P value | |||
Age (years) median, range | 35 [26–49.75] | 37 [28.5–52] | 34 [25–48] | 0.08 | 34 [25–47] | 0.04 |
Female | 233/500 (47) | 99/229 (43) | 134/271 (49) | 0.18 | 132/263 (50) | 0.13 |
Body Mass Index kg/m2 | ||||||
< 20 | 22/479 (5) | 11/222 (6) | 11/257 (3) | 0.07 | 11/249 (4) | 0.09 |
20–25 | 186/479 (39) | 82/222 (37) | 104/257 (41) | 100/249 (40) | ||
25–30 | 165/479 (34) | 68/222 (31) | 97/257 (38) | 94/249 (38) | ||
30–35 | 74/479 (15) | 45/222 (20) | 29/257 (11) | 29/249 (12) | ||
35 + | 32/479 (7) | 16/222 (8) | 16/257 (6) | 15/249 (6) | ||
Rockwood score | ||||||
Not frail (1–3) | 478/500 (96) | 220/229 (96) | 258/271 (95) | 0.87 | 250/263 (95) | 0.84 |
Pre-frail (4) | 14/500 (3) | 6/229 (3) | 8/271 (3) | 8/263 (3) | ||
Frail (5–9) | 8/500 (2) | 3/229 (1) | 5/271 (2) | 5/263 (2) | ||
Comorbidities | ||||||
None reported | 450/499 (90) | 207/229 (90) | 243/270 (90) | 1 | 236/262 (90) | 1 |
Diabetes | 18/499 (3) | 9/229 (4) | 9/270 (3) | 0.81 | 9/262 (3) | 0.81 |
COPD | 9/498 (2) | 4/228 (2) | 5/270 (2) | 1 | 5/262 (2) | 1 |
Myocardial infarction | 15/498 (3) | 8/313 (3) | 7/270 (3) | 0.61 | 7/262 (3) | 0.61 |
Immunosuppressed | 11/499 (2) | 3/229 (1) | 8/270 (3) | 0.24 | 7/262 (3) | 0.35 |
Active cancer | 4/499 (0.7) | 3/313 (1) | 1/270 (0) | 0.3 | 1/262 (0.4) | 0.34 |
Dementia | 4/499 (0.7) | 2/229 (0.6) | 2/270 (0.8) | 0.87 | 2/262 (0.8) | 1 |
Imaging | ||||||
No Imaging | 77/500 (15) | 35/229 (15) | 42/271 (16) | 0.95 | 42/263 (16) | 0.9 |
CT scan | 353/500 (71) | 174/229 (76) | 179/271 (66) | 0.018 | 171/263 (65) | 0.01 |
USS | 86/500 (17) | 26/229 (11) | 60/271 (22) | 0.002 | 60/263 (23) | 0.001 |
CT scan and USS | 16/500 (3) | 6/229 (2) | 10/271 (3) | 0.61 | 10/263 (4) | 0.61 |
Admission COVID swab | ||||||
Positive | 6/159 (4) | 3/91 (3) | 3/68 (4) | 1 | 3/64 (5) | 0.69 |
Negative | 153/159 (96) | 88/91 (97) | 65/68(96) | 61/64 (90) | ||
Not performed | 341/500 (68) | 138/229 (60) | 203/271(75) | < 0.001 | 199/263 (76) | < 0.001 |
Length of stay (days) median, range | 3 [1–4] | 3 [2–4] | 2 [1–4] | < 0.001 | 2 [1–4] | < 0.001 |
Managed without admission | 57/483 (12) | 9/223 (4) | 48/260 (18) | < 0.001 |
Imaging
Age group | Computed Tomography (CT) scan | Females | Males | P value |
---|---|---|---|---|
18–39 years | 165/300 (55) | 74/144 (51) | 91/156 (58) | 0.23 |
40–59 years | 118/128 (92) | 46/52 (88) | 72/76 (95) | 0.07 |
60 years and above | 70/72 (97) | 36/37 (97) | 34/35 (97) | 1 |
Management approach
Patient outcomes and 30-day follow-up
Event/Total (%)* | Open (n = 133) | Laparoscopic (n = 104) | P value |
---|---|---|---|
Age (years) median, range | 35 [29–51.5] | 37.5 [25–53] | 0.934 |
Female | 47/133 (35) | 56/104 (54) | 0.006 |
No comorbidity | 119/133 (90) | 95/104 (91) | 0.665 |
Time of day of operation | |||
8 am–6 pm | 87/133 (66) | 62/102 (61) | 0.135 |
6 pm–10 pm | 32/133 (24) | 20/102 (20) | |
10 pm–8 am | 14/133 (11) | 20/102 (20) | |
Operative time | |||
< 30 min | 3/133 (2) | 5/102 (5) | 0.612 |
30−60 min | 53/133 (40) | 44/102 (43) | |
60–90 min | 57/133 (43) | 35/102 (34) | |
90–120 min | 16/133 (16) | 14/102 (14) | |
> 120 min | 4/133 (3) | 4/102 (4) | |
Consultant performed procedure | 49/133 (37) | 33/103 (32) | 0.173 |
Consultant performing or assisting | 72/133 (54) | 42/103 (41) | 0.04 |
Postoperative care | |||
Level 2 High Dependency Unit | 4/133 (3) | 3/103 (3) | 0.749 |
Level 3 Intensive Care Unit | 3/133 (2) | 1/103 (1) | |
Converted to open from laparoscopic | – | 11/104 (11) | – |
Length of stay (days) median, range | 3 [2–5] | 2 [2–4] | 0.012 |
Event/Total (%) | Total (n = 470) | Operative management (n = 219) | Initial conservative management (n = 251) | |||
---|---|---|---|---|---|---|
Antibiotics and IR drain (n = 251) | P value | Antibiotics alone (n = 244) | P value | |||
Collection* | 27/470 (6) | 19/219 (8) | 8/251 (4) | 0.01 | 5/244 (2) | 0.001 |
Collection requiring IR drain | 3/470 (1) | 0/219 (0) | 3/251 (1) | 0.252 | 0/244 (0) | |
Collection requiring re-operation | 6/470 (1) | 5/219 (2) | 1/251 (0) | 0.102 | 0/244 (0) | |
Ileus** | 14/470 (4) | 14/219 (8) | 0/251 (0) | < 0.001 | 0/244 (0) | < 0.001 |
Wound infection*** | ||||||
Antibiotics | 18/470 (3) | 16/219 (7) | 2/251 (1) | < 0.001 | 2/242 (0.8) | < 0.001 |
Wound Opened | 9/470 (2) | 8/219 (4) | 1/251 (1) | 0.014 | 1/244 (0.4) | 0.02 |
Hospital Acquired Pneumonia | ||||||
Oral Antibiotics | 1/470 (0.2) | 1/219 (0.5) | 0/251 (0) | 1 | 0/244 (0) | 0.47 |
IV Antibiotics | 6/470 (2) | 6/219 (3) | 0/251 (0) | 0.01 | 0/244 (0) | 0.01 |
Deep Vein Thrombosis/ Pulmonary Embolism | 3/470 (0.2) | 1/219 (0.5) | 2/251 (1) | 1 | 2/244 (1) | 1 |
Reoperation**** | 8/470 (2) | 7/219 (3) | 1/251 (0) | 0.03 | 0/244 (0) | 0.005 |
Death | 0/470 (0) | 0/219 (0) | 0/251 (0) | 1 | 0/244 (0) | 1 |
Unplanned level 2/3 care | 6/470 (2) | 5/219 (4) | 1/251 (0) | 0.1 | 1/243 (0.4) | 0.11 |
Post presentation COVID | 7/470 (1) | 4/219 (2) | 3/251 (1) | 0.71 | 3/244 (1) | 0.71 |
Failed conservative management | – | – | 26/251 (10) | – | 24/244 (9) | – |