A Multi-Center Study of Clinical Outcomes in Crohn's Disease Patients With Acute Appendicitis Treated Operatively vs Non-Operatively

Introduction: There are limited data on the efficacy of medical vs surgical therapy in Crohn’s disease (CD) patients presenting with acute appendicitis. We have previously presented data in a small cohort of CD patients showing that medical therapy for acute appendicitis may be a safe and effective option compared to surgical therapy (Am J Gastro. 117(10S):e761. 2022). In this study, we sought to assess the outcomes of CD patients treated with non-operative vs operative strategies for acute appendicitis in a larger multi-center cohort. Methods: A multi-center retrospective review of electronic health records between 1/1/2015 and 1/31/2023 was conducted. Adult patients with a documented history of CD presenting with acute appendicitis were included. Patient demographics and inflammatory bowel disease history were collected. Clinical assessments, radiographic data, and medical and/or surgical interventions at the time of presentation for appendicitis were documented. T-tests were used to compare continuous variables and Chi-Square or Fisher’s exact tests were used to compare categorical variables. Results: A total of 52 patients with CD and acute appendicitis were identified (19 were treated medically with antibiotics and 33 underwent surgery). Fifty-two percent of patients were male. Demographic data including sex, age at CD diagnosis, and CD location were similar between surgical and medical management groups (Table 1). Crohn’s disease activity, derived from a physician global assessment (PGA) score, was similar in both groups. At the time of admission, 9 patients (47%) in the medical management group were in a CD flare vs. 3 patients (9%) in the surgical group (P< 0.01). Of those medically managed, 8 patients (44%) eventually required an appendectomy within 1 year. There were no differences in length of hospital stay, complication rate up to 6 months post-admission, time to subsequent CD-related surgery, and time to CD recurrence/flare between the two groups. Conclusion: In this multi-center cohort of CD patients presenting with acute appendicitis, we found similar outcomes between those who were managed surgically vs medically. CD patients in a flare at the time of presentation were more likely to receive medical therapy. Therefore, antibiotic therapy may be an effective and safe management strategy in the treatment of CD patients with acute appendicitis. Medical management may avoid surgery in over half of these patients. Table 1. - Clinical Characteristics of Crohn's Disease Patients Presenting with Acute Appendicitis All Antibiotics (n=19) Surgery (n=33) P-value Sex, n (%) >0.05 F 25 9 (36%) 16 (64%) M 27 10 (37%) 17 (63%) Montreal Classification Age, n (%) >0.05* A1 5 3 (17%) 2 (7%) A2 23 6 (33%) 17 (59%) A3 19 9 (50%) 10 (34%) Montreal Classification Age, n (%) >0.05* L1 15 4 (21%) 11 (36%) L2 15 6 (32%) 9 (29%) L3 20 9 (47%) 11 (35%) PGA, n (%) >0.05* 0 25 8 (42%) 17 (53%) 1 5 0 5 (16%) 2 11 6 (32%) 5 (16%) 3 10 5 (26%) 5 (16%) Presence of flare during admission, n (%) < 0.01* Yes 13 9 (47%) 3 (9%) No 39 10 (53%) 30 (91%) Age at appendicitis episode, years 43 (17-73) 41 (19-90) >0.05 LOS, days 3.9 (0-14) 2.8 (0-17) >0.05 [Chi-Square or *Fisher's Exact Test PGA: Physician Global Assessment; LOS: Length of Stay].