Acute Appendicitis Non-Operative Management Rate Trends Over Two Decades (2000 to 2019): The Israel experience

Background: Acute appendicitis (AA) is a medical emergency. The standard of care for AA had been surgical appendectomy. Recently, non-operative management (NOM) has been considered, mainly for uncomplicated AA.Objectives: To evaluate M NOM trends over two decades.Methods: We conducted a retrospective cohort study based on Israel's National Hospital Discharges Database (NHDD). Inclusion criteria were AA admissions from 1 January 2000 to 31 December 2019, with either primary discharged diagnosis of AA, or principal procedure of appendectomy. Predefined groups were children (5 < 18 years) and adults (z 18 years). We compared the last decade (2010-2019) with the previous one (2000-2009).Results: The overall M incidence rate over two decades was 126/100,000/year, higher in children 164/100,000/year than 113/100,000/year in adults. Surgery was the predominant AA treatment in 91.9%; 93.7% in children and 91.1% in adults. There was an increase in AA NOM rates when comparing the previous decade (5.6%) to the past decade (10.2%); 3.2% vs. 9.1% in children and 6.8% vs. 10.7% in adults, respectively. An-nual trends revealed a mild increase in M NOM rates. Delayed appendectomy (within 90 days of M NOM) was 19.7% overall; 17.3% in adults and 26.3% in children.Conclusions: There was an increase in M NOM rates during the last decade in the overall population. Since 2015, there has been a noticeable increase in AA NOM rates, probably asso-ciated with World Society of Emergency Surgery Jerusalem guidelires. Surgery is still the predominant treatment for M despite the increasing trend in NOM.