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

Doron Carmi, Ziona Haklai, Ethel Sherry Gordon, Ada Shteiman, Uri Gabbay*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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 AA 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 (18 years). We compared the last decade (2010-2019) with the previous one (2000-2009). Results: The overall AA 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. Annual trends revealed a mild increase in AA NOM rates. Delayed appendectomy (within 90 days of AA NOM) was 19.7% overall; 17.3% in adults and 26.3% in children. Conclusions: There was an increase in AA NOM rates during the last decade in the overall population. Since 2015, there has been a noticeable increase in AA NOM rates, probably associated with World Society of Emergency Surgery Jerusalem guidelines. Surgery is still the predominant treatment for AA despite the increasing trend in NOM.

Original languageEnglish
Pages (from-to)101-105
Number of pages5
JournalIsrael Medical Association Journal
Issue number2
StatePublished - Feb 2023


  • acute appendicitis
  • age groups
  • case fatality rate
  • incidence
  • non-operative management


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