Long-term Outcomes following Nonoperative Management of Acute Appendicitis
Bibliographic record
Abstract
OBJECTIVE: To describe long-term representations and interventions following nonoperative management (NOM) of acute appendicitis (AA). BACKGROUND: Trial data suggest NOM of AA carries a substantial risk of subsequent appendectomy, although NOM is increasingly offered to patients. Population-based data is required to understand the real-world long-term course of patients undergoing NOM of AA. METHODS: This population-based cohort study included all adult patients in Ontario, Canada who presented to any emergency department (ED) with AA between 2004 and 2019. Patients who did not undergo a procedure on index ED presentation or hospital admission were defined as NOM and followed for 5 years. The cumulative incidence of composite representation or intervention (ED representation, readmission, emergency, or scheduled appendicitis procedure) was calculated accounting for the competing risk of death. RESULTS: Of 156,362 patients identified with AA, 13,200 underwent NOM. The cumulative incidence of composite representation or intervention was 33% at 1 year (95% CI: 32%-33%) and 36% at 5 years (95% CI: 36%-37%). At 5 years, the incidence of appendicitis-specific ED representation or hospital readmission was 16% (95% CI: 15%-16%), the incidence of an emergency procedure for AA was 12% (95% CI: 12%-13%), and the incidence of scheduled surgery was 21% (95% CI: 20%-21%). In a subgroup of patients with uncomplicated AA, composite representation or intervention were 28% at 1 year (95% CI: 27%-29%) and 32% at 5 years (95% CI: 32%-33%). CONCLUSIONS: Real-world estimates of emergency representation with or without urgent surgery following NOM of AA were lower than previously described. Scheduled appendectomy made up an important proportion of long-term interventions following NOM.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".