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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".