Thirty-Day Outcomes in Ultrasound Versus CT-Only Imaging in Obese Adults With Acute Appendicitis

BackgroundAcute appendicitis is one of the most common surgical emergencies affecting people worldwide.Current guidelines suggest imaging with an immediate computed tomography (CT) scan as the gold standard imaging pathway.However, emerging research has suggested that the addition of an ultrasound (US) can play a role in the diagnosis of acute appendicitis.In this study, we wanted to see if US as an adjunct to the existing imaging pathway of a CT scan had any improvement in 30-day outcomes in adult obese patients. MethodUsing data gathered from real patients using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study on adult obese patients (BMI ≥ 30) with acute appendicitis who were diagnosed by US, with or without a CT scan, versus those who received only a CT scan.In order to balance for possible confounding variables, propensity score matching (1:1) was used to match for common demographic information and comorbidities known to worsen surgical outcomes (hypertension, diabetes mellitus, BMI).The study's primary outcome was emergency room revisit rate after their initial visit.Secondary outcomes included peritoneal abscess, perforation, and peritonitis.All outcomes were measured at 30 days after the acute appendicitis diagnosis. ResultsAfter propensity score matching, 968 patients were deemed eligible for analysis, with 484 patients within each cohort.There were no detectable statistical differences between these groups after matching for patient demographics and comorbidities.Those who underwent a US did not show significant differences in outcomes compared to those who received a CT scan only.The rates of emergency room revisits were similar between the US and CT scan groups, at 11.98% and 13.64%, respectively (RR = 0.879, p = 0.44).For secondary outcomes, no statistical difference was found for the risk of peritoneal/abdominal abscess (RR = 0.69, p = 0.16), perforation (RR = 1.32, p = 0.35), or peritonitis (RR = 0.90, p = 0.59). ConclusionOur study demonstrated no statistically significant difference in outcomes for adult obese patients diagnosed with acute appendicitis who received an ultrasound, compared to those who received a CT scan only.