Background: The aim of this study was to describe and analyze the current status of the diagnosis and management of acute
appendicitis in China. Patients and Methods: An online record system was used to collect data retrospectively from 52 medical centers in mainland China. All patients with acute
appendicitis who were first treated at the hospital in 2017 were included and followed up for one year. Propensity score matching (PSM) was used to exclude the potential confounders and analyze the difference in outcomes between the non-operative management (NOM) and surgical groups. Results: A total of 10,187 patients were enrolled, of whom 5,517 (54.2%) were males. A total of 2,056 (20.2%) cases received NOM. The one-year recurrence rate of
appendicitis in the NOM group was 19.3%. On PSM analysis, we found that the NOM group had a lower complication rate (2% vs. 4.2%; p = 0.001) and an acceptable success rate (96.8% vs. 100%; p < 0.001) compared with the operative group in patients with non-complicated acute
appendicitis. However, in the complicated acute
appendicitis population, the in-hospital complication rate in the NOM group was higher (10.8% vs. 5.8%; p = 0.048) and the success rate was lower (95.4% vs. 100%; p < 0.001) than the operative group. The recurrence rate was lower in patients with non-complicated acute
appendicitis than in those with complicated acute
appendicitis (17.3% vs. 30.8%; p = 0.010). In the operative group, pre-operative antimicrobial prophylaxis-covered anaerobes could reduce the
surgical site infection (SSI) rate compared with that in the non-covered anaerobes group in non-complicated patients (0.9% vs. 1.9%; p = 0.020). Conclusions:
Appendectomy is currently the most effective treatment for acute
appendicitis. However, NOM is an alternative treatment for non-complicated acute
appendicitis but not for complicated acute
appendicitis because of the lower complication rate, considerable success rate, and recurrence rate.