Appendectomy provides no additional benefit in UC

Appendectomy does not appear to alter the clinical course of patients with ulcerative colitis (UC), such that those who undergo the procedure are not more likely to experience a milder clinical course compared with those who choose not to, regardless of underlying appendicitis, as shown in a study.

Researchers used data from the Danish National Patient Registry. They looked at 22,098 patients with UC who had been followed for a median of 10.3 years. Those who underwent appendectomy were matched to those who did not based on age, sex, calendar year, and disease duration.

Outcomes including UC-related admission rates, rates of initiating treatment with biologics, and colorectal resection rates were compared between UC patients with (n=2,014) and without (n=20,084) appendectomy.

Hospitalization occurred more frequently among patients who underwent appendectomy without underlying appendicitis after UC (incidence rate ratio [IRR], 1.11, 95 percent confidence interval [CI], 1.01–1.22) and among those who underwent the procedure for appendicitis before UC (IRR, 1.22, 95 percent CI, 1.15–1.31) compared with those who did not undergo appendectomy.

Of note, appendectomy performed for appendicitis after UC was associated with a two- to threefold increase in the risk of colorectal resections 5–20 years after the procedure (5–10 years: adjusted hazard ratio [aHR], 2.08, 95 percent CI, 1.03–4.17); 10–20 years: aHR, 3.25, 95 percent CI, 1.31–8.08).

If not performed for appendicitis, appendectomy was also linked to heightened risk of colorectal resections 5–10 years after (aHR, 2.51, 95 percent CI, 1.01–6.23).

The number of patients who started treatment with biologics did not differ between the appendectomy and no-appendectomy groups.