Sami Ghazaleh, MD1, Azizullah Beran, MD1, Jordan Burlen, MD2, Ali Nawras, MD1, Muhammad Aziz, MD1, Justin Chuang, MD2 1University of Toledo Medical Center, Toledo, OH; 2University of Toledo, Toledo, OH
Introduction: The appendix and its function continue to be controversial. It has been suggested that the appendix is just a vestigial organ resulting from an evolutionary remnant. Previous studies suggested a lack of health consequences after patients received an appendectomy. However, newer studies have suggested that the appendix may serve as a replenishment of the gut microbiota and protect against the risk of fulminant Clostridium Difficile infections (CDI) leading to colectomy in severe cases. However, the association between appendectomy and the risk of CDI-induced colectomy remains uncertain. Therefore, we conducted a systematic review and meta-analysis to evaluate the correlation between appendectomy and the risk of colectomy in patients with CDI.
Methods: We performed a comprehensive literature search in the databases of PubMed/MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through November 2020. We considered randomized controlled trials, cohort studies, case-control studies, and case series. We excluded abstracts, animal studies, case reports, reviews, editorials, and letters to editors. From each study, we collected the number of patients with CDI-induced colectomy with and without a history of appendectomy. The primary outcome of interest was the occurrence of CDI-induced colectomy in both groups. The random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). A P-value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index.
Results: A total of three retrospective cohort studies, including 1424 patients, met our inclusion criteria and were included in the final analysis. A total of thirty-nine patients with a history of appendectomy required colectomy, while sixty-five patients without a history of appendectomy required colectomy. No statistically significant difference was found between the two groups regarding the occurrence of CDI-induced colectomy (RR: 1.14, 95% CI 0.53-2.49, P = 0.73, I2 = 71%) (Figure 1).
Discussion: Appendectomy does not appear to increase the risk of colectomy in patients with Clostridium Difficile infections. However, further studies with larger sample sizes are warranted to characterize this association better and confirm our findings.
Figure: Figure 1: Forest plot showing no statistically significant difference between the two groups regarding the occurrence of CDI-induced colectomy (RR: 1.14, 95% CI 0.53-2.49, P = 0.73, I2 = 71%)
Disclosures: Sami Ghazaleh indicated no relevant financial relationships. Azizullah Beran indicated no relevant financial relationships. Jordan Burlen indicated no relevant financial relationships. Ali Nawras indicated no relevant financial relationships. Muhammad Aziz indicated no relevant financial relationships. Justin Chuang indicated no relevant financial relationships.
Sami Ghazaleh, MD1, Azizullah Beran, MD1, Jordan Burlen, MD2, Ali Nawras, MD1, Muhammad Aziz, MD1, Justin Chuang, MD2. P2219 - Association Between Appendectomy and the Risk of Colectomy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.