Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis

Prechal, Daniela; Damirov, F; Grilli, Maurizio; Ronellenfitsch, Ulrich

doi:10.1007/s00384-019-03296-0

Cited by 48 publications

(42 citation statements)

References 27 publications

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“…The observations in this study are in keeping with previous reports of non-operative management being safe and effective for the majority of patients, with other studies reporting similar success rates, reduced social costs to the patient and less financial cost to the healthcare system if conservative management is considered as a treatment option for AA [ 9 , 11 , 12 , 21 – 26 ]. However, many of these studies were conducted in a research setting, where specific inclusion criteria were applied.…”

Section: Discussionsupporting

confidence: 90%

“…Though previously rarely used, conservative management of AA, whether with antibiotics alone or IR drain, has been effectively applied in the majority of patients in this study. With only 10% failing such management and requiring surgery, a shorter LOS and fewer complications compared to those who had initial operations, this interim analysis supports previous studies that have reported non-operative management of AA as a safe and effective option [21][22][23][24][25][26]. This study reassures surgeons about their decision making during the pandemic, supports routine CT imaging to aid such decisions and demonstrates that this option is generalisable in UK practice and perhaps, signals a reconsideration for first line treatment of AA beyond the pandemic.…”

Section: Discussionsupporting

confidence: 83%

“…This will inform practice during the rest of the COVID-19 pandemic, and potentially beyond. There is the opportunity to observe if the safe and efficient conservative management of AA previously seen in randomised controlled trials and meta-analysis in Europe and the USA is generalisable in the UK [21][22][23][24][25][26]. This interim analysis of our study aims to capture the management of AA during the first few weeks of the COVID-19 pandemic lockdown in the UK and to assess the 30-day outcomes [27].…”

Section: Introductionmentioning

confidence: 99%

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The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study

et al. 2020

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Background Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK). Methods Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up. Results The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive. Conclusion COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study

et al. 2020

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“…A growing evidence-base suggests that conservative treatment with antibiotics is an effective management strategy for cases of non-complicated appendicitis [6][7][8]. In the last decade, multiple meta-analysis and systematic reviews have been conducted comparing surgical and conservative management of AA [7][8][9]. The majority concludes that whilst appendicectomy remains the definitive treatment option, antibiotic treatment is a safe and effective alternative.…”

Section: Introductionmentioning

confidence: 99%

Surgical Versus Conservative Management of Acute Appendicitis During the COVID-19 Pandemic: A Single-Centre Retrospective Study

Lotfallah¹,

Aamery²,

Moussa³

et al. 2021

Cureus

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IntroductionThe COVID-19 pandemic provoked a change to normal surgical practice in the United Kingdom and led to an increase in acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse the management of patients presenting with AA to our institution during the first wave of the pandemic, comparing surgically and conservatively managed patients. MethodAll patients presenting to our centre with AA between March and July 2020 were included. Six-month followup data were collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcomes were length of hospital stay and Alvarado score. ResultsFifty-seven patients (n=57) were admitted with AA, 45.6% (n=26) managed conservatively compared to 54.4% (n=31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not found to be statistically significant (16% vs 35%; p=0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p=0.012 and p=0.028, respectively). ConclusionsCOVID-19 has led to a significant cohort of conservatively managed AA patients in the United Kingdom. We propose a stratification pathway based on clinical severity, Alvarado score and imaging to facilitate safe selection for conservative management of AA, in order to reduce failure of treatment rates in this patient group. Further UK-based studies will add to the evidence-based surrounding safe management of AA with conservative treatment.

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“…Many patients are managed non-operatively(1). Over the last several years, numerous studies have determined safety and e cacy of non-operative treatment with speci c indications (1,2,6,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Healthcare providers have been eager to adapt this new modality without consideration for possible long-term outcomes, and oncologic rami cation.…”

Section: Discussionmentioning

confidence: 99%

Appendiceal Adenocarcinoma Found by Surgery for Acute Appendicitis is Associated with Older Age – A Retrospective Cohort Study

Alemany

Skendelas

et al. 2020

Preprint

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Background: Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor as a primary therapy. Appendiceal neoplasms are found rarely and often as an incidental finding in the setting of appendectomy for acute appendicitis. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies.Methods: We reviewed electronic medical records for a nine-year period (2010-2018) of patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City. The authors also examined patients undergoing appendectomy during the same time interval through a query of the National Surgical Quality Improvement Program (NSQIP) database. Results: We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in available national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80, and peaked at 2.1% in patients between 70 and 79 years.Conclusions: We submit that the management of acute appendicitis involves a consideration of appendiceal neoplasm in patients over the age of 40. This should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy. If this is undertaken, interval appendectomy or further cancer screening and surveillance should be performed.

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Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis

Cited by 48 publications

References 27 publications

The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study

The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study

Surgical Versus Conservative Management of Acute Appendicitis During the COVID-19 Pandemic: A Single-Centre Retrospective Study

Appendiceal Adenocarcinoma Found by Surgery for Acute Appendicitis is Associated with Older Age – A Retrospective Cohort Study

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