Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: A meta-analysis of post-intervention complications

Kirby, Andrew; Hobson, Richard P.; Burke, Dermot; Cleveland, Victoria; Ford, G. J.; West, Robert

doi:10.1016/j.jinf.2014.08.009

Cited by 44 publications

(37 citation statements)

References 8 publications

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“…Non-complicated AA, when treated with appendectomy compared with treatment with antibiotics, has a lower rate of complications 16 Although antibiotic prophylaxis is common in surgical procedures, the inappropriate use of these drugs [18][19][20] . All patients undergoing appendectomy should receive antibiotics, prophylactic or therapeutic, and these should be started before surgery 21 .…”

Section: Discussionmentioning

confidence: 99%

Clinical-epidemiological profile of acute appendicitis: retrospective analysis of 638 cases

Lima¹,

Vieira²,

Oliveira³

et al. 2016

Rev. Col. Bras. Cir.

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Section: Discussionmentioning

confidence: 99%

Clinical-epidemiological profile of acute appendicitis: retrospective analysis of 638 cases

Lima¹,

Vieira²,

Oliveira³

et al. 2016

Rev. Col. Bras. Cir.

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“…Appendix S1 (supporting information) shows details of the search strategy. In addition, reference lists of other previous systematic reviews comparing antibiotic treatment with appendicectomy in patients with non‐perforated appendicitis were searched.…”

Section: Methodsmentioning

confidence: 99%

Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis

Sallinen

Akl

You

et al. 2016

British Journal of Surgery

223

158

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BackgroundFor more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non‐perforated appendicitis.MethodsA comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non‐perforated appendicitis. Key outcomes were analysed using random‐effects meta‐analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsFive studies including 1116 patients reported major complications in 25 (4·9 per cent) of 510 patients in the antibiotic and 41 (8·4 per cent) of 489 in the appendicectomy group: risk difference −2·6 (95 per cent c.i. –6·3 to 1·1) per cent (low‐quality evidence). Minor complications occurred in 11 (2·2 per cent) of 510 and 61 (12·5 per cent) of 489 patients respectively: risk difference −7·2 (−18·1 to 3·8) per cent (very low‐quality evidence). Of 550 patients in the antibiotic group, 47 underwent appendicectomy within 1 month: pooled estimate 8·2 (95 per cent c.i. 5·2 to 11·8) per cent (high‐quality evidence). Within 1 year, appendicitis recurred in 114 of 510 patients in the antibiotic group: pooled estimate 22·6 (15·6 to 30·4) per cent (high‐quality evidence). For every 100 patients with non‐perforated appendicitis, initial antibiotic therapy compared with prompt appendicectomy may result in 92 fewer patients receiving surgery within the first month, and 23 more experiencing recurrent appendicitis within the first year.ConclusionThe choice of medical versus surgical management in patients with clearly uncomplicated appendicitis is value‐ and preference‐dependent, suggesting a change in practice towards shared decision‐making is necessary.

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“…Although antibiotic treatment may fail in some patients and there is a risk of recurrence, the surgically treated patients are subjected to the risks of operative morbidity and mortality [15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Conservative Treatment Versus Appendectomy for Acute Uncomplicated Appendicitis

Hokkam¹

2016

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Background: For more than 100 years, surgeons have been successfully performing appendectomy to treat acute appendicitis. However; there is recent trend to shift towards a more conservative approach. This work aimed to assess the nonoperative management in the treatment of acute uncomplicated appendicitis. Methods: One hundred and sixteen patients with uncomplicated acute appendicitis were enrolled into the study. They were divided into two groups (Group A & Group B). Patients in Group A were subjected to non-operative management with antibiotics while patients in Group B were subjected to appendectomy. All patients were evaluated at hospital discharge, at 30-days and at a median follow-up on year. The primary outcome was the success rate of the non-operative management. Secondary outcomes were the difference of length of hospitalization, time to return to normal activity, and quality-of-life measures between both groups. Results: The success rate of non-operative strategy was 93.3% (42 of 45) at hospital discharge, 88.8% (40 of 45) at 30-days and 82.2% (37 of 45) at a median follow-up of one year. Patients in Group A have a significantly shorter time to return to normal activities. They reported higher quality of life scores. The length of hospitalization was significantly shorter in Group B. Conclusion: Giving intravenous antibiotics to some patients with uncomplicated acute appendicitis instead of having them undergo surgery may be safe and effective.

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Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: A meta-analysis of post-intervention complications

Cited by 44 publications

References 8 publications

Clinical-epidemiological profile of acute appendicitis: retrospective analysis of 638 cases

Clinical-epidemiological profile of acute appendicitis: retrospective analysis of 638 cases

Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis

Conservative Treatment Versus Appendectomy for Acute Uncomplicated Appendicitis

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