What is The Main Problem in The Conservative Management of Complicated Appendicitis? A Meta-Analysis.

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>As one of the classified groups of appendicitis, complicated appendicitis has no standardized treatment methods for adults.<jats:bold>Method</jats:bold>: The efficacy of surgical treatment and conservative treatment for complicated appendicitis was evaluated based on the literatures systematically searched on PubMed, Cochrane and Web of Science. A focus was given to important aspects, such as the outcomes of the length of stay, operation time, postoperative complications and unplanned additional interventions. <jats:bold>Result:</jats:bold> A total of 14 studies were involved in the meta-analysis, which included 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). The total hospitalization time for patients with surgical treatment was decreased by 1 day (WMD= -1.29, 95% CI [-2.42, -0.16], P= 0.03&lt; 0.05) compared to that of patients with conservative treatment. The incidence of unplanned additional interventions in patients who underwent emergency surgery is lower than that of patients with conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P&lt;0.00001). Compared to patients with conservative treatment, patients who received surgery are more likely to develop complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03&lt;0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P&lt;0.00001). The incidence of abdominal abscess in patients with surgery treatment was lower than that of patients with conservative treatment, but the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66&gt;0.05). <jats:bold>Conclusion: </jats:bold>In treating complicated appendicitis, patients who received immediate operation, when compared to patients managed under conservative treatment, have shorter hospitalization time and less unplanned interventions; hence significantly reduce the likelihood of readmission. This can decrease the requirements for follow-up treatments and ultimately lower the consumption of medical resources.</jats:p>