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Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial)

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A Correction to this article was published on 28 January 2021

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Abstract

Purpose

The aim of this prospective multicenter study was to compare antibiotic therapy and appendectomy as treatment for patients with uncomplicated appendicitis confirmed by ultrasound and/or computed tomography.

Methods

The study was conducted from January 2017 to January 2018. Data regarding all patients discharged from the participating centers with a diagnosis of uncomplicated appendicitis were collected prospectively.

Results

Of the 318 patients enrolled in the study, 27.4% underwent antibiotic-first therapy, and 72.6% underwent appendectomy. The matched group was composed of 87 patients in both study arms. Of the 87 patients available of 1-year follow-up in the antibiotic-first group, 64 (73.6%) did not require appendectomy. The complication-free treatment success in the antibiotic-first group was 64.4%. A statistically significant higher complication-free treatment success was found in the appendectomy group: 81.8% in the pre-matching sample and 83.9% in the post-matching sample. Patients in the antibiotic-first group reported lower VAS scores compared to those treated with an appendectomy, both at discharge (2.0 ± 1.7 vs 3.6 ± 2.3) and at 30-day follow-up (0.3 ± 0.6 vs 2.1 ± 1.7). The mean of the days of absence from work was higher in the appendectomy group (β 0.63; 95% CI 0.08–1.18).

Conclusion

Although laparoscopic appendectomy remains the gold standard of treatment for uncomplicated appendicitis, conservative treatment with antibiotics is a safe option in most cases. Approximately 65% of patients treated with antibiotics are symptom-free at 1 year, without increased risk of adverse events should symptoms recur, and better outcomes in terms of less pain and shorter period of absence from work compared to patients undergoing an appendectomy.

Trial registration

Clinicaltrials.gov identifier (NCT number): NCT03080103

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Acknowledgments

The authors thank and express gratitude to Professor Silvio Garattini and Doctor Vittorio Bertele’ (Istituto di Ricerche Farmacologiche Mario Negri – IRCSS) for the intellectual review of the ACTUAA study protocol.

The ACTUAA Study Collaborative Working Group: Fernando Serventi, Stefano Marini, Danilo Sirigu, Michela Piga, Massimiliano Coppola, Francesco Balestra, Carlo De Nisco, Marco Pazzona, Marco Anania, Fabio Pulighe, Antonio Lai, Roberto Ottonello, Renato De Angelis, Silverio Piro, Pietro Giorgio Calò, Francesco Podda, Luca Saba, Vincenzo Bottino, Patrizia Dalla Caneva, Luisa Canu, Emanuele Piras, Antonello Deserra, Francesco Virdis, Chiara Gerardi, Luca Gordini, Silvia Sanna.

Writing group: Mauro Podda, Gaetano Poillucci, Nicola Cillara.

IT support: Lorenzo Mortola.

Statistical analysis: Daniela Pacella, Gaetano Poillucci.

Author information

Authors and Affiliations

  1. Department of Emergency Surgery, Cagliari University Hospital “Duilio Casula”, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy

    Mauro Podda & Adolfo Pisanu

  2. Policlinico Universitario di Monserrato “Duilio Casula”, University of Cagliari, SS 554, Km 4,500, 09042, Monserrato, Italy

    Mauro Podda

  3. Department of General and Specialized Surgery “Paride Stefanini”, Policlinico Universitario Umberto I, La Sapienza University, Rome, Italy

    Gaetano Poillucci

  4. Department of Public Health, University of Naples Federico II, Naples, Italy

    Daniela Pacella

  5. Department of Surgery, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy

    Lorenzo Mortola

  6. Department of Surgery, Villa Betania Hospital, Naples, Italy

    Alfonso Canfora

  7. Department of Surgery, Nostra Signora della Mercede Hospital, Lanusei, Italy

    Simona Aresu

  8. Department of Surgery, San Marcellino Hospital, ASSL Cagliari, Muravera, Italy

    Marcello Pisano

  9. Department of General and Endocrine Surgery, Cagliari University Hospital “Duilio Casula”, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy

    Enrico Erdas

  10. Department of General Surgery, Santissima Trinità Hospital, ASSL Cagliari, Cagliari, Italy

    Nicola Cillara

Authors
  1. Mauro Podda
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  2. Gaetano Poillucci
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  3. Daniela Pacella
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  4. Lorenzo Mortola
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  5. Alfonso Canfora
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  6. Simona Aresu
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  7. Marcello Pisano
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  8. Enrico Erdas
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  9. Adolfo Pisanu
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  10. Nicola Cillara
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Consortia

The ACTUAA Study Collaborative Working Group

  • Fernando Serventi
  • , Stefano Marini
  • , Danilo Sirigu
  • , Michela Piga
  • , Massimiliano Coppola
  • , Francesco Balestra
  • , Carlo De Nisco
  • , Marco Pazzona
  • , Marco Anania
  • , Fabio Pulighe
  • , Antonio Lai
  • , Roberto Ottonello
  • , Renato De Angelis
  • , Silverio Piro
  • , Pietro Giorgio Calò
  • , Francesco Podda
  • , Luca Saba
  • , Vincenzo Bottino
  • , Patrizia Dalla Caneva
  • , Luisa Canu
  • , Emanuele Piras
  • , Antonello Deserra
  • , Francesco Virdis
  • , Chiara Gerardi
  • , Luca Gordini
  •  & Silvia Sanna

Contributions

Mauro Podda and Nicola Cillara: study principal investigators; Mauro Podda, Lorenzo Mortola, Nicola Cillara: ideated and designed the study; Mauro Podda, Gaetano Poillucci, Daniela Pacella, Lorenzo Mortola, Alfonso Canfora, Simona Aresu, Marcello Pisano, Enrico Erdas, Adolfo Pisanu, Nicola Cillara: acquisition, analysis, and interpretation of data; drafting and critically revising the manuscript for important intellectual contents; and final approval of the version to be published; the ACTUAA Study Collaborative Working Group: acquisition of data, critically revising the manuscript for important intellectual contents, and final approval of the version to be published.

Corresponding author

Correspondence to Mauro Podda.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Independent Ethics Committee of the University of Cagliari (Azienda Ospedaliero-Universitaria di Cagliari): acceptance code PG/2017/8426 29/05/2017.

Informed consent

A written informed consent was obtained from all enrolled patients for being included in the study. Additional written informed consent for the treatment of personal and sensible data was obtained from all patients prior to the data collection and evaluation.

Research involving human participants

All the investigators conducted the study in accordance with the principles of the Declaration of Helsinki of 1975 (as revised in 2008) and in accordance with the ethical standards of the responsible committee on human experimentation (Independent Ethics Committee of the University of Cagliari, Italy). All the investigators conducted the study according to the rules of the ethics committee regarding prospective collection of data.

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The original online version of this article was revised: All authors and affiliations of the The ACTUAA Study Collaborative Working Group are listed in the Acknowledgments section of the original published version of this article however, Luca Gordini and Silvia Sanna should have been added in the list. Thus, the names are now presented and cited correctly.

Mauro Podda and Gaetano Poillucci share the first authorship.

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Podda, M., Poillucci, G., Pacella, D. et al. Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial). Int J Colorectal Dis 36, 589–598 (2021). https://doi.org/10.1007/s00384-021-03843-8

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