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Updates in Surgery

, Volume 69, Issue 4, pp 531–540 | Cite as

Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study

  • Gaetano Poillucci
  • Lorenzo Mortola
  • Mauro PoddaEmail author
  • Salomone Di Saverio
  • Laura Casula
  • Chiara Gerardi
  • Nicola Cillara
  • Luigi Presenti
  • The ACTUAA-R Collaborative Working Group on Acute Appendicitis
Original Article

Abstract

Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively. Follow-up data were collected from January 1st, 2015 to December 31st, 2016. The complication-free treatment success of AT (53.7%) was significantly inferior to that of ST (86.4%) (P < 0.0001). Patients initially treated with antibiotics reported an index admission AT failure rate of 20.9% and a recurrence rate at 1-year follow-up of 20.3%. No statistically significant difference was found when comparing AT and ST groups for the outcome of interest post-operative complications (13.5 vs 13.6%, P = 0.834). Patients treated with AT were discharged home earlier than patients in the ST group (3.38 ± 1.89 vs 4.84 ± 2.69 days, P < 0.0001). Due to the low rates of complications occurred in the ST group and the high efficacy of the surgical therapy, laparoscopic appendectomy still represents the most effective treatment for patients with AA. AT is associated with shorter hospital stay and faster return to normal activity, and may prevent from appendectomies around 80% of patients who leave the hospital with clinical recovery.

Keywords

Appendicitis Appendectomy Antibiotics Propensity score analysis Multicenter study Multivariate analysis 

Abbreviations

AA

Acute appendicitis

LA

Laparoscopic appendectomy

OA

Open appendectomy

AT

Antibiotic therapy

ST

Surgical therapy

AIR

Appendicitis inflammatory response

US

Ultrasound scan

CT

Computed tomography

MRI

Magnetic resonance imaging

RCTs

Randomized controlled trials

Notes

Acknowledgements

The authors would like to thank and express gratitude to Professor Silvio Garattini and Doctor Vittorio Bertele’ (Mario Negri Institute for Pharmacological Research, Milan, Italy) for the intellectual review of the ACTUAA-R Study Project on Acute Appendicitis, and Mr. Christian Raffinetti for the English language editing. The study has been possible mainly thanks to all the colleagues of the ACTUAA-R study group on Acute Appendicitis and the Italian Surgical Units involved, which have taken the time to give their unique contribution.

Francesco Balestra: General, Emergency and Robotic Surgical Unit, San Francesco Hospital, Nuoro (Italy). Fernando Serventi: General and Emergency Surgical Unit, Civile Hospital, Alghero (Italy). Stefania Fiume: Emergency Surgical Unit, Brotzu Hospital, Cagliari (Italy). Antonio Lai: General and Emergency Surgical Unit, San Marcellino Hospital, Muravera (Italy). Simona Ledda: General and Emergency Surgical Unit, Nostra Signora di Bonaria Hospital, San Gavino (Italy). Fabio Pulighe: General, Emergency and Robotic Surgical Unit, San Francesco Hospital, Nuoro (Italy). Sara Gobbi: Department of Surgery, Giovanni Paolo II Hospital, Olbia (Italy). Carlo De Nisco: General, Emergency and Robotic Surgical Unit, San Francesco Hospital, Nuoro (Italy). Giulio Argenio: General, Emergency and Robotic Surgical Unit, San Francesco Hospital, Nuoro (Italy). Giorgio Norcia: General and Emergency Surgical Unit, Civile Hospital, Alghero (Italy). Sergio Gemini: Emergency Surgical Unit, Brotzu Hospital, Cagliari (Italy). Raffaele Sechi: General and Emergency Surgical Unit, Nostra Signora di Bonaria Hospital, San Gavino (Italy). Miriam Pala: Department of Surgery, Santissima Trinità Hospital, Cagliari (Italy). Renata Pau: Department of Surgery, Santissima Trinità Hospital, Cagliari (Italy). Roberto Ottonello: General and Emergency Surgical Unit, San Marcellino Hospital, Muravera (Italy). Marcello Pisano: General and Emergency Surgical Unit, San Marcellino Hospital, Muravera (Italy). Simona Aresu: General and Emergency Surgical Unit, Nostra Signora della Mercede Hospital, Lanusei (Italy). Massimiliano Coppola: General and Emergency Surgical Unit, Nostra Signora della Mercede Hospital, Lanusei (Italy). Antonio Tuveri: Department of Surgery, CTO Hospital, Iglesias (Italy). Francesco Madeddu: Department of Surgery, CTO Hospital, Iglesias (Italy). Antonella Piredda: Department of Surgery, Sirai Hospital, Carbonia (Italy). Giovanni Pinna: Department of Surgery, Sirai Hospital, Carbonia (Italy). Fabrizio Scognamillo: Surgical Pathology Institute, University Hospital, Sassari (Italy). PierLuigi Tilocca: Surgical Pathology Institute, University Hospital, Sassari (Italy). Leonardo Delogu: General Surgery Department, A. Segni Hospital, Ozieri (Italy). Gian Marco Carboni: General Surgery Department, A. Segni Hospital, Ozieri (Italy). Gianfranco Porcu: Department of Surgery, San Martino Hospital, Oristano (Italy). Danilo Piras: Department of Surgery, San Martino Hospital, Oristano (Italy)

Author contributions

Gaetano Poillucci, Lorenzo Mortola, Mauro Podda, Salomone Di Saverio, Chiara Gerardi, Nicola Cillara, and Luigi Presenti: study conception and design, acquisition, analysis and interpretation of data, drafting and critically revising the manuscript for important intellectual content, and final approval of the version to be published; Laura Casula: analysis and interpretation of data, critically revising the manuscript for important intellectual content, and final approval of the version to be published.

Compliance with ethical standards

Ethical approval

Independent Ethical Committee of the University of Cagliari (Acceptance Code: PG/2016/7825, 31/05/2016).

Conflict of interest

Gaetano Poillucci, Lorenzo Mortola, Mauro Podda, Salomone Di Saverio, Laura Casula, Chiara Gerardi, Nicola Cillara, and Luigi Presenti have no conflicts of interest or financial ties to disclose.

Research involving human participants and/or animals

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Independent Ethical Committee of the University of Cagliari) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all 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.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Gaetano Poillucci
    • 1
  • Lorenzo Mortola
    • 2
  • Mauro Podda
    • 3
    Email author
  • Salomone Di Saverio
    • 4
  • Laura Casula
    • 5
  • Chiara Gerardi
    • 6
  • Nicola Cillara
    • 7
  • Luigi Presenti
    • 8
  • The ACTUAA-R Collaborative Working Group on Acute Appendicitis
  1. 1.II Clinica Chirurgica, Policlinico Umberto ISapienza UniversityRomeItaly
  2. 2.Surgical Science DepartmentCagliari State University, Policlinico Universitario Duilio CasulaMonserratoItaly
  3. 3.Department of Surgery: General, Emergency and Robotic Surgical UnitSan Francesco Hospital, ASSL Nuoro, ATS SardegnaNuoroItaly
  4. 4.Department of Emergency Surgery and Trauma UnitMaggiore HospitalBolognaItaly
  5. 5.Department of Medicine and Public HealthCagliari State UniversityCagliariItaly
  6. 6.IRCCS “Mario Negri” Institute for Pharmacological ResearchMilanItaly
  7. 7.Department of SurgerySantissima Trinità HospitalCagliariItaly
  8. 8.Department of SurgeryGiovanni Paolo II HospitalOlbiaItaly

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