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

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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.

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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

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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 information

Authors and Affiliations

  1. II Clinica Chirurgica, Policlinico Umberto I, Sapienza University, Rome, Italy

    Gaetano Poillucci

  2. Surgical Science Department, Cagliari State University, Policlinico Universitario Duilio Casula, Monserrato, Italy

    Lorenzo Mortola

  3. Department of Surgery: General, Emergency and Robotic Surgical Unit, San Francesco Hospital, ASSL Nuoro, ATS Sardegna, Via Mannironi, 1, 08100, Nuoro, Italy

    Mauro Podda

  4. Department of Emergency Surgery and Trauma Unit, Maggiore Hospital, Bologna, Italy

    Salomone Di Saverio

  5. Department of Medicine and Public Health, Cagliari State University, Cagliari, Italy

    Laura Casula

  6. IRCCS “Mario Negri” Institute for Pharmacological Research, Milan, Italy

    Chiara Gerardi

  7. Department of Surgery, Santissima Trinità Hospital, Cagliari, Italy

    Nicola Cillara

  8. Department of Surgery, Giovanni Paolo II Hospital, Olbia, Italy

    Luigi Presenti

Authors
  1. Gaetano Poillucci
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  2. Lorenzo Mortola
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  3. Mauro Podda
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  4. Salomone Di Saverio
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  5. Laura Casula
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  6. Chiara Gerardi
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  7. Nicola Cillara
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  8. Luigi Presenti
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Consortia

The ACTUAA-R Collaborative Working Group on Acute Appendicitis

  • Francesco Balestra
  • , Fernando Serventi
  • , Stefania Fiume
  • , M Antonio D Lai
  • , Simona Ledda
  • , Fabio Pulighe
  • , Sara Gobbi
  • , Carlo De Nisco
  • , Giulio Argenio
  • , Giorgio Norcia
  • , Sergio Gemini
  • , Raffaele Sechi
  • , Miriam Pala
  • , Renata Pau
  • , Roberto Ottonello
  • , Marcello Pisano
  • , Simona Aresu
  • , Massimiliano Coppola
  • , Antonio Tuveri
  • , Francesco Madeddu
  • , Antonella Piredda
  • , Giovanni Pinna
  • , Fabrizio Scognamillo
  • , PierLuigi Tilocca
  • , Leonardo Delogu
  • , Gian Marco Carboni
  • , Gianfranco Porcu
  •  & Danilo Piras

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.

Corresponding author

Correspondence to Mauro Podda.

Ethics declarations

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.

Additional information

Members of the ACTUAA-R Collaborative Working Group on Acute Appendicitis are listed in the Acknowledgement section at the end of the article.

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Poillucci, G., Mortola, L., Podda, M. et al. Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study. Updates Surg 69, 531–540 (2017). https://doi.org/10.1007/s13304-017-0499-8

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  • DOI: https://doi.org/10.1007/s13304-017-0499-8

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