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Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials

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Abstract

Background

Uncomplicated acute appendicitis has been managed traditionally by early appendicectomy. However, recently, there has been increasing interest in the potential for primary treatment with antibiotics, with studies finding this to be associated with fewer complications than appendicectomy. The aim of this study was to compare outcomes of antibiotic therapy with appendicectomy for uncomplicated acute appendicitis.

Method

This meta-analysis of randomised controlled trials included adult patients presenting with uncomplicated acute appendicitis treated with antibiotics or appendicectomy. The primary outcome measure was complications. Secondary outcomes included treatment efficacy, hospital length of stay (LOS), readmission rate and incidence of complicated appendicitis.

Results

Five randomised controlled trials with a total of 1430 participants (727 undergoing antibiotic therapy and 703 undergoing appendicectomy) were included. There was a 39 % risk reduction in overall complication rates in those treated with antibiotics compared with those undergoing appendicectomy (RR 0.61, 95 % CI 0.44–0.83, p = 0.002). There was no significant difference in hospital LOS (mean difference 0.25 days, 95 % CI −0.05 to 0.56, p = 0.10). In the antibiotic cohort, 123 of 587 patients initially treated successfully with antibiotics were readmitted with symptoms suspicious of recurrent appendicitis. The incidence of complicated appendicitis was not increased in patients who underwent appendicectomy after “failed” antibiotic treatment (10.8 %) versus those who underwent primary appendicectomy (17.9 %).

Conclusion

Increasing evidence supports the primary treatment of acute uncomplicated appendicitis with antibiotics, in terms of complications, hospital LOS and risk of complicated appendicitis. Antibiotics should be prescribed once a diagnosis of acute appendicitis is made or considered.

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Abbreviations

LOS:

Hospital length of stay

IQR:

Interquartile range

RR:

Risk ratio

CI:

Confidence interval

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Funding

KER was funded by a Research Fellowship from the European Society for Clinical Nutrition and Metabolism (ESPEN). The funders had no role in the design, execution and writing up of the study.

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Authors and Affiliations

  1. Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen’s Medical Centre, E Floor, West Block, Nottingham, NG7 2UH, UK

    Katie E. Rollins, Krishna K. Varadhan & Dileep N. Lobo

  2. Department of Epidemiology and Public Health, Nottingham University Hospitals, City Hospital Campus, Nottingham, NG5 1PB, UK

    Keith R. Neal

Authors
  1. Katie E. Rollins
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  2. Krishna K. Varadhan
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  3. Keith R. Neal
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  4. Dileep N. Lobo
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Correspondence to Dileep N. Lobo.

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None of the authors has a conflict of interest to declare.

Additional information

This paper was presented at the Annual Meeting of the Society for Academic and Research Surgery, London, January 2016. It has been published in abstract form - Br J Surg 2016; 103 (S3): 34.

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Rollins, K.E., Varadhan, K.K., Neal, K.R. et al. Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials. World J Surg 40, 2305–2318 (2016). https://doi.org/10.1007/s00268-016-3561-7

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  • DOI: https://doi.org/10.1007/s00268-016-3561-7

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