Appendectomy versus antibiotic treatment for acute appendicitis

Wilms, Ingrid MHA; Hoog, Dominique Enm Suykerbuyk-de; Visser, Dianne C de; Janzing, H

doi:10.1002/14651858.cd008359.pub3

Cited by 9 publications

(9 citation statements)

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“…After screening of 487 non-duplicate articles, 18 systematic reviews with or without meta-analysis [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] published between 2011 and 2021 were included to the present umbrella review. The PRISMA flowchart for study selection is shown in Fig.…”

Section: Characteristics Of the Reviews Includedmentioning

confidence: 99%

“…It may be expected that NOM is associated with longer stay than appendectomy owing to the time required for the antibiotic treatment and for frequent observation of the patient to document improvement in symptoms with NOM. However, most meta-analyses documented similar stay with both treatment methods, except one [29] that concluded longer stay with NOM and another [32] that found longer stay with surgery. Interestingly, the summary effect estimate of hospital stay was significantly shorter with NOM overall, in adult-only population and in meta-analyses of RCTs alone, whereas meta-analyses entailing children only showed similar stay.…”

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confidence: 99%

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Efficacy and Safety of Non‐Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta‐Analyses

et al. 2022

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Background Non-operative management (NOM) of uncomplicated acute appendicitis (AA) has been introduced as an alternative to appendectomy. This umbrella review aimed to provide an overview of the efficacy and safety of NOM of uncomplicated AA in the published systematic reviews. Methods This umbrella review has been reported in line with the PRISMA guidelines and umbrella review approach. Systematic reviews with and without meta-analyses on the efficacy of NOM of AA were analyzed. The quality of the reviews was assessed with the AMSTAR 2 tool. The main outcomes measures were the treatment failure and complication rates of NOM and hospital stay as compared to appendectomy. Results Eighteen systematic reviews were included to this umbrella review. Eight reviews documented higher odds of failure with NOM, whereas two reviews revealed similar odds of failure. Six reviews reported lower odds of complications with NOM, six reported similar odds, and one reported lower odds of complications with surgery. Eight reviews reported similar hospital stay between NOM and appendectomy, one reported longer stay with NOM and another reported shorter stay with NOM. Pooled analyses showed that NOM was associated with higher treatment failure overall, in children-only, adults only, and RCTs-only meta-analyses. NOM was associated with lower complications overall, yet children-only and RCTs-only analyses revealed similar complications to surgery. NOM was associated with shorter stay in the overall and adult-only analysis, but not in the children-only analysis. Conclusions NOM of AA is associated with higher treatment failure, marginally lower rate of complications and shorter stay than appendectomy.

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Section: Characteristics Of the Reviews Includedmentioning

confidence: 99%

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confidence: 99%

Efficacy and Safety of Non‐Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta‐Analyses

et al. 2022

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“…The reported mortality rate is from <1% in younger patients up to 5% in the elderly ( 2 , 3 ). Abdominal pain is one of the most common cause of acute appendicitis, yet 34% of cases ( 4 , 5 ) are still misdiagnosed, which results in unnecessary surgery. This high rate of negative appendectomy can be decreased by careful and accurate diagnosis of appendicitis, thus preventing acute appendicitis from progressing to perforation and peritonitis ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with stomach pain who do not have AA are exposed to invasive surgery if the condition is misdiagnosed. It can happen in up to 34% of cases ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Abdominal Ultrasound and Its Diagnostic Accuracy in Diagnosing Acute Appendicitis: A Meta-Analysis

Chen

et al. 2021

Front. Surg.

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Background: Acute appendicitis (AA) is a common cause of abdominal pain encountering unnecessary surgeries in emergency departments. The present meta-analysis aims to assess the accuracy of abdominal ultrasound in suspected acute appendicitis cases in terms of sensitivity, specificity, and post-test odds for positive and negative results.Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 2010 till the end of March 2021. Two authors analyzed studies for inclusion, collected results, and conducted analyses separately. Examination of the histopathological tissue collected during appendectomy served as a gold standard for determining the final diagnosis of appendicitis. The accuracy was determined by evaluating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio.Results: Out of 3,193 references, a total of 18 studies were selected. Overall sensitivity of 77.2% (95% CI – 75.4–78.9%) and specificity of 60% (95% CI – 58–62%) were observed. The diagnostic odds ratio of 6.88(95% CI 1.99–23.82) was obtained.Conclusion: Abdominal ultrasound shows significant accuracy of diagnosis in patients with suspected acute appendicitis.

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“…Appendicitis is the most frequent aetiology of acute abdominal pain requiring surgical treatment, with an estimated lifetime risk between 7% and 8% 1 . Despite controversy surrounding the primary definitive treatment of appendicitis, appendectomy remains the gold standard 2 . Nevertheless, antibiotics play a substantial role in treatment, whether they be the definitive treatment of choice or as an adjunct to appendicectomy in both the pre‐ and post‐operative roles.…”

Section: Introductionmentioning

confidence: 99%

Duration of post‐operative antibiotic treatment in acute complicated appendicitis: systematic review and meta‐analysis

Ramson

Gao

Penny-Dimri

et al. 2021

ANZ Journal of Surgery

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Background Appendicitis is the most frequent aetiology of acute abdominal pain requiring surgical treatment, with an estimated lifetime risk between 7% and 8%. Antibiotics play a substantial role in treatment, and there is considerable debate regarding the duration of antibiotics in treating appendicitis. Methods We searched multiple databases from inception until June 2019 for peer‐reviewed studies that compared different durations of antibiotic treatment after appendicectomy for acute complicated appendicitis in adults. We dichotomized reported data into short‐ and extended‐term antibiotic use and controlled for different definitional thresholds in the meta‐analysis. We generated risk ratios using restricted maximum likelihood methods and mixed effects modelling for each outcome of interest. Results Four observational studies involving 847 participants were included in the meta‐analysis. For the primary outcomes of intra‐abdominal infection, we did not find a statistically significant difference between extended‐ and short‐term antibiotic strategies for intra‐abdominal infection (Risk ratio 0.92, 95% confidence interval (CI) 0.49–1.74). Three randomized controlled trials involving 291 participants were included in a separate meta‐analysis. We found that extended antibiotic usage was not associated with a statistically significant reduced risk for intra‐abdominal infection (RR 0.52, 95% CI 0.21–1.29) or surgical site skin infection (RR 1.44, 95% CI 0.43–4.81). Conclusion This systematic review and meta‐analysis found that extended post‐operative antibiotic treatment may not be associated with a reduced risk of intra‐abdominal infection; however, meta‐analysis was significantly limited by heterogeneity between studies and underpowered trials. Further large randomized controlled trials are needed to confirm these findings.

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Appendectomy versus antibiotic treatment for acute appendicitis

Cited by 9 publications

References 0 publications

Efficacy and Safety of Non‐Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta‐Analyses

Efficacy and Safety of Non‐Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta‐Analyses

Abdominal Ultrasound and Its Diagnostic Accuracy in Diagnosing Acute Appendicitis: A Meta-Analysis

Duration of post‐operative antibiotic treatment in acute complicated appendicitis: systematic review and meta‐analysis

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