Nonoperative Management of Appendicitis in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Findlay, John M.; Kafsi, Jihène El; Hammer, Clare; Gilmour, Jeffrey; Gillies, Richard; Maynard, Nicholas

doi:10.1016/j.jamcollsurg.2016.09.005

Cited by 79 publications

(62 citation statements)

References 24 publications

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“…While appendectomy has long been considered the gold standard treatment for appendicitis and continues to be the most common treatment, there has been a movement towards exploring the efficacy and safety of nonoperative management. Observational and randomized controlled studies have shown that nonoperative management of appendicitis is a safe alternative to surgical intervention with respect to clinical outcomes, such as symptom relief, development of peritonitis, and return to work . These studies have been underpowered or not designed to evaluate the potential for missed malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Observational and randomized controlled studies have shown that nonoperative management of appendicitis is a safe alternative to surgical intervention with respect to clinical outcomes, such as symptom relief, development of peritonitis, and return to work. [15][16][17][18] These studies have been underpowered or not designed to evaluate the potential for missed malignancy. In our study, we found that approximately 1% of patients who underwent appendectomy for possible appendicitis were diagnosed with malignancy on pathology, which is in accordance with previously reported rates.…”

Section: Discussionmentioning

confidence: 99%

“…Variables specific to the patient's perioperative presentation were included, such as preoperative WBC count level, presence of preoperative sepsis or shock, preoperative imaging of either imaging confirmed or imaging indeterminate appendicitis, and specimen pathology results. WBC count was evaluated within clinically important parameters as a categorical variable using traditional cut-offs of below normal (<4.5), normal (4.5-11), elevated (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and significantly elevated (>20). The primary goal of this study was to determine independent risk factors associated with the pathologic diagnosis of cancer after appendectomy in patients with imaging-confirmed or indeterminate appendicitis with additional focus on the contribution of age to the final model.…”

Section: Variablesmentioning

confidence: 99%

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Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management

McCarty

Fields

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Management practices for acute appendicitis are changing. In cases of nonoperative treatment, the risk of missed or delayed diagnosis of malignancy should be considered. We aimed to identify predictors associated with appendiceal cancer diagnosis after appendectomy for acute appendicitis. Materials and Methods This retrospective cohort study was performed using the National Surgical Quality Improvement Program (NSQIP) appendectomy‐targeted data set from 2016 to 2017. A total of 21 069 patients with imaging‐confirmed or imaging indeterminate appendicitis who underwent appendectomy were included. Logistic regression was used to identify predictors of cancer diagnosis. Results Increasing age had an increasing monotonic relationship with the odds of pathologic cancer diagnosis after appendectomy (age 50‐59 odds ratio [OR], 2.08, 95% confidence interval [CI], 1.28‐3.39, P = .003; age 60‐69 OR, 2.89, 95% CI, 1.72‐4.83, P < .001; age 70‐79 OR, 3.85, 95% CI, 2.08‐7.12, P < .001; age >80 OR, 5.32, 95% CI, 2.38‐11.9, P < .001). Other significant predictors included obesity, morbid obesity, normal preoperative white blood cell count, and imaging indeterminate for appendicitis. Conclusions When counseling patients regarding operative vs nonoperative treatment options for management of acute appendicitis, the rising risk of a delayed or missed cancer diagnosis with increasing age must be discussed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

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Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management

McCarty

Fields

et al. 2019

Journal of Surgical Oncology

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“…Various studies have shown that non-operative treatment of uncomplicated cases of AA is a good alternative in management of considerable portion of patients. [5][6][7][8][9][10][11][12][13][14] Additionally, other studies have shown that presence of fecalith and appendix diameter >1.1 cm are main predictive factors that might be associated with higher failure rate of this non-operative treatment. 15,16 Therefore, stratification of the patients with AA based on clinical, laboratory and radiological findings allow for the identification of patients with uncomplicated appendicitis which can be managed by antibiotics alone with higher success rate and lower recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

Non-operative treatment of acute appendicitis in selected patients

Ağaoğlu

Uluşahin

2017

Int Surg J

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Background: Surgical approach for acute appendicitis (AA) is a standard live saving treatment method. The purpose of this study was to assess the feasibility, initial safety and success rate of non-operative treatment of AA in selected patients. Methods: Selected AA patients were enrolled in this prospective study (non-operative treatment). This was based on IV antibiotic therapy and followed up with oral antibiotic. Patients who declined to participate or excluded were managed with appendectomy and considered as controls. The primary goal of the study was to determine the feasibility, initial safety, early and late success rates of non-operative management. Secondary outcomes include hospital length of stay and charge, days of missed works and return to normal activity at home of patients treated non-operatively in comparison to appendectomy group. Results: In non-operative group (36 patients), 7 patients failed to response and managed by appendectomy with early success rate of 80.5%. Three patients experienced recurrent attacks of AA were managed with appendectomy. Late success rate was 72.2%. In appendectomy group (53 patients) one patient with adenocarcinoma of the colon detected during surgery and in ten patients the appendix was perforated. One patient died due to generalized peritonitis. In nonoperative group length of stay and hospital charge were lower but only days to resume home activities and days of missed work were shorter and statistically significant as compared to appendectomy group. Conclusions: This study confirms the feasibility, safety and optimum success rate of non-operative treatment of early AA in selected patients.

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“…Now there has been a paradigm shift towards a conservative (Non -operative) approach for Acute appendicitis. [6] In many centres traditional open surgery has been abandoned and Laparoscopic Surgery [7] is becoming the standard of care. However, the role of a Classical Open Mc.Burney's approach [8] to the appendix cannot be denied.…”

Section: …………………………………………………………………………………………………… Introduction:-mentioning

confidence: 99%

A Comparison of Outcomes Between Uncomplicated and Complicated Appendicitis. Can a Rational Approach of Injectable Antibiotics Be Applied for Uncomplicated Appendicitis? - A Single Centre Experience.

Basu¹

2018

IJAR

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Nonoperative Management of Appendicitis in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 79 publications

References 24 publications

Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management

Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management

Non-operative treatment of acute appendicitis in selected patients

A Comparison of Outcomes Between Uncomplicated and Complicated Appendicitis. Can a Rational Approach of Injectable Antibiotics Be Applied for Uncomplicated Appendicitis? - A Single Centre Experience.

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