Abstract
BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. METHODS: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when substantial heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. Quality assessment of included RCTs was performed using the modified Jadad scale. RESULTS: Five RCTs were included in this review. Overall, 1,430 adult patients with uncomplicated acute appendicitis underwent either nonoperative (n=727) or operative management (n=703). Treatment efficacy at 1-year follow-up was significantly lower (63.8%) for antibiotics compared to the surgery group (93%) (RR 0.68; 95% CI, 0.60-0.77, p<0.001). Overall complications were significantly higher in the surgery group (166/703, 23.6%) compared to the antibiotics group (56/727, 7.7%) (RR: 0.32, 95% CI, 0.24 to 0.43, p<0.001). No difference was found between the two treatment modalities in terms of perforated appendicitis rates (RR: 0.52, 95% CI, 0.14 to 1.92), length of hospital stay (WMD: 0.20, 95%CI -0.16 to 0.56), duration of pain (WMD: 0.22, 95%CI -5.30 to -5.73) and sick leave (WMD: -2; 95%CI, -5.2 to 1.1). CONCLUSIONS: Conservative management of uncomplicated appendicitis in adults warrants further study. Addressing patients’ expectations via a shared-decision making process is a crucial step in optimizing nonoperative outcomes.
| Original language | English (US) |
|---|---|
| Journal | Journal of Trauma and Acute Care Surgery |
| DOIs | |
| State | Accepted/In press - Mar 23 2017 |
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ASJC Scopus subject areas
- Surgery
- Critical Care and Intensive Care Medicine
Cite this
Operation versus antibiotics––The “appendicitis conundrum” continues : A meta-analysis. / Sakran, Joseph; Mylonas, Konstantinos S.; Gryparis, Alexandros; Stawicki, Stanislaw P.; Burns, Christopher J.; Matar, Maher M.; Economopoulos, Konstantinos P.
In: Journal of Trauma and Acute Care Surgery, 23.03.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Operation versus antibiotics––The “appendicitis conundrum” continues
T2 - A meta-analysis
AU - Sakran, Joseph
AU - Mylonas, Konstantinos S.
AU - Gryparis, Alexandros
AU - Stawicki, Stanislaw P.
AU - Burns, Christopher J.
AU - Matar, Maher M.
AU - Economopoulos, Konstantinos P.
PY - 2017/3/23
Y1 - 2017/3/23
N2 - BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. METHODS: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when substantial heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. Quality assessment of included RCTs was performed using the modified Jadad scale. RESULTS: Five RCTs were included in this review. Overall, 1,430 adult patients with uncomplicated acute appendicitis underwent either nonoperative (n=727) or operative management (n=703). Treatment efficacy at 1-year follow-up was significantly lower (63.8%) for antibiotics compared to the surgery group (93%) (RR 0.68; 95% CI, 0.60-0.77, p<0.001). Overall complications were significantly higher in the surgery group (166/703, 23.6%) compared to the antibiotics group (56/727, 7.7%) (RR: 0.32, 95% CI, 0.24 to 0.43, p<0.001). No difference was found between the two treatment modalities in terms of perforated appendicitis rates (RR: 0.52, 95% CI, 0.14 to 1.92), length of hospital stay (WMD: 0.20, 95%CI -0.16 to 0.56), duration of pain (WMD: 0.22, 95%CI -5.30 to -5.73) and sick leave (WMD: -2; 95%CI, -5.2 to 1.1). CONCLUSIONS: Conservative management of uncomplicated appendicitis in adults warrants further study. Addressing patients’ expectations via a shared-decision making process is a crucial step in optimizing nonoperative outcomes.
AB - BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. METHODS: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when substantial heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. Quality assessment of included RCTs was performed using the modified Jadad scale. RESULTS: Five RCTs were included in this review. Overall, 1,430 adult patients with uncomplicated acute appendicitis underwent either nonoperative (n=727) or operative management (n=703). Treatment efficacy at 1-year follow-up was significantly lower (63.8%) for antibiotics compared to the surgery group (93%) (RR 0.68; 95% CI, 0.60-0.77, p<0.001). Overall complications were significantly higher in the surgery group (166/703, 23.6%) compared to the antibiotics group (56/727, 7.7%) (RR: 0.32, 95% CI, 0.24 to 0.43, p<0.001). No difference was found between the two treatment modalities in terms of perforated appendicitis rates (RR: 0.52, 95% CI, 0.14 to 1.92), length of hospital stay (WMD: 0.20, 95%CI -0.16 to 0.56), duration of pain (WMD: 0.22, 95%CI -5.30 to -5.73) and sick leave (WMD: -2; 95%CI, -5.2 to 1.1). CONCLUSIONS: Conservative management of uncomplicated appendicitis in adults warrants further study. Addressing patients’ expectations via a shared-decision making process is a crucial step in optimizing nonoperative outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85015980054&partnerID=8YFLogxK
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U2 - 10.1097/TA.0000000000001450
DO - 10.1097/TA.0000000000001450
M3 - Article
C2 - 28338596
AN - SCOPUS:85015980054
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
ER -