Appendectomy versus Conservative Antibiotics Treatment for Non-Complicated Acute Appendicitis: A Meta-Analysis of Randomized Controlled Trials

Hyun Kang, Yoo Shin Choi, Suk Won Seo, Geun Joo Choi and Seung Eun Lee

Department of Anesthesiology, Chung-Ang University College of Medicine, South Korea
Department of Surgery, Chung-Ang University College of Medicine, South Korea

^*Correspondance to: Seung Eun Lee 

 PDF  Full Text DOI: 10.25107/2474-1647.2164

Abstract

Purpose: In this meta-analysis, we compared the safety and efficacy of antibiotic treatment with appendectomy for the primary treatment of uncomplicated acute appendicitis.Methods: A comprehensive search was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials that compared antibiotic treatment with appendectomy in uncomplicated acute appendicitis. The primary outcome measure was the initial treatment failure rate. Secondary outcomes included the overall treatment failure rate, length of primary hospital stay, time for sick leave, and cost.Results: In total, 1,480 patients from 6 randomized controlled trials (751 undergoing antibiotic treatment, 729 undergoing appendectomy) were included in the final analysis. Overall treatment efficacy in the antibiotic group was 0.77 (95% CI, 0.68 to 0.84; Pchi 2<0.001; I2=81.51%) versus 0.91 (95% CI, 0.81 to 0.96; Pchi 2<0.001; I2=80.23%) in the appendectomy group. There were no differences with regard to overall treatment efficacy (Risk ratio (RR), 0.88; 95% CI, 0.74 to 1.04; Pchi 2<0.001; I2=90.98%; NNT=6), complication rate (Risk ratio(RR), 1.56; 95% CI, 0.48 to 5.05; Pchi 2=0.008; I2=71.21%; NNT=186), hospital stay (mean difference(MD), -0.05; 95% CI, -0.65 to 0.55; Pchi 2<0.001; I2=98.24%), time for sick leave (MD, -4.36; 95% CI, -12.00 to 3.28; Pchi 2<0.001; I2=99.45%) and cost (MD, -12230.46; 95% CI, -17086.77 to -7374.15; Pchi 2=0.321; I2=0.00%).Conclusion: Antibiotic treatment is effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Therefore, antibiotic treatment could be considered as an alternative option in the treatment of patients with acute uncomplicated appendicitis.

Keywords

Acute appendicitis; Appendectomy; Antibiotic; Meta-analysis

Cite the article

Kang H, Choi YS, Seo SW, Choi GJ, Lee SE. Appendectomy versus Conservative Antibiotics Treatment for Non-Complicated Acute Appendicitis: A Meta-Analysis of Randomized Controlled Trials. Clin Surg. 2018; 3: 2164.