August 24, 2022
2 minute read
Disclosures: de Almeida Leite does not report any relevant financial information. Please see the study for relevant financial information from all other authors.
Nonoperative management of patients with acute uncomplicated appendicitis is comparable to surgical treatment in terms of safety and effectiveness, although longer hospital stays and recurrences are possible, according to a meta-analysis by JAMA Surgery.
“Treatment with antibiotics alone may be an attractive option for patients, as it may be associated with avoidance of surgical scarring, reduced postoperative pain, and faster recovery,” Rodrigo Moises de Almeida Leitedoctor, from the Department of Colon and Rectal Surgery at Massachusetts General Hospital, and colleagues wrote. “It can also offer potential benefits to healthcare systems by reducing the load on operating rooms, saving the use of personal protective equipment and reducing overall costs.
“However, the wide range of treatment failure rates (7% to 39%) led to confusion about the overall effectiveness of nonoperative treatment and made these analyzes difficult to interpret.”
To help determine which form of treatment might be best for a patient, the researchers conducted a systematic review of the Embase and PubMed databases for clinical trials comparing nonoperative management and appendectomy in adults with Alzheimer’s disease. uncomplicated acute appendicitis. Of 1504 studies identified for screening, eight met their inclusion criteria.
Treatment success at 30 days – including resolution of abdominal pain, freedom from complications, and improvement in inflammatory markers – served as the primary outcome. Secondary outcomes included risk of major complications and length of hospital stay.
Using the Cochrane risk of bias 2 tool for their analysis, the researchers found that surgical and non-surgical management had similar treatment success at 30 days (RR = 0.85; 95% CI, 0 .66-1.11), with a similar percentage of major adverse events reported ( RR = 0.72; 95% CI, 0.29-1.79).
However, the researchers noted differences between the two forms of care: patients who received non-surgical treatment had a significantly longer hospital stay (RR = 1.48; 95% CI, 1.26- 1.7) and a median cumulative incidence of 18% recurrent appendicitis.
“A non-significant trend toward better outcomes was observed in the nonoperative group compared to the surgical group, specifically a higher incidence of treatment success with longer follow-up periods,” wrote de Almeida Leite and colleagues. . “This may be due to the higher incidence of long-term complications in the surgical group, such as incisional hernias or adhesions.”
The researchers noted that: “Patient-centered discussion given the substantial rate of recurrent appendicitis with antibiotics alone should be prioritized. Patients should be informed that despite the promising results of nonoperative management of acute appendicitis, nearly one in five patients treated nonoperatively in this review eventually experienced recurrent symptoms of appendicitis.