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Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis.

Publication ,  Journal Article
Sakran, JV; Mylonas, KS; Gryparis, A; Stawicki, SP; Burns, CJ; Matar, MM; Economopoulos, KP
Published in: The journal of trauma and acute care surgery
June 2017

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.A systematic literature search of the PubMed, Cochrane, and Scopus databases was performed with respect to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 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.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 with the surgery group (93%) (risk ratio [RR], 0.68; 95% confidence interval [CI], 0.60-0.77; p < 0.001). Overall complications were significantly higher in the surgery group (166/703 [23.6%]) compared with the antibiotics group (56/727 [7.7%]) (RR, 0.32; 95% CI, 0.24-0.43; p < 0.001). No difference was found between the two treatment modalities in terms of perforated appendicitis rates (RR, 0.52; 95% CI, 0.14-1.92), length of hospital stay (weighted mean difference [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).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.Systematic review, level II.

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Published In

The journal of trauma and acute care surgery

DOI

EISSN

2163-0763

ISSN

2163-0755

Publication Date

June 2017

Volume

82

Issue

6

Start / End Page

1129 / 1137

Related Subject Headings

  • Treatment Outcome
  • Humans
  • Emergency & Critical Care Medicine
  • Appendicitis
  • Appendectomy
  • Anti-Bacterial Agents
  • 4205 Nursing
  • 3202 Clinical sciences
  • 1110 Nursing
  • 1103 Clinical Sciences
 

Citation

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Sakran, J. V., Mylonas, K. S., Gryparis, A., Stawicki, S. P., Burns, C. J., Matar, M. M., & Economopoulos, K. P. (2017). Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis. The Journal of Trauma and Acute Care Surgery, 82(6), 1129–1137. https://doi.org/10.1097/ta.0000000000001450
Sakran, Joseph V., Konstantinos S. Mylonas, Alexandros Gryparis, Stanislaw P. Stawicki, Christopher J. Burns, Maher M. Matar, and Konstantinos P. Economopoulos. “Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis.The Journal of Trauma and Acute Care Surgery 82, no. 6 (June 2017): 1129–37. https://doi.org/10.1097/ta.0000000000001450.
Sakran JV, Mylonas KS, Gryparis A, Stawicki SP, Burns CJ, Matar MM, et al. Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis. The journal of trauma and acute care surgery. 2017 Jun;82(6):1129–37.
Sakran, Joseph V., et al. “Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis.The Journal of Trauma and Acute Care Surgery, vol. 82, no. 6, June 2017, pp. 1129–37. Epmc, doi:10.1097/ta.0000000000001450.
Sakran JV, Mylonas KS, Gryparis A, Stawicki SP, Burns CJ, Matar MM, Economopoulos KP. Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis. The journal of trauma and acute care surgery. 2017 Jun;82(6):1129–1137.

Published In

The journal of trauma and acute care surgery

DOI

EISSN

2163-0763

ISSN

2163-0755

Publication Date

June 2017

Volume

82

Issue

6

Start / End Page

1129 / 1137

Related Subject Headings

  • Treatment Outcome
  • Humans
  • Emergency & Critical Care Medicine
  • Appendicitis
  • Appendectomy
  • Anti-Bacterial Agents
  • 4205 Nursing
  • 3202 Clinical sciences
  • 1110 Nursing
  • 1103 Clinical Sciences