Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: A meta-analysis of post-intervention complications - 17/01/15
, Richard P. Hobson a, b , Dermot Burke c, d , Victoria Cleveland b , Georgia Ford b , Robert M. West e Summary |
Objectives |
Recent literature has concluded antibiotic therapy results in fewer complications than appendicectomy for patients with uncomplicated appendicitis. This studies aim was to undertake a meta-analysis of major post-intervention outcomes in patients with suspected uncomplicated appendicitis treated with antibiotics or appendicectomy, and determine which treatment is associated with the lowest rate of major complications.
Methods |
We analysed randomised trials of antibiotics vs. appendicectomy in adults with suspected uncomplicated appendicitis. The primary outcome measure was a composite of major complications, peritonitis and intra-abdominal abscess, occurring after appendicectomy or initiation of therapeutic antibiotics.
Results |
The rate of major post-intervention complications was 0.8% (2/263) in the appendicectomy group and 10.1% (27/268) in the antibiotic group. This difference was statistically significant by the random effects model: Risk Ratio 7.71, 95% C.I. 2.33 to 25.53, Risk Difference 0.09: 95% C.I. 0.05 to 0.13. The Number Needed to Harm (NNH) from antibiotic therapy is 10.7.
Conclusions |
Suspected uncomplicated appendicitis has a lower rate of major post-intervention complications when managed with primary appendicectomy compared to antibiotic therapy.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Antibiotics have been investigated as treatment for appendicitis, instead of surgery. |
• | A recent meta-analysis reported antibiotics were safe and effective for appendicitis. |
• | We completed a meta-analysis comparing antibiotics and surgery for appendicitis. |
• | We compared post-intervention major complications (peritonitis, abscess). |
• | Antibiotics are unsafe for appendicitis (cf. surgery: Number Needed to Harm, 10.7). |
Keywords : Antimicrobial, Appendicectomy, Appendicitis
Plan
Vol 70 - N° 2
P. 105-110 - février 2015 Retour au numéro
Article précédent
- Editorial Board
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- Stig Lønberg Nielsen, Annmarie Touborg Lassen, Kim Oren Gradel, Thøger Gorm Jensen, Hans Jørn Kolmos, Jesper Hallas, Court Pedersen
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