Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis

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http://hdl.handle.net/10138/176222

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Sallinen , V , Akl , E A , You , J J , Agarwal , A , Shoucair , S , Vandvik , P O , Agoritsas , T , Heels-Ansdell , D , Guyatt , G H & Tikkinen , K A O 2016 , ' Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis ' , British Journal of Surgery , vol. 103 , no. 6 , pp. 656-667 . https://doi.org/10.1002/bjs.10147

Title: Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis
Author: Sallinen, V.; Akl, E. A.; You, J. J.; Agarwal, A.; Shoucair, S.; Vandvik, P. O.; Agoritsas, T.; Heels-Ansdell, D.; Guyatt, G. H.; Tikkinen, K. A. O.
Contributor: University of Helsinki, Clinicum
University of Helsinki, Urologian yksikkö
Date: 2016-05
Language: eng
Number of pages: 12
Belongs to series: British Journal of Surgery
ISSN: 0007-1323
URI: http://hdl.handle.net/10138/176222
Abstract: Background: For more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non-perforated appendicitis. Methods: A comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non-perforated appendicitis. Key outcomes were analysed using random-effects meta-analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Five studies including 1116 patients reported major complications in 25 (4.9 per cent) of 510 patients in the antibiotic and 41 (8.4 per cent) of 489 in the appendicectomy group: risk difference -2.6 (95 per cent c.i. -6.3 to 1.1) per cent (low-quality evidence). Minor complications occurred in 11 (2.2 per cent) of 510 and 61 (12.5 per cent) of 489 patients respectively: risk difference -7.2 (-18.1 to 3.8) per cent (very low-quality evidence). Of 550 patients in the antibiotic group, 47 underwent appendicectomy within 1 month: pooled estimate 8.2 (95 per cent c.i. 5.2 to 11.8) per cent (high-quality evidence). Within 1 year, appendicitis recurred in 114 of 510 patients in the antibiotic group: pooled estimate 22.6 (15.6 to 30.4) per cent (high-quality evidence). For every 100 patients with non-perforated appendicitis, initial antibiotic therapy compared with prompt appendicectomy may result in 92 fewer patients receiving surgery within the first month, and 23 more experiencing recurrent appendicitis within the first year. Conclusion: The choice of medical versus surgical management in patients with clearly uncomplicated appendicitis is value-and preference-dependent, suggesting a change in practice towards shared decision-making is necessary.
Subject: RANDOMIZED-CONTROLLED-TRIAL
UNCOMPLICATED ACUTE APPENDICITIS
ADDRESSING CONTINUOUS DATA
NEGATIVE APPENDECTOMY
SYSTEMATIC REVIEWERS
CLINICAL-TRIAL
UNITED-STATES
MANAGEMENT
THERAPY
SURGERY
3126 Surgery, anesthesiology, intensive care, radiology
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