O016 Antibiotics versus appendicectomy for uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials

Abstract

Abstract Introduction Previous meta-analyses of randomised controlled trials (RCTs) on patients with uncomplicated acute appendicitis have demonstrated reduced complication rates with primary antibiotic therapy when compared with appendicectomy. This aim of this systematic review and meta-analysis of RCTs was to provide an update of the efficacy of antibiotic therapy compared with appendicectomy in adult patients with uncomplicated acute appendicitis. Methods MEDLINE, EMBASE and CENTRAL databases were searched with no date or language restriction. Data on complications of treatment, treatment efficacy (defined in the antibiotic group as not undergoing appendicectomy at 1 year, versus surgery without complications or negative histology in the appendicectomy group), readmissions, and length of stay (LOS) were extracted. Results We included 8 RCTs involving 3203 participants (1613 antibiotics/1590 appendicectomy; 2041 males/1162 females). Antibiotics had a reduced treatment efficacy compared with primary appendicectomy (RR 0.75, 95% CI 0.63–0.89). There was no significant benefit of primary antibiotic treatment on complication rates (RR 0.66 95% CI 0.41–1.04). In total 1010/1613 (62.6%) patients had successful antibiotic treatment at 1 year. In the 5 studies which explicitly reported hospital re-admission as an outcome, primary antibiotic treatment had a six-fold increase in readmissions (RR 6.28 95% CI 2.87–13.74). There was no difference in index admission LOS [Mean Difference 0.15 days (95%CI -0.05–0.35)]. Conclusion Primary antibiotic treatment for acute appendicitis is associated with a reduced treatment efficacy and a significant readmission rate, without any benefit on complications or LOS. Approximately 40% of patients initially treated with antibiotics will require surgery within 1 year. Take-home message Contrary to previous meta-analyses, the current study suggests that although primary antibiotic therapy may be tried for uncomplicated acute appendicitis in adults, it is not definitive treatment in the long term.