Efficacy and safety of nonoperative treatment for acute uncomplicated appendicitis: a meta-analysis

Abstract

Context: Non-operative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendicectomy.
Objective: To determine safety and efficacy of NOT based on current literature.
Data Sources: Three electronic databases.
Study selection: All articles reporting NOT for AUA in children.
Data extraction: Two reviewers independently verified study inclusion and extracted data.
Results: Ten articles reporting 413 children receiving NOT were included. Six, including one RCT, compared NOT with appendicectomy. The remaining four reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95%CI 96, 99). Initial length of hospital stay was shorter in children treated with appendectomy compared to NOT (mean difference 0.5 days [95%CI 0.2, 0.8]; p=0.002). At final reported follow-up (range 8 weeks – 4 years), NOT remained effective (no appendicectomy performed) in 79% of children (95%CI 73, 86%). Recurrent appendicitis occurred in 14% (95%CI 7, 21). Complications, and total length of hospital stay during follow-up were similar for NOT and appendicectomy. No serious adverse events related to NOT were reported.
Limitations: The lack of prospective randomised studies limits definitive conclusions to influence clinical practice.
Conclusions: Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA and the rate of recurrent appendicitis is 14%. Longer term clinical outcomes and cost effectiveness of NOT compared to appendicectomy require further evaluation, preferably as large randomised trials to reliably inform decision making.

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ORCID for Nigel J. Hall: orcid.org/0000-0001-8570-9374

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