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J Infect. 2015 Feb;70(2):105-10. doi: 10.1016/j.jinf.2014.08.009. Epub 2014 Aug 29.

Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: a meta-analysis of post-intervention complications.

Author information

1
The Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, England, UK; Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: a.kirby@leeds.ac.uk.
2
The Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, England, UK; Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: Richard.Hobson@leedsth.nhs.uk.
3
The Department of Surgery, Lincoln Wing, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, England, UK; Leeds Institute of Biomedical and Clinical Sciences, Clinical Sciences Building, The University of Leeds, St. James's University Hospital, Leeds LS9 7TF, England, UK. Electronic address: d.burke@leeds.ac.uk.
4
Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: um12vc@leeds.ac.uk.
5
Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: um12gmf@leeds.ac.uk.
6
Charles Thackrah Building, Leeds Institute of Health Sciences, The University of Leeds, LS2 9LJ, UK. Electronic address: R.M.West@leeds.ac.uk.

Abstract

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.

KEYWORDS:

Antimicrobial; Appendicectomy; Appendicitis

PMID:
25175926
DOI:
10.1016/j.jinf.2014.08.009
[Indexed for MEDLINE]
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