Andrew Kirby1, Richard P Hobson2, Dermot Burke3, Victoria Cleveland4, Georgia Ford5, Robert M West6. 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.
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.
Authors: Ramon R Gorter; Hasan H Eker; Marguerite A W Gorter-Stam; Gabor S A Abis; Amish Acharya; Marjolein Ankersmit; Stavros A Antoniou; Simone Arolfo; Benjamin Babic; Luigi Boni; Marlieke Bruntink; Dieuwertje A van Dam; Barbara Defoort; Charlotte L Deijen; F Borja DeLacy; Peter Mnyh Go; Annelieke M K Harmsen; Rick S van den Helder; Florin Iordache; Johannes C F Ket; Filip E Muysoms; M Mahir Ozmen; Michail Papoulas; Michael Rhodes; Jennifer Straatman; Mark Tenhagen; Victor Turrado; Andras Vereczkei; Ramon Vilallonga; Jort D Deelder; Jaap Bonjer Journal: Surg Endosc Date: 2016-09-22 Impact factor: 4.584
Authors: V Sallinen; E A Akl; J J You; A Agarwal; S Shoucair; P O Vandvik; T Agoritsas; D Heels-Ansdell; G H Guyatt; K A O Tikkinen Journal: Br J Surg Date: 2016-03-17 Impact factor: 6.939