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

Andrew Kirby; Richard P Hobson; Dermot Burke; Victoria Cleveland; Georgia Ford; Robert M West

doi:10.1016/j.jinf.2014.08.009

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

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

Authors

Andrew Kirby¹, Richard P Hobson², Dermot Burke³, Victoria Cleveland⁴, Georgia Ford⁵, Robert M West⁶

Affiliations

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: [email protected].
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: [email protected].
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: [email protected].
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: [email protected].
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: [email protected].
⁶ Charles Thackrah Building, Leeds Institute of Health Sciences, The University of Leeds, LS2 9LJ, UK. Electronic address: [email protected].

PMID: 25175926
DOI: 10.1016/j.jinf.2014.08.009

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.

Publication types

Meta-Analysis

MeSH terms

Adolescent
Adult
Anti-Bacterial Agents / therapeutic use
Appendectomy* / adverse effects
Appendectomy* / statistics & numerical data
Appendicitis* / drug therapy
Appendicitis* / epidemiology
Appendicitis* / surgery
Female
Humans
Male
Middle Aged
Postoperative Complications / epidemiology*
Young Adult

Substances

Anti-Bacterial Agents