Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study

Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational...

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Bibliographic Details
Published in:British journal of surgery 2021-11, Vol.108 (11), p.1351-1359
Main Authors: Javanmard-Emamghissi, H, Hollyman, M, Boyd-Carson, H, Doleman, B, Adiamah, A, Lund, J N, Moler-Zapata, S, Grieve, R, Moug, S J, Tierney, G M
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Appendectomy - statistics & numerical data
Appendicitis - economics
Appendicitis - therapy
Cohort Studies
Female
Follow-Up Studies
Humans
Ireland
Length of Stay - statistics & numerical data
Male
Matched-Pair Analysis
Middle Aged
Original
United Kingdom
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Summary:Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up. A prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment. A total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P 
ISSN:0007-1323
1365-2168
DOI:10.1093/bjs/znab287