Appendectomy versus Conservative Antibiotics Treatment for Non-Complicated Acute Appendicitis : A Meta-Analysis of Randomized Controlled Trials

Purpose: In this meta-analysis, we compared the safety and efficacy of antibiotic treatment with appendectomy for the primary treatment of uncomplicated acute appendicitis. Methods: A comprehensive search was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials that compared antibiotic treatment with appendectomy in uncomplicated acute appendicitis. The primary outcome measure was the initial treatment failure rate. Secondary outcomes included the overall treatment failure rate, length of primary hospital stay, time for sick leave, and cost. Results: In total, 1,480 patients from 6 randomized controlled trials (751 undergoing antibiotic treatment, 729 undergoing appendectomy) were included in the final analysis. Overall treatment efficacy in the antibiotic group was 0.77 (95% CI, 0.68 to 0.84; Pchi 2<0.001; I2=81.51%) versus 0.91 (95% CI, 0.81 to 0.96; Pchi 2<0.001; I2=80.23%) in the appendectomy group. There were no differences with regard to overall treatment efficacy (Risk ratio (RR), 0.88; 95% CI, 0.74 to 1.04; Pchi 2<0.001; I2=90.98%; NNT=6), complication rate (Risk ratio(RR), 1.56; 95% CI, 0.48 to 5.05; Pchi 2=0.008; I2=71.21%; NNT=186), hospital stay (mean difference(MD), -0.05; 95% CI, -0.65 to 0.55; Pchi 2<0.001; I2=98.24%), time for sick leave (MD, -4.36; 95% CI, -12.00 to 3.28; Pchi 2<0.001; I2=99.45%) and cost (MD, -12230.46; 95% CI, -17086.77 to -7374.15; Pchi 2=0.321; I2=0.00%). Conclusion: Antibiotic treatment is effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Therefore, antibiotic treatment could be considered as an alternative option in the treatment of patients with acute uncomplicated appendicitis.