The last several years has seen the pendulum swing from operative to nonoperative to operative management of acute appendicitis. In this month’s Journal of Trauma and Acute Care Surgery, a systematic review of 5 randomized control trials was summarized. The study included over 1,430 patients with uncomplicated acute appendicitis. 7272 underwent nonoperative treatment and 703 underwent operative management.

Here’s a summary of the findings:

  • How effective is operative management vs. nonoperative treatment at 1 year follow up?
    • The nonoperative, or antibiotics, group had a efficacy of 63.8%.
    • The operative or surgery, group had a efficacy of 93%
    • Risk ratio is 0.68; 95% CI, 0.60–0.77 with a p < 0.001
  • Overall complications
    • The operative or surgery, group had a complication rate of 23.6%
    • The nonoperative, or antibiotics, group had a complication rate of 7.7%
    • Risk ratio is 0.32; 95% CI, 0.24–0.43; with a p < 0.001

There was no difference in outcomes for perforated appendicitis, length of hospital stay, duration of pain and sick leave. Leading one to summarize that operative management of acute appendicitis is more efficacious but prone to more complications. At this point, I will still just opt to take out the appendix for my patients. What will you do based upon this information?

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The Dilemma with Managing Appendicitis

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