Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis.

Background: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. Methods: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29th, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when substantial heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. Quality assessment of included RCTs was performed using the modified Jadad scale. Results: Five RCTs were included in this review. Overall, 1,430 adult patients with uncomplicated acute appendicitis underwent either nonoperative (n=727) or operative management (n=703). Treatment efficacy at 1-year follow-up was significantly lower (63.8%) for antibiotics compared to the surgery group (93%) (RR 0.68; 95% CI, 0.60-0.77, p

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2nPhS4J