Conclusion The paradigm remains unchanged , that appendectomy is the gold st and ard of treatment for uncomplicated appendicitis , given its higher efficacy rate when compared to NOM
Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis , aim ing at preventing perforation , peritonitis , abscess formation and recurrence .
With better underst and ing of the disease process , non-operative management ( NOM ) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis .
This article aim ed at systematic ally review ing the available literature s and discussing the question whether NOM should replace appendectomy as the st and ard first-line treatment for uncomplicated appendicitis .
Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis.
BACKGROUND Emerging literature has supported the safety of nonoperative management of uncomplicated appendicitis . STUDY DESIGN Patients with emergent , uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development data base from 1997 to 2008 . Rates of treatment failure , recurrence , and perforation after nonsurgical management were calculated . Factors associated with treatment failure , recurrence , and perforation were identified using multivariable logistic regression . Mortality , length of stay , and total charges were compared between treatment cohorts using matched propensity score analysis . RESULTS Of 231,678 patients with uncomplicated appendicitis , the majority ( 98.5 % ) were managed operatively . Of the 3,236 nonsurgically managed patients who survived to discharge without an interval appendectomy , 5.9 % and 4.4 % experienced treatment failure or recurrence , respectively , during a median follow-up of more than 7 years . There were no mortalities associated with treatment failure or recurrence . The risk of perforation after discharge was approximately 3 % . Using multivariable analysis , race and age were significantly associated with the odds of treatment failure . Sex , age , and hospital teaching status were significantly associated with the odds of recurrence . Age and hospital teaching status were significantly associated with the odds of perforation . Matched propensity score analysis indicated that after risk adjustment , mortality rates ( 0.1 % vs 0.3 % ; p = 0.65 ) and total charges ( $ 23,243 vs $ 24,793 ; p = 0.70 ) were not statistically different between operative and nonoperative patients ; however , length of stay was significantly longer in the nonoperative treatment group ( 2.1 days vs 3.2 days ; p < 0.001 ) . CONCLUSIONS This study suggests that nonoperative management of uncomplicated appendicitis can be safe and prompts additional investigations . Comparative effectiveness research using prospect i ve r and omized studies can be particularly useful
Conclusion The paradigm remains unchanged , that appendectomy is the gold st and ard of treatment for uncomplicated appendicitis , given its higher efficacy rate when compared to NOM
Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis , aim ing at preventing perforation , peritonitis , abscess formation and recurrence .
With better underst and ing of the disease process , non-operative management ( NOM ) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis .
This article aim ed at systematic ally review ing the available literature s and discussing the question whether NOM should replace appendectomy as the st and ard first-line treatment for uncomplicated appendicitis .