Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study

Gaetano Poillucci, Lorenzo Mortola, Mauro Podda, Salomone Di Saverio, Laura Casula, Chiara Gerardi, Nicola Cillara, Luigi Presenti, Francesco Balestra, Fernando Serventi, Stefania Fiume, M. Antonio D Lai, Simona Ledda, Fabio Pulighe, Sara Gobbi, Carlo De Nisco, Giulio Argenio, Giorgio Norcia, Sergio Gemini, Raffaele SechiMiriam Pala, Renata Pau, Roberto Ottonello, Marcello Pisano, Simona Aresu, Massimiliano Coppola, Antonio Tuveri, Francesco Madeddu, Antonella Piredda, Giovanni Pinna, Fabrizio Scognamillo, Pier Luigi Tilocca, Leonardo Delogu, Gian Marco Carboni, Gianfranco Porcu, Danilo Piras, The ACTUAA-R Collaborative Working Group on Acute Appendicitis

Research output: Contribution to journalArticle

Abstract

Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively. Follow-up data were collected from January 1st, 2015 to December 31st, 2016. The complication-free treatment success of AT (53.7%) was significantly inferior to that of ST (86.4%) (P < 0.0001). Patients initially treated with antibiotics reported an index admission AT failure rate of 20.9% and a recurrence rate at 1-year follow-up of 20.3%. No statistically significant difference was found when comparing AT and ST groups for the outcome of interest post-operative complications (13.5 vs 13.6%, P = 0.834). Patients treated with AT were discharged home earlier than patients in the ST group (3.38 ± 1.89 vs 4.84 ± 2.69 days, P < 0.0001). Due to the low rates of complications occurred in the ST group and the high efficacy of the surgical therapy, laparoscopic appendectomy still represents the most effective treatment for patients with AA. AT is associated with shorter hospital stay and faster return to normal activity, and may prevent from appendectomies around 80% of patients who leave the hospital with clinical recovery.

Original languageEnglish
Pages (from-to)531-540
Number of pages10
JournalUpdates in Surgery
Volume69
Issue number4
DOIs
Publication statusPublished - Dec 1 2017

Keywords

  • Antibiotics
  • Appendectomy
  • Appendicitis
  • Multicenter study
  • Multivariate analysis
  • Propensity score analysis

ASJC Scopus subject areas

  • Surgery

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    Poillucci, G., Mortola, L., Podda, M., Di Saverio, S., Casula, L., Gerardi, C., Cillara, N., Presenti, L., Balestra, F., Serventi, F., Fiume, S., D Lai, M. A., Ledda, S., Pulighe, F., Gobbi, S., De Nisco, C., Argenio, G., Norcia, G., Gemini, S., ... The ACTUAA-R Collaborative Working Group on Acute Appendicitis (2017). Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study. Updates in Surgery, 69(4), 531-540. https://doi.org/10.1007/s13304-017-0499-8