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

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Outcomes Research

Background:

• Acute appendicitis (AA) is a common cause of emergency department visits for abdominal pain.
• There is ongoing debate regarding the optimal management strategy for AA: surgical intervention versus non-operative treatment.
• Assessing the safety and feasibility of antibiotic therapy (AT) versus surgical appendectomy (ST) is crucial for patient care.

Purpose of the Study:

• To compare the efficacy and safety of non-operative management with antibiotics (AT) versus surgical therapy with appendectomy (ST) for acute appendicitis.
• To evaluate complication-free treatment success rates and recurrence rates at one-year follow-up.
• To analyze outcomes such as post-operative complications and hospital stay duration.

Main Methods:

• A propensity score-matched analysis was conducted across seven Italian hospitals.
• Retrospective data collection from January 2014 to December 2014 for patients diagnosed with appendicitis.
• Follow-up data were gathered from January 2015 to December 2016 to assess long-term outcomes.

Main Results:

• Complication-free treatment success was significantly higher for surgical appendectomy (ST) at 86.4% compared to antibiotic therapy (AT) at 53.7% (P < 0.0001).
• AT had an index admission failure rate of 20.9% and a 1-year recurrence rate of 20.3%.
• Patients treated with AT experienced shorter hospital stays (3.38 days) than those treated with ST (4.84 days) (P < 0.0001).

Conclusions:

• Surgical appendectomy (ST) remains the most effective treatment for acute appendicitis due to its high efficacy and low complication rates.
• Antibiotic therapy (AT) can prevent appendectomies in approximately 80% of patients with clinical recovery and is associated with shorter hospital stays.
• While AT offers benefits like earlier discharge, ST demonstrates superior complication-free treatment success, highlighting the need for careful patient selection for non-operative management.