Three-year follow-up of antibiotics versus surgery for acute appendicitis

Acute appendicitis is one of the most common surgical emergencies. Emerging evidence suggests uncomplicated appendicitis could be treated by antibiotics. We investigated the outcome of patients treated with antibiotics for acute appendicitis with a three-year follow-up. Secondary aims were to assess recurrence of appendicitis and potential missed pathologies with nonoperative management.

All computed tomography (CT) scan reports with keyword 'appendicitis' of adult patients performed from January 2020 to December 2021 were reviewed. Reports were classified as uncomplicated or complicated based on previous definition. Demographic data, treatment information including operative details and complications, and recurrence of antibiotic-treated appendicitis were collected retrospectively.

Among 3,252 scans, 1,008 confirmed appendicitis (631 uncomplicated, 377 complicated; median age 46 years). 212 patients (21.0%) were treated with antibiotics and 796 (79.0%) underwent appendicectomy. After excluding deaths, 195 nonoperatively treated patients were available for three-year follow-up: 83 (42.6%) developed recurrence and 57 (29.2%) had surgery. Neoplasms were found in 19 of 591 (3.2%) CT-diagnosed uncomplicated appendicitis. Overall, neoplasms were found in 3.5% of the specimens. Postoperative complications occurred in 11% of all surgeries, of which 2.3% were Clavien-Dindo grade III-V.

Antibiotic treatment of appendicitis is associated with high recurrence and risk of missed neoplasms. Appendicectomy is safe, with low rates of significant complication. When offering nonoperative management for appendicitis, patients should be informed about the risk of recurrence and missing sinister pathologies.