Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis

被引:118
作者
Georgiou, Roxani [1 ]
Eaton, Simon [2 ]
Stanton, Michael P. [1 ]
Pierro, Agostino [3 ]
Hall, Nigel J. [1 ,4 ]
机构
[1] Southampton Childrens Hosp, Dept Paediat Surg & Urol, Southampton, Hants, England
[2] UCL, UCL Great Ormond St Inst Child Hlth, Dev Biol & Canc Programme, London, England
[3] Hosp Sick Children, Div Gen & Thorac Surg, Toronto, ON, Canada
[4] Univ Southampton, Fac Med, Univ Surg Unit, Southampton, Hants, England
关键词
UNCOMPLICATED ACUTE APPENDICITIS; ANTIBIOTIC-TREATMENT; ABDOMINAL-PAIN; CHILDREN; APPENDECTOMY; MANAGEMENT; TRIALS; MULTICENTER; OUTCOMES;
D O I
10.1542/peds.2016-3003
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
CONTEXT: Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy. OBJECTIVE: To determine safety and efficacy of NOT based on current literature. DATA SOURCES: Three electronic databases. STUDY SELECTION: All articles reporting NOT for AUA in children. DATA EXTRACTION: Two reviewers independently verified study inclusion and extracted data. RESULTS: Ten articles reporting 413 children receiving NOT were included. Six, including 1 randomized controlled trial, compared NOT with appendectomy. The remaining 4 reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95% confidence interval [CI] 96% to 99%). Initial length of hospital stay was shorter in children treated with appendectomy compared with NOT (mean difference 0.5 days [95% CI 0.2 to 0.8]; P =.002). At final reported follow-up (range 8 weeks to 4 years), NOT remained effective (no appendectomy performed) in 82% of children (95% CI 77% to 87%). Recurrent appendicitis occurred in 14% (95% CI 7% to 21%). Complications and total length of hospital stay during follow-up were similar for NOT and appendectomy. No serious adverse events related to NOT were reported. LIMITATIONS: The lack of prospective randomized studies limits definitive conclusions to influence clinical practice. CONCLUSIONS: Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA, and the rate of recurrent appendicitis is 14%. Longer-term clinical outcomes and cost-effectiveness of NOT compared with appendicectomy require further evaluation, preferably in large randomized trials, to reliably inform decision-making.
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页数:9
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