Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However, the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.
Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life, hence surgery should remain the mainstay of treatment for such individuals, reports a study published recently in the Annals of Surgery.
O'Leary, D. Peter and colleagues from the Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland conducted the present study to evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.
Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.
The authors randomly included a total of one hundred eighty-six patients. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001).
Also, the EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01).
The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).
As a result, the authors concluded that patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.
doi: 10.1097/SLA.0000000000004785