Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study
Author:
Javanmard-Emamghissi H1ORCID, Hollyman M2ORCID, Boyd-Carson H3, Doleman B1, Adiamah A4ORCID, Lund J N1, Moler-Zapata S5, Grieve R5, Moug S J6ORCID, Tierney G M3, Kulkarni N, Pereira I, Barlow S, Vanniasegaram S, Loro F, Blencowe N S, Zucker B E, Tyler A, Hollyman MORCID, Kosti A, Wijeyaratne M, Badenoch T, Wheatstone S, Jaffer M, Gerretsen H, Sajid M S, Kennedy L, Malik A, Nada A, Ray K, Khan M, Varcada M, Froghi F, Khalil A, Kyprianou D, Tewari N, Sarma D R, Baig M, Sood S, Yu Wen Ng E, Ng V, Shortland T, Marangoni G, Khan S, Ahmad J, Brown S, Steele C, Pannu A, Gemmill E, Boyd-Carson H, Herrod P, Singh Shari S, Mohammed M J S, Narbad V, Hanbali N, Kushairi A, Mathew M A, Downey C, Alamassi A, Wheatley T, Emslie K, Alcocer B, Lau S, Morgan R, Gala T, Ibrahim S, Stephanos M, Mithany R, Abdelkarim M, Venkatesan G, Aqsalan A, Taylor J, Fok M, Kattakayam A, Rajput K, Bevan K, Kim H-K, Salih L, Sabaratnam R, Creanga M, Shafi A, Law J, Elniel M, Walley M, Ayyar S, Cornish J, Reeves N, Mowbray N, Mayo I, Chohda E, McCaughran W, Beck E, Garikipati S, Lovett B E, Alkistawi F, Franklin S, Hadjitoffi C, Uddin A, Patel P K, Handa S, Parker J, Littlehales D, Belgaumkar A P, Oyewole B, Narayan P, Elahi Z, Gaukroger A, Dunne D F J, Nita G E, Baron R D, Sochorova D, Szatmary P, Gahunia S A K, Thomas A J, Mann K S, McFall M, Farkas N, Siddig H, Camilleri-Brennan J, Rutherford D, Wilson M, Massie E, McGivern K, McGuckin J, McKee C, Marinos-Kouris S, Gammeri E, Patel N, Cillo G, Baldwin A J, Magro T, Krishna K, Olivier J, Anyaugo N, Philip K, Pearce L, Al-Amin A, Thomas M, Anderson I, Clark R, Basamh M, Navaratnam S M, Saunt A, Karki B Bekhyat, Jeong H, Singh B, Rajendirin A, Boyle K, Fahmy S, Couch J H, Butt H Z, Popa M, Sharma S, Cabdisalaam S, Kourdouli A, Zaheer M, Tierney G, Lund J N, Javanmard-Emamghissi HORCID, Doleman B, Hope C, Gowda A, Photiou D, Malcolm F, Daliya P, Rye N, Chia Z, Anis F, Thomas P, Urbonas T, Centea D, Husain N, Moug SORCID, Ingham A, Alexander R, Bisset C, Galbraith N, Clifford R, Dickerson L, Lockwood S, Johnston J, Guy R, Majeed T, Young R, Shamim S, Mesri M, Date R, Chaudhury M P, Zambas G, Patel R, Lewis S, Eigbadon A T, Thakrar D, Karamitsou E, Oyeyipo Y, Nadeem U, Ndlovu S, Fnshawe A, Henderson N, Payne C, Porter D, Brooks A, Lee R X N, Jackman J, Morton A J, Ebunoluwa Oyende O, Worku D, Koh A, Kanani T, Blackwell J, Shaw M, Lewis C Lloyd, Blackburn L, Adiamah AORCID, Shaikh S, Ghazanfar M, Elhusseini M, Abdelhamid A, Eley J, Nassar A, Nunn R, Gales A, Farinella E, Mahmood Z, Policastro T, Bagnall N M, Blyth U, McGregor R J, Damaskos D, Drogouti M, Tuharska Z, Davies J, Bennett J M, Antakia R, O’Neill J R, Hardwick R H, Fearnhead N, Xanthis A, Georgiades F, Hudson V, Ashcroft J, Singh A A, Kabir S M U, Huan H, Sugrue M, Riera M, Chang J, Omosebi A, Rigby E, Kim L, Ali S, Gates Z, Alasa H, Bo J Y N, Gangwar A, Osborne L, Perakath B, Chandarana M, Galea M, Luhmann A, Ryska O, Searight F, McCoss C, Weber B, Sallam M, Patel R, Bignell M, Bond-Smith G, Lewis C, Williams G, Whewell H, Smith L, Ooi R, Powell-Chandler A, Tang A M, Richards S K, Thompson D B, Cross R, van Dellen J, Alberto V, Shirazi S, Arang H, Rahman N, Monaghan E, Dodds K, Babalola O, Airhunmwunde P, Chinaka C, Wijetunga I, Kidd T, Nambiar K, Ng C E, Collier T, Ibrahim B, Khan K, Sriskandarajah K, Pelly T, Vance-Daniel J, Nastro P, Khan A, Ekowo O, Devadoss A, Rao P D, Bateman K, Gavrila A, Hannan E, Winter D, Martin S, Kennelly R, Hanly A, Aslam M I, Amin V, Wilkins R, Zafar S, Konstantinou C, Mcdonald S, Baker A, Fardie A, Hill A, De Marchi J, O'Grady S, Faulkner G, Sekhar H, Martinez-Iglesias M, Alexander C, Lawrence E, Argyropoulos S, Williams G, Bhasin S, Paduraru M, Pawelec K, Bylapudi S, Byrne H, Da Silva Bento E R, Zahari F, Roslan F, Rao M, Hudson-Phillips S, Kenington C, Tellman S, Abraham P, Dhillon A, Vinnicombe Z, Giles M, Abbakar M, Khadem N, Buckley E, Macdonald L, Norman J, Bond R, White T, Gana T, Kotecha S, Rajain S, Ahmad S, Wadham B, Hancock L, Liyanage A, Dorrington I, Mian A, Satchidanand R Y, Weerasinghe C, Etherson K J, Hidayat H, Bhandari M, Agarwal A, Sagar J, Kudchadkar S, Ghosh A, Cirocchi N, Rai A, AlHabsha O, Mujtaba S S, Ejtehadi F, Warrag I, Ivanov B, Refson J, Boateng C, Madani R, Buhsk M M, Kesharwani D, Kumar L, Prakash V, Zulfiqar S, Jayakumar A, Payne A, Davies C, Buhain R, Osilli D, Rashid T, Elzayat I, Kanakala V, Nevins E J, Madhavan A, Oates E, France K, Cowie S, Bowen J, Nam Y-J, Bradbury M, Mitchell V, Mirza S M, Raiz M M, Weatherstone E, Wilson R, Sasapu K, Rahman M M A, Chan E, Ko K Y, Sharman M, Thiruppathy K, Hodgkinson J, Chadha R, Pilpel T, Dale J, Carter N, Botros A, Bondoqa I, Sandabah S, Sherwood K, Harries R, Hurt L, Egan R, Gauntlett L, Bevan V, Vipond M, Ireland P, Granger S, Preece R, Frith D, Eves J, Abuown A, Apollos J, Macleod A, Hemadasa N, McNaught C, Mir R, Cuthbert G, Valero C, Williams D, Fakhrul-Aldeen M, Willis K, Kelly L, Lawes D, Poynter L, Knowles H, Saeed S, Shehata M, Rafiq I, Boshnaq M, Ayoub F, Mcnair A, Pournaras D J, Lawday S, Martin R, Cohen H, Okocha M, Shalli K, Chin M, Joliffe S, Taylor F, Argyriou E O, Dornseifer M, Schembari E, Surandran S, Roberts L, Kakaniaris G, Mallidis E, Karagiannidis G, Youssef F, Chan A, Macutkiewicz C, Davenport M, Hodge S, Clarke A, Branagan G, Thakkar R, Harris C, Brown C, McGuigan M-C, Shrestha A K, Balakumar C, Iqbal S, Kawabata M, Ogbuagu N, Alam I, Wang K, Artemis F,
Affiliation:
1. Faculty of Medicine and Health Sciences, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK 2. Upper Gastrointestinal Surgery Department, Musgrove Park Hospital, Taunton, UK 3. Colorectal Department, Royal Derby Hospital, Derby, UK 4. Department of Gastrointestinal Surgery, NIHR Nottingham Digestive Disease Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK 5. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK 6. Colorectal Department, Royal Alexandra Hospital, Paisley, UK
Abstract
Abstract
Background
Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up.
Methods
A prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment.
Results
A total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P < 0.001) were noted in the antibiotic management group. Accounting for interval appendicectomy rates, the mean total cost was €1034 lower per patient managed without surgery.
Conclusion
This study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions.
Publisher
Oxford University Press (OUP)
Cited by
35 articles.
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