Comparison of operative and non operative management of acute appendicitis.
BACKGROUND
In this prospective study, operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness.


METHODS
Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospective study. Nonoperative medical therapy was performed in 107 patients (Group 1), and 183 patients were treated surgically (Group 2). Routine follow-up controls were done on the 10th day, at the 3rd and 6th months and at the first year after discharge in Group 1. Both groups were compared regarding age, gender, mean hospital stay, modified Alvarado score, morbidity, mortality, and cost effectiveness.


RESULTS
The male/female ratio of Groups 1 and 2 were 65/42 (mean age: 30.98+/-1.30) and 125/58 (mean age: 26.25+/-0.79), respectively. In Group 1, 19 patients were operated. Operation indications were resistance to therapy, patient's request, and operation in another hospital. Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2, the mean cost of the therapy was $559 in Group 2 and $433 in Group 1. Morbidity rates were similar, with no mortality in either group.


CONCLUSIONS
With its high success rate and cost effectiveness, medical treatment seems to be a good alternative to the gold standard therapy of surgery in management of acute appendicitis.
Department of General Surgery, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ahmetnturhan@gmail.com
Ahmet Nuray
AN
Turhan
Selin
S
Kapan
Ersen
E
Kütükçü
Hakan
H
Yiğitbaş
Sinan
S
Hatipoğlu
Erşan
E
Aygün
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents