title: Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: a meta-analysis of post-intervention complications.
abstract: OBJECTIVE
  Recent literature has concluded antibiotic therapy results in fewer complications than appendicectomy for patients with uncomplicated appendicitis. This studies aim was to undertake a meta-analysis of major post-intervention outcomes in patients with suspected uncomplicated appendicitis treated with antibiotics or appendicectomy, and determine which treatment is associated with the lowest rate of major complications.
  
  
  METHODS
  We analysed randomised trials of antibiotics vs. appendicectomy in adults with suspected uncomplicated appendicitis. The primary outcome measure was a composite of major complications, peritonitis and intra-abdominal abscess, occurring after appendicectomy or initiation of therapeutic antibiotics.
  
  
  RESULTS
  The rate of major post-intervention complications was 0.8% (2/263) in the appendicectomy group and 10.1% (27/268) in the antibiotic group. This difference was statistically significant by the random effects model: Risk Ratio 7.71, 95% C.I. 2.33 to 25.53, Risk Difference 0.09: 95% C.I. 0.05 to 0.13. The Number Needed to Harm (NNH) from antibiotic therapy is 10.7.
  
  
  CONCLUSIONS
  Suspected uncomplicated appendicitis has a lower rate of major post-intervention complications when managed with primary appendicectomy compared to antibiotic therapy.
authors.affiliation: The Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, England, UK; Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: a.kirby@leeds.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirby
authors.affiliation: The Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, England, UK; Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: Richard.Hobson@leedsth.nhs.uk.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Hobson
authors.affiliation: The Department of Surgery, Lincoln Wing, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, England, UK; Leeds Institute of Biomedical and Clinical Sciences, Clinical Sciences Building, The University of Leeds, St. James's University Hospital, Leeds LS9 7TF, England, UK. Electronic address: d.burke@leeds.ac.uk.
authors.forename: Dermot
authors.initials: D
authors.lastname: Burke
authors.affiliation: Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: um12vc@leeds.ac.uk.
authors.forename: Victoria
authors.initials: V
authors.lastname: Cleveland
authors.affiliation: Leeds Institute of Biomedical and Clinical Sciences, Old Medical School, The University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, England, UK. Electronic address: um12gmf@leeds.ac.uk.
authors.forename: Georgia
authors.initials: G
authors.lastname: Ford
authors.affiliation: Charles Thackrah Building, Leeds Institute of Health Sciences, The University of Leeds, LS2 9LJ, UK. Electronic address: R.M.West@leeds.ac.uk.
authors.forename: Robert M
authors.initials: RM
authors.lastname: West
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D001064:Appendicitis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial; Appendicectomy; Appendicitis