title: A National Evaluation of the Conservative Management of Uncomplicated Acute Appendicitis: How Common Is This and What Are the Issues.
abstract: BACKGROUND
  The management approach for acute appendicitis has been challenged in recent years, with numerous randomized controlled trials demonstrating that antibiotics/conservative management is an efficacious treatment, with lower complication rates.
  
  
  METHODS
  A national survey of all consultant general surgeons evaluating their practices was performed. Reasons for changed practices, choice of antibiotics and follow-up investigations were evaluated. In addition, the role of interval appendicectomy and conservative management in the pediatric population was also assessed.
  
  
  RESULTS
  The response rate for this survey was 74.7% (n = 74/99). Over one-fifth (n = 17, 22.9%) routinely treat acute appendicitis conservatively, while another 14.8% (n = 11) consider this approach in selected cases. Main reasons for modified practices included the presence of inflammatory phlegmon (75%), delayed presentation (64%), and recent evidence-based medicine developments (46%). Co-amoxiclav/clavulanic acid was the most popular antibiotic for conservative management (53%). Alternatively, combinations of antibiotics were also utilized. One-third felt interval appendicectomy was warranted, while one-fifth supported conservative management in the paediatric setting. The overwhelming majority (>95%) advocate follow-up colonoscopy ± computed tomography in any patient aged >40 years managed conservatively.
  
  
  CONCLUSIONS
  Considerable variation in management of uncomplicated appendicitis remains in Ireland despite growing evidence suggesting that the non-operative approach is safe. Reasons for adopting a conservative management practice have been identified and reflect the expanding literature on this subject.
authors.affiliation: Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Ireland.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kelly
authors.forename: Asif
authors.initials: A
authors.lastname: Khan
authors.forename: Jameel
authors.initials: J
authors.lastname: Ur Rehman
authors.forename: Ronan M
authors.initials: RM
authors.lastname: Waldron
authors.forename: Waqar
authors.initials: W
authors.lastname: Khan
authors.forename: Kevin
authors.initials: K
authors.lastname: Barry
authors.forename: Iqbal Z
authors.initials: IZ
authors.lastname: Khan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents