title: Should the non-operative management of appendicitis be the new standard of care?
abstract: Appendicitis is one of the most commonly encountered emergency presentations to the general surgical services. The operative management of this condition is associated with significant financial costs and represents a significant workload on the emergency surgical services. Negative appendicectomy rates remain high (20-25%) despite advancements in laboratory testing and imaging techniques. Recent data from randomized controlled trials suggests that non-operative management in patients presenting with uncomplicated or non-perforated acute appendicitis is a viable alternative, with only 23% of patients requiring an appendicectomy at 1 year and an overall reduction in complications. In view of this, the traditional teaching of mandatory appendicectomy for all patients with acute appendicitis should be challenged. This article briefly reviews the evidence that supports the use of diagnostic tests to reduce the negative appendicectomy rate and examines the potential selection criteria for non-operative management. The data raises the questions: can a 20-25% negative appendicectomy rate be defended as best practice and can the traditional dogma of early appendicectomy to prevent perforation be supported?
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.|Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gandy
authors.affiliation: Department of Surgery, Campbelltown Hospital, Campbelltown, New South Wales, Australia.|Academic Division of Surgery, Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: Wang
mesh_terms: D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis* / Q000191:economics / Q000601:surgery / Q000628:therapy*; D019468:Disease Management; D004638:Emergency Treatment / Q000379:methods; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D059039:Standard of Care
keywords: appendicectomy; emergency surgery