title: Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis.
abstract: BACKGROUND
  Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy.
  
  
  OBJECTIVE
  To determine safety and efficacy of NOT based on current literature.
  
  
  METHODS
  Three electronic databases.
  
  
  METHODS
  All articles reporting NOT for AUA in children.
  
  
  METHODS
  Two reviewers independently verified study inclusion and extracted data.
  
  
  RESULTS
  Ten articles reporting 413 children receiving NOT were included. Six, including 1 randomized controlled trial, compared NOT with appendectomy. The remaining 4 reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95% confidence interval [CI] 96% to 99%). Initial length of hospital stay was shorter in children treated with appendectomy compared with NOT (mean difference 0.5 days [95% CI 0.2 to 0.8];P= .002). At final reported follow-up (range 8 weeks to 4 years), NOT remained effective (no appendectomy performed) in 82% of children (95% CI 77% to 87%). Recurrent appendicitis occurred in 14% (95% CI 7% to 21%). Complications and total length of hospital stay during follow-up were similar for NOT and appendectomy. No serious adverse events related to NOT were reported.
  
  
  CONCLUSIONS
  The lack of prospective randomized studies limits definitive conclusions to influence clinical practice.
  
  
  CONCLUSIONS
  Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA, and the rate of recurrent appendicitis is 14%. Longer-term clinical outcomes and cost-effectiveness of NOT compared with appendicectomy require further evaluation, preferably in large randomized trials, to reliably inform decision-making.
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom.
authors.forename: Roxani
authors.initials: R
authors.lastname: Georgiou
authors.affiliation: Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stanton
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada; and.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom; n.j.hall@soton.ac.uk.|University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000628:therapy*; D000072700:Conservative Treatment; D006801:Humans; D007902:Length of Stay; D010359:Patient Readmission; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents