Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study
Hannah Javanmard‐Emamghissi, Marianne Hollyman, Hannah Boyd‐Carson, Brett Doleman, Alfred Adiamah, Jonathan N. Lund, Silvia Moler Zapata, Richard Grieve, Susan Moug, Gillian Tierney, The COVID: HAREM (Had Appendicitis and Resolved/Recurred Emergency Morbidity/Mortality) Collaborative Group, Nikhil Kulkarni, Isabel Jesus Pereira, Sarah E. Barlow, S. Vanniasegaram, F Loro, Natalie Blencowe, Benjamin E. Zucker, A Tyler, Marianne Hollyman, Angeliki Kosti, Manuk Wijeyaratne, T Badenoch, Sarah Wheatstone, Margaret Jaffer, Hannah Gerretsen, Muhammad Shafique Sajid, LeAnne Kennedy, Atul Malik, A Nada, Kausik K. Ray, Mansoor Khan, M Varcada, Farid Froghi, Antoine Khalil, D. Kyprianou, N. Tewari, Diwakar Sarma, M. Baig, Seema Sood, E. Ng, V Ng, T Shortland, Gabriele Marangoni, Sujoy Khan, Jawad Ahmad, S. J. Brown, Cynthia Steele, Arslan Pannu, E Gemmill, Hannah Boyd‐Carson, P Herrod, S. Singh Shari, M Mohammed, V Narbad, Nabih Hanbali, Anisa Kushairi, M A Mathew, Candice Downey, A Alamassi, T. Wheatley, K Emslie, Bruno Alcocer, Stanley C. K. Lau, Rebecca Morgan, Tanzeela Gala, Sufyan Ibrahim, Mina Stephanos, R Mithany, M Abdelkarim, G Sundaram Venkatesan, A. Aqsalan, John V. Taylor, Matthew Fok, A Kattakayam, Kunal Rajput, K Bevan, H-K Kim, L Salih, R Sabaratnam, M Creanga, Ahmed Mohamed Abdel Shafì, Jennifer Law, Mohammed Elniel, M. Walley, S Ayyar, Julie Cornish, Nicola Reeves, Nicholas Mowbray, Isabel Mayo, Ezzat Chohda, W. McCaughran, Eduardo Beck, Subhash Garikipati, B Lovett, Firas Alkistawi, Samantha Franklin, C. Hadjitoffi, Akhlaque Uddin, Pankaj Kumar Patel
Abstract
BACKGROUND: Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up. METHODS: A prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment. RESULTS: A total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P < 0.001) were noted in the antibiotic management group. Accounting for interval appendicectomy rates, the mean total cost was €1034 lower per patient managed without surgery. CONCLUSION: This study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions.