Evaluation of clinical outcomes of antibiotic treatment and appendectomy for appendicitis: Systematic review and meta-analysis of randomized controlled trials

Background: and aims: Studies have exhibited the superiority of appendectomy to antibiotics in acute appendicitis (AA) treatment for the overall effective rate and relapse. However, evidence to support the efficacy of appendectomy is lacking because limited randomized controlled trials (RCTs) have been conducted. Thus, the present study attempted to compare the two treatment methods through the meta-analysis of RCTs. Methods Databases such as PubMed, Cochrane Library, Medline, Embase, and Web of Knowledge were searched. RCTs comparing conservative therapy and surgical treatment for AA and published in any language between January 1, 1990, and December 31, 2020 were included in the study. The primary outcomes were 1-year efficiency and incidences of complications, whereas the secondary outcomes were length of stay and sick leave duration. The odds ratios (OR) and mean differences (MD) were combined, and the fixed- and random-effects models were calculated with 95% confidence intervals (CIs). Results The present study was conducted based on 12 studies involving 4195 patients and comparing appendectomy with antibiotic treatment. Of the total, 2135 patients had underwent appendectomy and 2060 were treated with antibiotics. The 1-year OR after antibiotic therapy and appendectomy was 0.03 (95% CI: 0.01–0.06). The MD for the two groups for length of stay was 0.38 (95% CI: 0.16–0.61). Appendectomy exhibited a significantly higher treatment efficiency at 1 year and shorter hospital stay than antibiotic treatment. However, antibiotic treatment exhibited lower incidences of treatment-related complications (RR: 0.52, 95% CI: 0.37–0.74; P = 0.0002) and sick leave duration (P < 0.05) than appendectomy. Conclusions Antibiotics are not inferior to appendectomy for the treatment of uncomplicated appendicitis. However, patients with an appendicolith exhibited higher recurrence risk after conservative treatment, and surgery is a better option for such patients.