University of Milan, Via Festa Del Perdono 7, 20122, Milan, Italy.
, Milan, Italy.
World J Emerg Surg. 2024 Jan 13;19(1):2. doi: 10.1186/s13017-023-00531-6.
The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis.
A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs.
Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61-1.04, P = 0.07, I = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p < 0.00001, I = 87%) and at 1 year was successful in 540 out of 837 (64.6%, RR = 0.69, 95% confidence interval 0.61 to 0.77, p < 0.00001, I = 81%) participants. There was no difference in LOS (mean difference - 0.58 days 95% confidence interval - 1.59 to 0.43, p = 0.26, I = 99%). The trial sequential analysis has revealed that, concerning the three primary outcomes, it is improbable that forthcoming RCTs will significantly alter the existing body of evidence.
As further large-scale trials have been conducted, antibiotic therapy proved to be safe, less expensive, but also less effective than surgical treatment. In order to ensure well-informed decisions, further research is needed to explore patient preferences and quality of life outcomes.
本研究旨在对成人单纯性急性阑尾炎保守治疗与手术治疗的随机对照试验（RCT）进行荟萃分析。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统文献检索。在 MEDLINE、Embase 和 CENTRAL 中进行全面检索。我们专门纳入了随机对照试验（RCT）。排除了涉及复杂阑尾炎或儿童参与者的研究。考虑的变量如下：治疗并发症、指数入院时和 1 年随访时无并发症治疗成功率、住院时间（LOS）、生活质量（QoL）和成本。
纳入了 8 项 RCT，共 3213 名参与者（1615 名抗生素/1598 名阑尾切除术）。两种治疗方法在并发症发生率方面无显著差异（RR=0.66；95%CI 0.61-1.04，P=0.07，I=69%）。与阑尾切除术相比，抗生素治疗的疗效降低（RR=0.80；95%CI 0.71 至 0.90，p<0.00001，I=87%），1 年后 837 名参与者中有 540 名（540/837；64.6%，RR=0.69，95%置信区间 0.61 至 0.77，p<0.00001，I=81%）成功。LOS 无差异（平均差-0.58 天，95%置信区间-1.59 至 0.43，p=0.26，I=99%）。试验序贯分析表明，就三个主要结局而言，未来的 RCT 不太可能显著改变现有的证据体系。
随着进一步的大规模试验的开展，抗生素治疗已被证明是安全的、更经济的，但也不如手术治疗有效。为了确保做出明智的决策，需要进一步研究来探索患者的偏好和生活质量结果。
