Evidence map›Paper›PMID 33454817›Full record

ArticleInternational journal of colorectal disease2021

Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score-matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial).

Mauro Podda, Gaetano Poillucci, Daniela Pacella, Lorenzo Mortola, Alfonso Canfora, Simona Aresu, Marcello Pisano, Enrico Erdas, Adolfo Pisanu, Nicola Cillara and 1 more

Erratum issued Registry-linked trialAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in International journal of colorectal disease, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03080103 (A Prospective Non-randomized Controlled, Multicenter, Multidisciplinary Trial Comparing Appendectomy and Conservative Treatment for Patients With Uncomplicated Acute Appendicitis), which is not on this map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
9.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03080103 completednot on this map

A Prospective Non-randomized Controlled, Multicenter, Multidisciplinary Trial Comparing Appendectomy and Conservative Treatment for Patients With Uncomplicated Acute Appendicitis (the ACTUAA STUDY).

TypeobservationalSponsorMauro PoddaRan2017 to 2019Enrolled300ConditionsAcute Appendicitis, Appendicitis Recurrent, Appendectomy, Antibiotic TherapyArmsLaparoscopic or Open appendectomy, Antibiotic-first therapy
3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Article
  14. Review
  15. Acute appendicitis-advances and controversies.World journal of gastrointestinal surgery · 2021
    Review
  16. Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis.International journal of environmental research and public health · 2021
    Article
  17. Article
  18. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 1 country.

Mauro PoddaDepartment of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy. mauropodda@ymail.com.ORCID http://orcid.org/0000-0001-9941-0883
Gaetano PoillucciDepartment of General and Specialized Surgery "Paride Stefanini", Policlinico Universitario Umberto I, La Sapienza University, Rome, Italy.
Daniela PacellaDepartment of Public Health, University of Naples Federico II, Naples, Italy.
Lorenzo MortolaDepartment of Surgery, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
Alfonso CanforaDepartment of Surgery, Villa Betania Hospital, Naples, Italy.
Simona AresuDepartment of Surgery, Nostra Signora della Mercede Hospital, Lanusei, Italy.
Marcello PisanoDepartment of Surgery, San Marcellino Hospital, ASSL Cagliari, Muravera, Italy.
Enrico ErdasDepartment of General and Endocrine Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
Adolfo PisanuDepartment of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
Nicola CillaraDepartment of General Surgery, Santissima Trinità Hospital, ASSL Cagliari, Cagliari, Italy.
ACTUAA Study Collaborative Working Group
Azienda Ospedaliero-Universitaria Cagliari · ITPoliclinico Umberto I · ITSantissima Trinità · ITUniversità degli Studi del Piemonte Orientale “Amedeo Avogadro” · ITUniversity of Cagliari · ITVilla Pineta Hospital · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe aim of this prospective multicenter study was to compare antibiotic therapy and appendectomy as treatment for patients with uncomplicated appendicitis confirmed by ultrasound and/or computed tomography.

methodsThe study was conducted from January 2017 to January 2018. Data regarding all patients discharged from the participating centers with a diagnosis of uncomplicated appendicitis were collected prospectively.

resultsOf the 318 patients enrolled in the study, 27.4% underwent antibiotic-first therapy, and 72.6% underwent appendectomy. The matched group was composed of 87 patients in both study arms. Of the 87 patients available of 1-year follow-up in the antibiotic-first group, 64 (73.6%) did not require appendectomy. The complication-free treatment success in the antibiotic-first group was 64.4%. A statistically significant higher complication-free treatment success was found in the appendectomy group: 81.8% in the pre-matching sample and 83.9% in the post-matching sample. Patients in the antibiotic-first group reported lower VAS scores compared to those treated with an appendectomy, both at discharge (2.0 ± 1.7 vs 3.6 ± 2.3) and at 30-day follow-up (0.3 ± 0.6 vs 2.1 ± 1.7). The mean of the days of absence from work was higher in the appendectomy group (β 0.63; 95% CI 0.08-1.18).

conclusionAlthough laparoscopic appendectomy remains the gold standard of treatment for uncomplicated appendicitis, conservative treatment with antibiotics is a safe option in most cases. Approximately 65% of patients treated with antibiotics are symptom-free at 1 year, without increased risk of adverse events should symptoms recur, and better outcomes in terms of less pain and shorter period of absence from work compared to patients undergoing an appendectomy.

trial registrationClinicaltrials.gov identifier (NCT number): NCT03080103.

Indexed as

AppendectomyAppendicitisAcute DiseaseAnti-Bacterial AgentsConservative TreatmentHumansPatient-Centered CarePropensity ScoreProspective StudiesTreatment OutcomeAnti-Bacterial AgentsAntibiotic treatmentAppendectomyClinical outcomesConservative treatmentMulticenter studyUncomplicated appendicitis

Identifiers

PMID33454817
OpenAlexW3123503197

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.