Observational studyThe British journal of surgery2021
Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study.
Observational study in The British journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
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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.
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.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- SAGES guidelines update to laparoscopy in the era of COVID-19.Surgical endoscopy · 2025Guideline
- Appendectomy versus antibiotic treatment for acute appendicitis.The Cochrane database of systematic reviews · 2024Pooled it
- Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis: A Systematic Review and Meta-analysis.JAMA surgery · 2022Pooled it
- Analysis of predictive factors and development of a nomogram for complicated acute appendicitis in adults.BMC surgery · 2026Article
- Obesity and perioperative outcomes in pediatric laparoscopic appendectomy: a retrospective, propensity score-matched cohort study.Translational pediatrics · 2026Article
- Nonoperative management of uncomplicated acute appendicitis; results of 5 years follow.Langenbeck's archives of surgery · 2025Article
- Diagnostic value of the MZXBTCH scoring system for acute complex appendicitis.Scientific reports · 2025Article
- An Approach for Combining Clinical Judgment with Machine Learning to Inform Medical Decision Making: Analysis of Nonemergency Surgery Strategies for Acute Appendicitis in Patients with Multiple Long-Term Conditions.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
- A Study of Misconceptions About Appendicitis Among the Resident Population of the Aseer Region.Cureus · 2023Article
- Predicting complicated appendicitis is possible without the use of sectional imaging-presenting the NoCtApp score.International journal of colorectal disease · 2023Article
- Two-year outcomes of conservatively managed appendicitis during the COVID-19 pandemic-a multicentre cohort study.Langenbeck's archives of surgery · 2023Observational
- One-year follow-up of conservative management of appendicitis: results from a single centre during extended lockdown in the COVID-19 pandemic.Annals of the Royal College of Surgeons of England · 2023Article
- Management of acute appendicitis during COVID-19 pandemic. Single center data from a tertiary care hospital in Germany.Innovative surgical sciences · 2023Article
- Observational
- Letter to the Editor: Conversion from Laparoscopic to Open Appendectomy: Trends, Risk Factors and Outcomes. A 15-Year Single-Center Analysis of 2,193 Adult Patients.World journal of surgery · 2023Article
- Focus on identifying and closing knowledge gaps in acute appendicitis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Moving to Medical Treatment for COVID-19 Influence on Pediatric Appendicitis: A Meta-Analysis.Cureus · 2022Review
- IL-5 Serum and Appendicular Lavage Fluid Concentrations Correlate with Eosinophilic Infiltration in the Appendicular Wall Supporting a Role for a Hypersensitivity Type I Reaction in Acute Appendicitis.International journal of molecular sciences · 2022Article
- Local Instrumental Variable Methods to Address Confounding and Heterogeneity when Using Electronic Health Records: An Application to Emergency Surgery.Medical decision making : an international journal of the Society for Medical Decision Making · 2022Article
- Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis.World journal of clinical cases · 2022Article
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Authors and funding
11 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUncomplicated 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.
methodsA 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.
resultsA 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.
conclusionThis study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions.
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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.