Академический Документы
Профессиональный Документы
Культура Документы
Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated
Meta-Analysis of Randomised Controlled Trials
■ Writers:
■ Departments:
1. Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health
Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, E
Floor, West Block, Nottingham, NG7 2UH, UK.
2. Department of Epidemiology and Public Health, Nottingham University Hospitals, City Hospital
Campus, Nottingham, NG5 1PB, UK.
■ Publisher: World Journal of Surgery, October 2016, Volume 40, issue 10, pp 2305–2318
Uncomplicated acute appendicitis has been managed traditionally by early appendicectomy. However, recently, there has
been increasing interest in the potential for primary treatment with antibiotics, with studies finding this to be associated
with fewer complications than appendicectomy. The aim of this study was to compare outcomes of antibiotic therapy with
appendicectomy for uncomplicated acute appendicitis.
■ Method
This meta-analysis of randomised controlled trials included adult patients presenting with uncomplicated acute
appendicitis treated with antibiotics or appendicectomy. The primary outcome measure was complications. Secondary
outcomes included treatment efficacy, hospital length of stay (LOS), readmission rate and incidence of complicated
appendicitis.
■ Results
Five randomised controlled trials with a total of 1430 participants (727 undergoing antibiotic therapy and 703 undergoing
appendicectomy) were included. There was a 39 % risk reduction in overall complication rates in those treated with
antibiotics compared with those undergoing appendicectomy (RR 0.61, 95 % CI 0.44–0.83, p = 0.002). There was no
significant difference in hospital LOS (mean difference 0.25 days, 95 % CI -0.05 to 0.56, p = 0.10). In the antibiotic cohort,
123 of 587 patients initially treated successfully with antibiotics were readmitted with symptoms suspicious of recurrent
appendicitis. The incidence of complicated appendicitis was not increased in patients who underwent appendicectomy after
‘‘failed’’ antibiotic treatment (10.8 %) versus those who underwent primary appendicectomy (17.9 %).
■ Conclusion
Increasing evidence supports the primary treatment of acute uncomplicated appendicitis with antibiotics, in terms of
complications, hospital LOS and risk of complicated appendicitis. Antibiotics should be prescribed once a diagnosis of
acute appendicitis is made or considered.
Background
We found 5 of the 349 studies identified in the screening process eligible for inclusion.
Two studies which met the inclusion criteria were excluded after closer review: one due to
retraction of the study following publication and one due to a lack of evidence of
randomisation.
Results
■ Complications
All studies There was 39% risk reduction (RR 0.61, 95% CI 0.44-0.83, p= 0.002) in
complication rates in patients treated with antibiotics when compared with those
undergoing appendicectomy
Excluding 1 study with cross-over risk ratio increased further (RR 0.52, 95% CI 0.36-
0.75, p=0.0005)
■ Length of stay
All studies no significant difference (mean difference 0.25 days, 95% CI 0.05-0.56,
p=0.10)
■ Treatment efficacy
Overall treatment efficacy in the antibiotic group at 1-year follow-up was 62.6% versus
88.1% in the appendicectomy group
Excluding 1 study with cross-over treatment efficacy associated with antibiotic therapy
ranging from 65-75.8%
Hansson et al. 41.1%, possibly related to the high cross-over rates in the study
Results
■ Most recent study stipulated a 24% non inferiority margin between
the therapy modalities.
Results
■ Complicated appendicitis
Those treated primarily with antibiotics who went on to an appendicectomy for failure of
treatment did not have a higher rate of complicated appendicitis than those who
underwent appendicectomy as the primary treatment modality (10.9% vs 17.9%)
■ Readmissions
Antibiotics 123 of 602 patients (20.4%) were readmitted with symptoms suspicious
of recurrent appendicitis
3. Cukup menarik Ya
Abstrak Ya/Tidak
6. Abstrak satu paragraf atau terstruktur Ya
7. Mencakup komponen IMRAD Ya
8. Secara keseluruhan informatif Ya
9. Tanpa singkatan, selain yang baku Ya
10. Kurang dari 250 kata Tidak (258 kata)
Pendahuluan Ya/Tidak
13. Paragraf berikut menyatakan hipotesis atau tujuan penelitian Hipotesis tidak ada, tujuan ada
di paragraf 3
14. Didukung oleh pustaka yang relevan Ya
Metode Ya/Tidak
16. Disebutkan desain, tempat, dan waktu penelitian Ya(desain), tidak (tempat dan
waktu)
17. Disebutkan populasi sumber (populasi terjangkau) Tidak
23. Observasi, pengukuran, serta intervensi dirinci sehingga orang lain dapat Tidak
mengulanginya
24. Ditulis rujukan bila teknik pengukuran tidak dirinci Tidak
Hasil Ya/Tidak
67. Bahasa yang baik dan benar, enak dibaca, informatif, dan efektif Ya