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)
PURPOSE: The 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.
METHODS: The 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.
RESULTS: Of 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).
CONCLUSION: Although 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 REGISTRATION: Clinicaltrials.gov identifier (NCT number): NCT03080103.
| Errataetall: |
ErratumIn: Int J Colorectal Dis. 2021 Jan 28;:. - PMID 33507364 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
International journal of colorectal disease - 36(2021), 3 vom: 12. März, Seite 589-598 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Podda, Mauro [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 23.06.2021 Date Revised 23.06.2021 published: Print-Electronic ClinicalTrials.gov: NCT03080103 ErratumIn: Int J Colorectal Dis. 2021 Jan 28;:. - PMID 33507364 Citation Status MEDLINE |
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| doi: |
10.1007/s00384-021-03843-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320174980 |
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| 100 | 1 | |a Podda, Mauro |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis |b a propensity score-matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial) |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 23.06.2021 | ||
| 500 | |a Date Revised 23.06.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT03080103 | ||
| 500 | |a ErratumIn: Int J Colorectal Dis. 2021 Jan 28;:. - PMID 33507364 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: The 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 | ||
| 520 | |a METHODS: The 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 | ||
| 520 | |a RESULTS: Of 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) | ||
| 520 | |a CONCLUSION: Although 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 | ||
| 520 | |a TRIAL REGISTRATION: Clinicaltrials.gov identifier (NCT number): NCT03080103 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Antibiotic treatment | |
| 650 | 4 | |a Appendectomy | |
| 650 | 4 | |a Clinical outcomes | |
| 650 | 4 | |a Conservative treatment | |
| 650 | 4 | |a Multicenter study | |
| 650 | 4 | |a Uncomplicated appendicitis | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Poillucci, Gaetano |e verfasserin |4 aut | |
| 700 | 1 | |a Pacella, Daniela |e verfasserin |4 aut | |
| 700 | 1 | |a Mortola, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Canfora, Alfonso |e verfasserin |4 aut | |
| 700 | 1 | |a Aresu, Simona |e verfasserin |4 aut | |
| 700 | 1 | |a Pisano, Marcello |e verfasserin |4 aut | |
| 700 | 1 | |a Erdas, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Pisanu, Adolfo |e verfasserin |4 aut | |
| 700 | 1 | |a Cillara, Nicola |e verfasserin |4 aut | |
| 700 | 0 | |a ACTUAA Study Collaborative Working Group |e verfasserin |4 aut | |
| 700 | 1 | |a Serventi, Fernando |e investigator |4 oth | |
| 700 | 1 | |a Marini, Stefano |e investigator |4 oth | |
| 700 | 1 | |a Sirigu, Danilo |e investigator |4 oth | |
| 700 | 1 | |a Piga, Michela |e investigator |4 oth | |
| 700 | 1 | |a Coppola, Massimiliano |e investigator |4 oth | |
| 700 | 1 | |a Balestra, Francesco |e investigator |4 oth | |
| 700 | 1 | |a De Nisco, Carlo |e investigator |4 oth | |
| 700 | 1 | |a Pazzona, Marco |e investigator |4 oth | |
| 700 | 1 | |a Anania, Marco |e investigator |4 oth | |
| 700 | 1 | |a Pulighe, Fabio |e investigator |4 oth | |
| 700 | 1 | |a Lai, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Ottonello, Roberto |e investigator |4 oth | |
| 700 | 1 | |a De Angelis, Renato |e investigator |4 oth | |
| 700 | 1 | |a Piro, Silverio |e investigator |4 oth | |
| 700 | 1 | |a Calò, Pietro Giorgio |e investigator |4 oth | |
| 700 | 1 | |a Podda, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Saba, Luca |e investigator |4 oth | |
| 700 | 1 | |a Bottino, Vincenzo |e investigator |4 oth | |
| 700 | 1 | |a Dalla Caneva, Patrizia |e investigator |4 oth | |
| 700 | 1 | |a Canu, Luisa |e investigator |4 oth | |
| 700 | 1 | |a Piras, Emanuele |e investigator |4 oth | |
| 700 | 1 | |a Deserra, Antonello |e investigator |4 oth | |
| 700 | 1 | |a Virdis, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Gerardi, Chiara |e investigator |4 oth | |
| 700 | 1 | |a Gordini, Luca |e investigator |4 oth | |
| 700 | 1 | |a Sanna, Silvia |e investigator |4 oth | |
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