![]() ![]() Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. METHODS: A systematic literature search of the PubMed, Cochrane, and Scopus databases was performed with respect to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement (end-of-search date: January 29, 2017). The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. N2 - BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. T1 - Operation versus antibiotics-The appendicitis conundrum continues Addressing patients' expectations via a shared decision-making process is a crucial step in optimizing nonoperative outcomes.", CONCLUSIONS: Conservative management of uncomplicated appendicitis in adults warrants further study. No difference was found between the two treatment modalities in terms of perforated appendicitis rates (RR, 0.52 95% CI, 0.14-1.92), length of hospital stay (weighted mean difference, 0.20 95% CI,-0.16 to 0.56), duration of pain (WMD, 0.22 95% CI,-5.30 to-5.73), and sick leave (WMD,-2 95% CI,-5.2 to 1.1). Overall complications were significantly higher in the surgery group (166/703 ) compared with the antibiotics group (56/727 ) (RR, 0.32 95% CI, 0.24-0.43 p < 0.001). Treatment efficacy at 1-year follow-up was significantly lower (63.8%) for antibiotics compared with the surgery group (93%) (risk ratio, 0.68 95% confidence interval, 0.60-0.77 p < 0.001). Overall, 1,430 adult patients with uncomplicated acute appendicitis underwent either nonoperative (n = 727) or operative management (n = 703). RESULTS: Five RCTs were included in this review. Quality assessment of included RCTs was performed using the modified Jadad scale. The random-effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when substantial heterogeneity was encountered otherwise, the fixed-effects (Mantel-Haenszel) model was implemented. Addressing patients' expectations via a shared decision-making process is a crucial step in optimizing nonoperative outcomes.Ībstract = "BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. ![]() BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. ![]()
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