A meta-analysis and trial sequential analysis comparing nonoperative versus operative management for uncomplicated appendicitis: a focus on randomized controlled trials

Autor: Francesco Brucchi, Greta Bracchetti, Paola Fugazzola, Jacopo Viganò, Claudia Filisetti, Luca Ansaloni, Francesca Dal Mas, Lorenzo Cobianchi, Piergiorgio Danelli
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: World Journal of Emergency Surgery, Vol 19, Iss 1, Pp 1-15 (2024)
Druh dokumentu: article
ISSN: 1749-7922
DOI: 10.1186/s13017-023-00531-6
Popis: Abstract Background The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis. Methods A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs. Results Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61—1.04, P = 0.07, I 2 = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p
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