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Non-operative management with antibiotics for acute uncomplicated appendicitis (AUA), as opposed to mainstay appendectomy, failed to make its case as first-choice therapy in a national
retrospective study.
Although the overall failure rate was lower than previously reported, at about 4%, non-operative management was associated with worse short-term outcomes, including a 40% higher rate of
abscess and more than double the rate of readmission. And although the mean index hospitalization cost was less for non-operative management, the overall mean total cost of
appendicitis-associated care ended up being higher.
"Taken together, these data do not support the use of non-operative management as first-line therapy for uncomplicated appendicitis until more conclusive randomized clinical trial data
become available," wrote Kristan L. Staudenmayer, MD, MS, of Stanford University in California, and co-authors in JAMA Surgery.
The investigation used claims from 2008 through 2014 from a private insurance database for patients with uncomplicated appendicitis, undergoing non-surgical management (treatment arm) or
appendectomy (control arm).
Of 58,329 patients identified with uncomplicated appendicitis (mean age 31.9, 52.7% men), 4.5% had non-operative management while the remaining 95.5% had appendectomy. Patients in the
non-operative arm were significantly older, at a mean age of 34.2 compared with 31.8 years (and 31.4% versus 25.8% in the 46-64 age group), and had more comorbid conditions, Charlson index
≥2 (7.2% versus 4.7%).
In terms of outcomes, the non-operative group was more likely to have appendicitis-associated readmissions, for an adjusted odds ratio (aOR) of 2.13 (95% CI 1.63-2.77, P