Diagnosis and treatment of appendicitis: Systematic review and meta-analysis

Ryan Lamm, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Sunjay S. Kumar, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Sunjay.kumar@jefferson.edu.
Amelia T. Collings, Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA.Follow
Ivy N. Haskins, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Ahmed Abou-Setta, Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
Nisha Narula, Department of Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA.
Pramod Nepal, Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Nader M. Hanna, Department of Surgery, Queen's University, Kingston, ON, Canada.
Dimitrios I. Athanasiadis, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Stefan Scholz, Division of General and Thoracic Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Joel F. Bradley, Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Arianne T. Train, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA.
Philip H. Pucher, Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Francisco Quinteros, Advocate Aurora Health
Bethany Slater, Advocate Aurora HealthFollow

Affiliations

Advocate Lutheran General Hospital

Abstract

Background:The optimal diagnosis and treatment of appendicitis remains controversial. This systematic review details the evidence and current best practices for the evaluation and management of uncomplicated and complicated appendicitis in adults and children.

Methods:Eight questions regarding the diagnosis and management of appendicitis were formulated. PubMed, Embase, CINAHL, Cochrane and clinicaltrials.gov/NLM were queried for articles published from 2010 to 2022 with key words related to at least one question. Randomized and non-randomized studies were included. Two reviewers screened each publication for eligibility and then extracted data from eligible studies. Random effects meta-analyses were performed on all quantitative data. The quality of randomized and non-randomized studies was assessed using the Cochrane Risk of Bias 2.0 or Newcastle Ottawa Scale, respectively.

Results:2792 studies were screened and 261 were included. Most had a high risk of bias. Computerized tomography scan yielded the highest sensitivity (> 80%) and specificity (> 93%) in the adult population, although high variability existed. In adults with uncomplicated appendicitis, non-operative management resulted in higher odds of readmission (OR 6.10) and need for operation (OR 20.09), but less time to return to work/school (SMD - 1.78). In pediatric patients with uncomplicated appendicitis, non-operative management also resulted in higher odds of need for operation (OR 38.31). In adult patients with complicated appendicitis, there were higher odds of need for operation following antibiotic treatment only (OR 29.00), while pediatric patients had higher odds of abscess formation (OR 2.23). In pediatric patients undergoing appendectomy for complicated appendicitis, higher risk of reoperation at any time point was observed in patients who had drains placed at the time of operation (RR 2.04).

Conclusions:This review demonstrates the diagnosis and treatment of appendicitis remains nuanced. A personalized approach and appropriate patient selection remain key to treatment success. Further research on controversies in treatment would be useful for optimal management.

Type

Article

PubMed ID

37914953

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