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Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study

Lookup NU author(s): Venkatesh Kanakala



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up. Methods: A prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment. Results: A total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P < 0.001) were noted in the antibiotic management group. Accounting for interval appendicectomy rates, the mean total cost was €1034 lower per patient managed without surgery. Conclusion: This study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions.

Publication metadata

Author(s): Javanmard-Emamghissi H, Hollyman M, Boyd-Carson H, Doleman B, Adiamah A, Lund JN, Moler-Zapata S, Grieve R, Moug SJ, Tierney GM, The COVID: HAREM Collaborative Group

Publication type: Article

Publication status: Published

Journal: British Journal of Surgery

Year: 2021

Volume: 108

Issue: 11

Pages: 1351-1359

Print publication date: 01/11/2021

Online publication date: 03/09/2021

Acceptance date: 20/07/2021

Date deposited: 25/01/2023

ISSN (electronic): 1365-2168

Publisher: Oxford University Press


DOI: 10.1093/bjs/znab287

PubMed id: 34476484


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