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Background <p>This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis.</p> Methods <p>A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024. Only randomized controlled trials (RCTs) were included, excluding studies involving adult patients and/or participants with complicated appendicitis. The variables considered were treatment complications, treatment efficacy during index admission and one-year follow-up, length of hospital stay (LOS), quality of life, and presence of appendicoliths.</p> Results <p>Three RCTs involving 269 participants (134 antibiotics/135 appendectomy) were included. There was no statistically significant difference between the two treatments in terms of complication risk (combined RD = − 0.03; 95% CI − 0.11; 0.06, <i>p</i> = 0.54), even including complications related to NOM failure. The risk of complication-free treatment success rate in the antibiotic group is lower than in the surgery group (combined RD = − 0.05; 95% CI − 0.13; − 0.04; <i>p</i> = 0.29). In patients without appendicolith, the combined risk difference of treatment success between NOM and OM was not statistically significant − 0.01 (IC − 0.17; 0.16; <i>p</i> value: 0.93). There is no statistical difference in terms of efficacy at 1&#xa0;year, between NOM and OM (combined RD = − 0.06; 95% CI − 0.21; 0.09), <i>p</i> = 0.44). The LOS in the NOM group is significantly longer than in the OM group (difference of median = − 19.90&#xa0;h; 95% CI − 29.27; − 10.53, <i>p</i> &lt; .0001).</p> Conclusions <p>This systematic review and meta-analysis provide evidence that NOM is safe and feasible for children with uncomplicated appendicitis and, in the group of patients without appendicolith, it is associated with a similar success rate to OM. However, more high-quality studies with adequate power and construction are still needed.</p>

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Non-operative management of uncomplicated appendicitis in children, why not? A meta-analysis of randomized controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月25日

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  • Francesco Brucchi,
  • Claudia Filisetti,
  • Ester Luconi,
  • Paola Fugazzola,
  • Dario Cattaneo,
  • Luca Ansaloni,
  • Gianvincenzo Zuccotti,
  • Simona Ferraro,
  • Piergiorgio Danelli,
  • Gloria Pelizzo

摘要

Background

This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis.

Methods

A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024. Only randomized controlled trials (RCTs) were included, excluding studies involving adult patients and/or participants with complicated appendicitis. The variables considered were treatment complications, treatment efficacy during index admission and one-year follow-up, length of hospital stay (LOS), quality of life, and presence of appendicoliths.

Results

Three RCTs involving 269 participants (134 antibiotics/135 appendectomy) were included. There was no statistically significant difference between the two treatments in terms of complication risk (combined RD = − 0.03; 95% CI − 0.11; 0.06, p = 0.54), even including complications related to NOM failure. The risk of complication-free treatment success rate in the antibiotic group is lower than in the surgery group (combined RD = − 0.05; 95% CI − 0.13; − 0.04; p = 0.29). In patients without appendicolith, the combined risk difference of treatment success between NOM and OM was not statistically significant − 0.01 (IC − 0.17; 0.16; p value: 0.93). There is no statistical difference in terms of efficacy at 1 year, between NOM and OM (combined RD = − 0.06; 95% CI − 0.21; 0.09), p = 0.44). The LOS in the NOM group is significantly longer than in the OM group (difference of median = − 19.90 h; 95% CI − 29.27; − 10.53, p < .0001).

Conclusions

This systematic review and meta-analysis provide evidence that NOM is safe and feasible for children with uncomplicated appendicitis and, in the group of patients without appendicolith, it is associated with a similar success rate to OM. However, more high-quality studies with adequate power and construction are still needed.