Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: A meta-analysis of post-intervention complications

•Antibiotics have been investigated as treatment for appendicitis, instead of surgery.•A recent meta-analysis reported antibiotics were safe and effective for appendicitis.•We completed a meta-analysis comparing antibiotics and surgery for appendicitis.•We compared post-intervention major complications (peritonitis, abscess).•Antibiotics are unsafe for appendicitis (cf. surgery: Number Needed to Harm, 10.7).

SummaryObjectivesRecent literature has concluded antibiotic therapy results in fewer complications than appendicectomy for patients with uncomplicated appendicitis. This studies aim was to undertake a meta-analysis of major post-intervention outcomes in patients with suspected uncomplicated appendicitis treated with antibiotics or appendicectomy, and determine which treatment is associated with the lowest rate of major complications.MethodsWe analysed randomised trials of antibiotics vs. appendicectomy in adults with suspected uncomplicated appendicitis. The primary outcome measure was a composite of major complications, peritonitis and intra-abdominal abscess, occurring after appendicectomy or initiation of therapeutic antibiotics.ResultsThe rate of major post-intervention complications was 0.8% (2/263) in the appendicectomy group and 10.1% (27/268) in the antibiotic group. This difference was statistically significant by the random effects model: Risk Ratio 7.71, 95% C.I. 2.33 to 25.53, Risk Difference 0.09: 95% C.I. 0.05 to 0.13. The Number Needed to Harm (NNH) from antibiotic therapy is 10.7.ConclusionsSuspected uncomplicated appendicitis has a lower rate of major post-intervention complications when managed with primary appendicectomy compared to antibiotic therapy.