%0 Journal Article
%@ 0031-4005
%A Georgiou, R
%A Eaton, SJ
%A Stanton, M
%A Pierro, A
%A Hall, N
%D 2017
%F discovery:1529248
%I American Academy of Pediatrics
%J Pediatrics
%N 3
%T Efficacy and safety of non-operative treatment for acute appendicitis: a meta-analysis
%U https://discovery.ucl.ac.uk/id/eprint/1529248/
%V 139
%X CONTEXT: Non-operative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendicectomy.  OBJECTIVE: To determine safety and efficacy of NOT based on current literature.  DATA SOURCES: Three electronic databases.  STUDY SELECTION: All articles reporting NOT for AUA in children.  DATA EXTRACTION: Two reviewers independently verified study inclusion and extracted data.  RESULTS: Ten articles reporting 413 children receiving NOT were included. Six, including one RCT, compared NOT with appendicectomy. The remaining four reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95%CI 96, 99). Initial length of hospital stay was shorter in children treated with appendectomy compared to NOT (mean difference 0.5 days [95%CI 0.2, 0.8]; p=0.002). At final reported follow-up (range 8 weeks – 4 years), NOT remained effective (no appendicectomy performed) in 79% of children (95%CI 73, 86%). Recurrent appendicitis occurred in 14% (95%CI 7, 21). Complications, and total length  of hospital stay during follow-up were similar for NOT and appendicectomy. No serious adverse events related to NOT were reported.  LIMITATIONS: The lack of prospective randomised studies limits definitive conclusions to influence clinical practice.  CONCLUSIONS: Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA and the rate of recurrent appendicitis is 14%.  Longer term clinical outcomes and cost effectiveness of NOT compared to appendicectomy require further evaluation, preferably as large randomised trials to reliably inform decision making.