• D Peter O'Leary, Siun M Walsh, Jarlath Bolger, Chwanrow Baban, Hilary Humphreys, Sorcha O'Grady, Aisling Hegarty, Aoife M Lee, Mark Sheehan, Jack Alderson, Ruth Dunne, Martina M Morrin, Michael J Lee, Colm Power, Deborah McNamara, Niamh McCawley, Will Robb, John Burke, Jan Sorensen, and Arnold D Hill.
• Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
• Ann. Surg. 2021 Aug 1; 274 (2): 240247240-247.

ObjectiveEvaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.Summary Background DataConservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.MethodsSymptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.ResultsOne hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).ConclusionsPatients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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