Review
Copyright ©The Author(s) 2021.
World J Clin Cases. Jul 16, 2021; 9(20): 5372-5390
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5372
Table 1 Clinical trials and meta-analyses comparing primary antibiotic treatment vs surgery for acute appendicitis
Ref.
Publishing year
Study design
Patients in NOM (n)
Age (yr)
Initially successful
Recurrence rate
Harnoss et al[10]2017Meta-analysis131213-7589.2%1-yr: 27.4%
Podda et al[11]2019Meta-analysis1743Unrestricted91.5%1-yr: 19.2%
Eriksson et al[13]1995RCT20≥ 1895%1-yr: 37%
APPAC study[14,15]2015Multicentre RCT257≥ 1894%1-yr: 27%; 5-yr: 39.1%;
Minneci et al[16]2016Prospective cohort377-1794.6%30-d: 5.4%; 1-yr: 18.9%
Georgiou et al[72]2017Meta-analysis413< 1897%Adjusted: 14%
Joo et al[73]2017Prospective observational20Pregnant women85%10%
Table 2 Effects of delaying appendectomy on incidence of complicated appendicitis
Ref.
Publishing year
Age (yr)
Patients (n)
Delay
Conclusion
Li et al[21]2019≥ 18 421In-hospital No differences were found between patients with uncomplicated and complicated AA
Lee et al[22]20182–85 1076In-hospitalAdvanced pathology was not associated with in-hospital delay
Aiken et al[23]2020≥ 18 1372In-hospitalNo differences between delayed cases and nondelayed cases for rate of perforation
Bhangu et al[24]2014Unrestricted2510In-hospitalShort delays of less than 24 h were not associated with increased rates of complex pathology
Stevenson et al[25]2017< 18955In-hospitalShort time delays from ED evaluation to operation did not independently increase the odds of perforation
Almström et al[26]2017< 152756In-hospitalIn-hospital delay was not associated with an increased rate of histopathologic perforation
Hornby et al[27]2014Unrestricted2403In-hospitalAppendicitis is not more likely to lead to perforation if a short delay prior to surgery is allowed
Jeon et al[28]2016Unrestricted4148In-hospitalHospital delays were not associated with significantly increased risks of perforation
van Dijk et al[30]2018Unrestricted20668In-hospitalDelaying appendicectomy for presumed uncomplicated appendicitis for up to 24 h after admission does not appear to be a risk factor for complicated appendicitis
Abdul Jawad et al[33]2020≥ 183004In-hospital≥ 24-h delay from ED triage to appendectomy is not associated with an increased rate of severity upgrade from simple to complicated appendicitis
Abou-Nukta et al[34]200618-90309In-hospitalDelaying appendectomies for AA for 12 to 24 h after presentation does not significantly increase the rate of perforations
Busch et al[74]2011Adult1675In-hospitalIn-hospital delay of more than 12 h is an independent risk factor for perforation
Giraudo et al[75]20133–90723In-hospitalDelayed appendectomy after 24 h from onset increases the rate of complicated AA
Meltzer et al[76]2019< 18857In-hospitalEvery hour increase in the time from ED triage to incision was independently associated with a 2% increase in the odds of perforation
Papandria et al[77]2014< 181388In-hospitalAn increased risk of perforation was found beginning on hospital day 2
Saar et al[79]2016≥ 18266TotalExtended time interval from the onset of initial symptoms to appendectomy is associated with increased rates of complicated AA
Elniel et al[80]201816–87190TotalA significant increase in the likelihood of a perforated appendicitis occurs after 72 h of symptom onset
Canal et al[81]2020Unrestricted9224TotalA longer length of preoperative stay significantly increases the risk of perforation
Bickell et al[82]2005Unrestricted219TotalRisk of rupture in ensuing 12-h periods rises to 5% after 36 h of untreated symptoms
Li et al[83]2019Unrestricted4889TotalComplicated appendicitis incidence was associated with overall elapsed time from symptom onset to admission or operation
Table 3 Effects of delaying appendectomy on incidence of postoperative complications
Ref.
Publishing year
Age (yr)
Patients (n)
Delay
Conclusion
Aiken et al[23]2020≥ 18 1372In-hospitalNo differences between delayed cases and nondelayed cases for POCs
Almström et al[26]2017< 152756In-hospitalTiming of surgery was not an independent risk factor for POCs
van Dijk et al[30]2018Unrestricted20668In-hospitalDelaying appendicectomy for presumed uncomplicated appendicitis for up to 24 h after admission does not appear to be a risk factor for postoperative SSI
Kim et al[35]2018Unrestricted397In-hospitalThe time from CT to operation has no effect on the results of appendicitis
Boomer et al[36]2016< 181338In-hospitalA 16-h delay from ED presentation or a 12-h delay from hospital admission to appendectomy was not associated with an increased risk for SSI
Fair et al[37]2015Unrestricted69926In-hospitalThere was a 2-fold increase in complication rate for patients delayed longer than 48 h
Lee et al[84]2012< 18683016In-hospitalIn-hospital delay beyond 2 d is associated with significant negative outcomes with regard to complications
Teixeira et al[85]2012Unrestricted4108In-hospitalAppendectomy delay was associated with a significantly increased risk of SSI in patients with nonperforated appendicitis