AB235. SOH26AB_0082. Non-operative management vs. operative management of acute uncomplicated in adults: a systematic review and meta-analysis in adults
General Posters III

AB235. SOH26AB_0082. Non-operative management vs. operative management of acute uncomplicated in adults: a systematic review and meta-analysis in adults

Almuntasir Beallah Eltayb, Ahmed Elmakki, Gerry O’Donoghue

Department of General Surgery, University Hospital Waterford, Waterford, Ireland

Background: Acute uncomplicated appendicitis (AUA) has been managed with appendectomy; however, non-operative management (NOM) using antibiotics has gained attention in recent decades, particularly following the coronavirus disease 2019 (COVID-19) pandemic. Our aim is to evaluate the efficacy, safety, and cost-effectiveness of NOM compared to surgery in adults.

Methods: PubMed, Embase, Cochrane Library, and Google Scholar were searched for studies published in the last 10 years comparing NOM and operative management in adults with AUA. Twelve studies met the inclusion criteria. Primary outcomes were recurrence rate, index admission failure, success rate, complication rate, and length of hospital stay. Secondary outcomes were pain levels, health care costs, and patient satisfaction.

Results: Pooled recurrence rate after NOM was ~14% [95% confidence interval (CI): 9.3–20.2%]. The success rate was 77.2% (95% CI: 72.7–81.1%), with index admission failure at 6.7% (95% CI: 2.7–15.3%). Length of hospital stay was shorter for NOM [standard mean difference (SMD) =−1.01; 95% CI: −1.85 to −0.18], NOM patients stayed 3.19±1.99 days vs. appendectomy patients stayed for 4.58±4.68 days. Complication rates were lower in NOM 7.6% compared to operative management 13.0%, though the odds ratio (OR) wasn’t statistically significant (OR =0.53; 95% CI: 0.21–1.36). Pain scores reported favouring NOM in the short term. Patient satisfaction was similar in both groups. United States (US) studies showed higher costs with NOM, while European studies reported lower costs

Conclusions: NOM is a safe and effective alternative to surgery for adults with AUA. However, recurrence and early failure remain a valid concern. Further long-term studies are needed to validate these findings and update guidelines.

Keywords: Acute appendicitis; non-operative management (NOM); appendectomy; antibiotics; surgery

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab235
Cite this abstract as: Eltayb AB, Elmakki A, O’Donoghue G. AB235. SOH26AB_0082. Non-operative management vs. operative management of acute uncomplicated in adults: a systematic review and meta-analysis in adults. Mesentery Peritoneum 2026;10:AB235.

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