2005 Abstracts: Can Acute Appendicitis Be Treated by Antibiotics Alone
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Can Acute Appendicitis Be Treated by Antibiotics Alone
Sadie Ahanchi, Chicago Medical School, Chicago, IL; Katherine J. Liu, Rush University, Chicago, IL; Robert Walter, Irene Lin, Mark Pisaneschki, Stroger Hospital of Cook County, Chicago, IL
Acute appendicitis has been regarded as a surgical emergency and is treated with appendectomy at presentation. Although perioperative antibiotic coverage is an integral component of surgical management, antibiotic therapy alone without surgical intervention has not been accepted as adequate treatment especially in patients without abscess formation at presentation.
Methods: From September 2002 to August 2003, medical records of 170 consecutive patients who were diagnosed with acute appendicitis without abscess formation were retrospectively reviewed. Patients with acute appendicitis, either treated with emergency appendectomy (Group I, N=151) or received antibiotics alone (Group II, N=19), were compared. The mode of treatment was selected at the sole discretion of the attending surgeon. Patients with abscess formation either identified by CT at presentation or found intraoperatively were excluded. Results: The age (Group I 34.2±1.1 and Group II 38.5±3.1) and race for the two groups were similar. More female patients were treated with antibiotics alone (M:F 104:47 for Group I and 8:11 for Group II, P=0.037). In Group II, 5 patients underwent interval appendectomy (IA, 26%). One Group II patient without IA presented with recurrent acute appendicitis one year later and was subjected to emergency appendectomy. Group II patients had no complications except one patient with IA who developed a postoperative wound infection. Overall complication rate was 10% for Group I patients and 5% for Group II patients including complications with IA (p=0.22). The length of stay (LOS) was 2.61±0.21 days for Group I and 2.95±0.38 days for Group II patients (p=0.57) excluding the second admission for IA. The LOS for patients who underwent IA, including the second hospitalization, was 3.60±0.93 days, which is not significantly different from the LOS in Group I patients (p=0.39). Conclusion: When presenting with acute appendicitis without abscess formation, patients treated with antibiotics alone confers similar complication rate and length of hospital stay as those who underwent emergency appendectomy. Therefore, antibiotic therapy alone may be safely employed and should be considered in these patients.
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