Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 11, Number 1, January 2019, pages 56-64


Acute Appendicectomy or Conservative Treatment for Complicated Appendicitis (Phlegmon or Abscess)? A Systematic Review by Updated Traditional and Cumulative Meta-Analysis

Figures

Figure 1.
Figure 1. Flow diagram of the search strategy.
Figure 2.
Figure 2. (a) Overall duration of hospital stay of the whole sample. (b) Overall duration of hospital stay of RCTs. (c) Overall duration of hospital stay of the high-quality RCTs.
Figure 3.
Figure 3. (a) Abdominal/pelvic abscesses of the whole sample illustrating favor of the conservative treatment. (b) Statistically non-significant studies of St Peter et al [33] and Mentula et al [34] demonstrating an impact of preference for laparoscopic appendicectomy compared to conservative treatment.
Figure 4.
Figure 4. Traditional and cumulative meta-analysis of complicated appendicitis. (a) Traditional meta-analysis; (b) cumulative meta-analysis.

Tables

Table 1. Characteristics of the Included Studies
 
Authors year study designAA (n)CM (n)Age AA-CM (years ± SD)Inclusion criteria*Matching criteria**NOS
AA: acute appendicectomy; CM: conservative management; RS: retrospective study; RCT: randomized controlled trial; NOS: Newcastle-Ottawa scale; NR: non-reported; HQ: high quality; ASA: American Society of Anesthesiologists. *Inclusion criteria: 1 = pediatric cases, 2 = adults, 3 = clinical symptoms, 4 = appendicular mass, 5 = appendicular abscess, 6 = perforated appendix. **Matching criteria: 1 = sex, 2 = age, 3 = duration of symptoms, 4 = ASA, 5 = body mass index, 6 = heart rate, 7 = white blood cells, 8 = temperature, 9 = C-reactive protein, 10 = size of appendicular mass.
Mentula et al [34], 2015 RCT303045 ± 14
46 ± 13.75
2, 3, 51, 2, 3, 4, 5, 7, 9, 109
St Peter et al [33], 2010 RCT202010.1 ± 4.2
8.8 ± 4.2, P = 0.31
2, 3, 4, 51, 3, 5, 7, 89
Aranda-Narvaez et al [32], 2010 RS151535.8 ± 12
35.4 ± 12
2, 3, 4, 51, 2, 3, 4, 6, 7, 8, 97
Roach et al [31], 2007 RS6032NR1, 3, 4, 5, 61, 2, 7, 87
Henry et al [30], 2007 RS48488.5 - 91, 3, 61, 2, 7, 88
Erdogan et al [29], 2005 RS192181, 3, 41, 2, 3, 5, 7, 85
Kumar et al [28], 2004 RCT202031.6 ± 14.6
26 ± 12.4
3, 425
Ho et al [27], 2004 RS273212 - 111, 3, 4, 61, 2, 3, 5, 7, 89
Brown et al [26], 2003 RS366831 - 352, 4, 51, 2, 4, 6, 7, 87
Samuel et al [25], 2002 PS34487 - 71, 3, 4, 51, 2, 37
Tingstedt et al [24], 2002 RS435042 - 502, 3, 4, 51, 2, 3, 6, 7, 88
Oliak et al [23], 2001 RS678831 - 352, 3, 4, 51, 2, 3, 4, 6, 7, 89
Bufo et al [22], 1998 RS464110 - 111, 3, 4, 5, 61, 2, 3, 7, 88
Handa et al [21], 1997 RS867 - 81, 3, 51, 2, 3, 77
Hume et al [20], 1995 RS786948 - 432, 3, 4, 51, 26
Gahukambe et al [19], 1993 RS759< 121, 3, 425
Hoffmann et al [18], 1991 RS192835 - 371, 2, 3, 4, 51, 34
Lewin et al [17], 1988 RS9598492, 3, 4, 51, 2, 34
Gomez-Lorenzo et al [16], 1987 RS8910639 - 531, 2, 3, 41, 2, 3, 7, 88
Foran et al [15], 1978 RS133030 - 342, 3, 4, 52, 3, 7, 8, 98
Gastrin et al [14], 1969 RS3623< 151, 3, 4, 51, 2, 36
Pooled n = 1,864810 (43%)932 (57%)HQ = 14

 

Table 2. Outcomes of Interest
 
Outcome of interestNo. of studies, no. of patientsStatistical method, estimated effect, 95% CIP valueI2 (%)
RCTs: randomized controlled trials; IV: intravenous; MD: mean difference; RE: random-effects; FE: fixed-effects; OR: odds ratio.
Duration of first hospitalization [15, 17, 23-27, 30, 34]9, 885MD: -0.48, 95% CI: -3.11 -2.160.7298
Overall duration of hospitalization [18, 21, 24-26, 28, 31, 33, 34]10, 605MD: -0.48, 95% CI: -2.86 -1.890.6994
Overall duration of hospitalization RCTs [28, 33, 34]3, 140MD: 1.48, 95% CI: -2.60 -5.57 (RE)
MD: -0.94, 95% CI: -1.26 to -0.62 (FE)
0.48
< 0.001
86
86
Overall duration of hospitalization high-quality RCTs [33, 34]2, 100MD: -0.99, 95% CI: -1.31 to -0.67 (FE)< 0.0010
Duration of IV antibiotics [22, 24, 25, 27, 34]5, 383MD: -0.52, 95% CI: -2.42 - 1.380.5994
Re-operations [14, 16, 20, 22, 34]5, 423Peto OR: 1.41, 95% CI: 0.64 - 3.130.4081
Overall complications [14-34]20, 1,660Peto OR: 2.90, 95% CI: 2.31 - 3.65< 0.00178
Abdominal/pelvic abscesses RCTs [33, 34]2, 100OR: 0.46, 95% CI: 0.17 - 1.290.140
Abdominal/pelvic abscesses [14, 16, 17, 23, 26, 30, 31, 32-34]11, 1,116OR: 3.13, 95% CI: 1.18 - 8.300.0271
Wound infections [16, 17, 19, 20, 22, 23, 26-28, 30, 32]12, 1,094OR: 3.95, 95% CI: 1.95 - 8.00< 0.00143