• H Javanmard-Emamghissi, M Hollyman, H Boyd-Carson, B Doleman, A Adiamah, J N Lund, S Moler-Zapata, R Grieve, S J Moug, G M Tierney, and COVID: HAREM (Had Appendicitis and Resolved/Recurred Emergency Morbidity/Mortality) Collaborative Group.
• Faculty of Medicine and Health Sciences, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK.
• Br J Surg. 2021 Nov 11; 108 (11): 135113591351-1359.

BackgroundUncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up.MethodsA prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment.ResultsA total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P < 0.001) were noted in the antibiotic management group. Accounting for interval appendicectomy rates, the mean total cost was €1034 lower per patient managed without surgery.ConclusionThis study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

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