1. Appendicitis --- Operate or Antibiotics?
E. Patchen Dellinger, MD University of Washington

2. Operate of Course ! !
Duuhh

3. Ultrasound Findings after Antibiotic Rx of Appendicitis
Ultrasound helpful to verify response and see failures 7/19 (37%) failures to O.R. in 1 year
Eriksson. Acta Radiologica 1995; 36: 173-7

4. Randomized Trial – O.R. vs. Antibiotics Amox/Clav 8-16 days
O.R. (119) Ab (120) 30 d peritonitis 2 (2%) 9 (8%) Length of stay 3.04 d 3.96 d Appe_itis at 30d 0 14 (12%) Appe_itis 30d-1 yr 0 30 (25%) SBO at 1 year 0 1
Vans. Lancet 2011; 377:1573-9

5. NOTA (Nonoperative Treatment for Acute Appendicitis) –Amox/Clav
To O.R. in 7d 19/159 (12%) SSI 6/19 (32%) Recurrence in 2 yr 22/140 (16%) To O.R. 7 d-2 yr 8/140 (6%) Total 2 yr 27/159 (17%)
Di Saverio. Ann Surg 2014; 260:

6. Surgical Appendectomy Length of Hospital Stay
Time of Adm hr hr hr Ave for 176 pts 27.9 hr
Crandall. Surg Infect 2009; 10: 65-69

7. Randomized Trial – Children Appendectomy vs. Antibiotics
Appe (26) Ab (24) Complications 0 2 O.R. 1 d – 1 yr 0 9/24 (38%) Length of Stay 34.5 hr 51.5 hr
Svensson. Ann Surg 2015; 261: 67-71

8. Varadhan Meta-analysis 5 studies with 900 pts
Surgery Antibiotic Total “Success” 398 (93%) 274 (58%) Recurrence 0 68 (14%) Late Surgery (34%)
Varadhan. BMJ 2012; 344: e2156

9. Appendicitis – L.O.S. & Charges CA Office Statewide Health Planning & Development 231,678 patients
Surg Ab p L.O.S. (days) <0.001 Cost (x $1,000) <0.001
McCutcheon. J Amer Coll Surg 2014; 218:

10. Cochrane Review
Cured within 2 weeks and No Recurrence in 2 years Appendectomy 97.4% Antibiotics 73.4%
Wilms.Cochrane DataSyst Rev 2011; #11.CD008359

11. Meta-Analysis Appendectomy vs. Ab First
Negative appendectomy 11% Recurrence after Ab 14% Range 7% – 35% over 1 year 14% / %
Mason. Surg Infect 2012; 13:74-84

12. Treatment Failure Index Adm Appendectomy vs. Ab First
Mason. Surg Infect 2012; 13:74-84

13. Overall Treatment Failure Appendectomy vs. Ab First
Mason. Surg Infect 2012; 13:74-84

14. Length of Stay Appendectomy vs. Ab First
Mason. Surg Infect 2012; 13:74-84

15. Better to Operate Fewer failures No recurrence Less expensive
Less time in hospital

16. Rebuttal

17. Be Modern
Single Incision Appendectomy