A Meta-analysis To Compare The Efficacy Of Early Surgery And Conservative Treatment For Adult Complicated Appendicitis

Objective:Analyze the literature from 2000 to January 2020 on immediate operation and conservative treatment of complicated appendicitis in adults,explore the differences in outcomes such as length of stay,duration of surgery,postoperative complications,and unplanned intervention events between the two treatment regimens.And compare the clinical effects of early surgical treatment and non-surgical treatment(conservative treatment)for complicated appendicitis,and provide help for the designation of clinical treatment plans.Method:Search the research literature on the treatment of adult complicated appendicitis in EMBASE,Pub Med,Web of Science,Ovid,Cochrane database from 2000 to January2020.Randomized controlled trials or cohort studies that compared the clinical effects of early surgical methods(laparoscopic or open)and conservative methods(anti-infection or including early drainage,elective appendectomy)were included in the study.Sort out the data of the two treatment options in the selected study,including hospital stay,operation time,additional intervention,and complications such as incision infection,abdominal abscess,intestinal obstruction,and intestinal fistula.Divide all data into two groups:immediate operation group(IO group)and conservative treatment group(CM group),and analyze the various indicators in the study.When P<0.05,the difference is considered to be statistically significant.If OR<1,the IO group is better than the CM group.The analysis of heterogeneity among the studies used the X~2 test,with I~2<50%as the criterion for evaluating heterogeneity,the fixed effects model was used for homogeneity studies(P>0.05,I~2<50%),and the random effects model was used for heterogeneity studies(P<0.05,I~2>50%).Conduct bias analysis on heterogeneity research,and apply clipping method to analyze the robustness of conclusions.Comprehensive evaluation of the pros and cons of early surgical treatment and conservative treatment for complicated appendicitis.Results:A total of 1801 non-repetitive articles were obtained.Finally,14 studies were included in the meta-analysis,4 randomized controlled studies(RCT),and 10 retrospective studies(RS)were included.1601 people were included in the study,of which 845 were in the surgical group(IO)and 756 were in the conservative group(CM).Compared with conservative treatment,the hospitalization time of early surgical treatment patients was reduced by about 1 day(WMD=-1.29,95%CI[-2.42,-0.16],P=0.03<0.05),the incidence of additional intervention was lower than that of conservative treatment(OR=0.18,95%CI[0.11,0.30],P<0.00001),the difference was statistically significant.There was no statistically significant difference in complications(OR=1.65,95%CI[0.94,3.84],P=0.1>0.05)and abdominal abscess(OR=0.9,95%CI[0.54,1.47],P=0.66>0.05)between the immediate operation group and the conservative treatment group;however,the incidence of incision or drainage infection(OR=2.41,95%CI[1.08,5.38],P=0.03<0.05)and intestinal obstruction(OR=4.14,95%CI[2.21,7.75],P<0.00001)was higher,and the difference was statistically significant.Conclusion:Complicated appendicitis represented by gangrene,perforation or abscess is more serious than acute simple appendicitis.At present,there are mainly two diagnosis and treatment plans:immediate surgery and conservative treatment.The current research and clinical guidelines do not give an ideal diagnosis and treatment plan for this type of appendicitis.Through the analysis of clinical studies on adult complicated appendicitis reported in the past 20 years,it can be found that patients with early surgery have shorter hospital stays for conservatively treated patients and require fewer additional interventions(conservative failures,contraindicated surgery,etc.).This means that it can significantly reduce the chance of patients with complicated appendicitis being admitted to the hospital,and reduce the burden of follow-up and the consumption of medical resources.At the same time,early surgical treatment has a higher probability of incision infection,intestinal obstruction and other complications than conservative treatment.In clinical diagnosis and treatment,doctors should carefully choose treatment plans on the basis of fully respecting the patient’s right to informed consent.