Non-operative versus operative management of uncomplicated acute appendicitis: a randomized controlled study in Sierra Leone
Abstract
Background: Acute appendicitis is the leading cause of acute abdomen in young adults, typically managed by appendectomy. A growing body of evidence supports non-operative management as an alternative for uncomplicated cases. This study aimed to compare the effectiveness of non-operative management (NOM) versus operative management (OM) for uncomplicated acute appendicitis.
Methods: A prospective, longitudinal, randomized controlled trial was conducted at Connaught Hospital, Sierra Leone. Sixty patients were randomized: 30 to NOM and 30 to OM. NOM patients received intravenous metronidazole and ceftriaxone for 48 h, followed by oral metronidazole and ciprofloxacin for 5 days. OM patients underwent open appendectomy. NOM patients were monitored for symptom resolution or progression; failure required appendectomy. Both groups were followed up on days 7, 10, 30, 60, and 90 post-admissions to assess recurrence, cost of care, and quality of life (QoL).
Results: The median age was 26 years (IQR 14-42) for NOM and 27 years (IQR 18-54) for OM. Most patients were males (NOM: 66.7%, OM: 63.3%). Antibiotic treatment was successful in 18 (60%) NOM patients. Failure occurred in 12 (40%) NOM patients, 11 during the index admission, with 1 (3.3%) experiencing recurrence within a week of discharge. Successful NOM resulted in a significantly improved QoL score (5.98), a shorter mean hospital stays (4 days), a lower mean cost of care (NLe 482.29; $49.08), and no catastrophic health…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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