Comparison of operative and non operative management of acute appendicitis

BACKGROUND
In this prospective study, operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness.
METHODS
Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospective study. Nonoperative medical therapy was performed in 107 patients (Group 1), and 183 patients were treated surgically (Group 2). Routine follow-up controls were done on the 10th day, at the 3rd and 6th months and at the first year after discharge in Group 1. Both groups were compared regarding age, gender, mean hospital stay, modified Alvarado score, morbidity, mortality, and cost effectiveness.
RESULTS
The male/female ratio of Groups 1 and 2 were 65/42 (mean age: 30.98±1.30) and 125/58 (mean age: 26.25±0.79), respectively. In Group 1, 19 patients were operated. Operation indications were resistance to therapy, patient’s request, and operation in another hospital. Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2, the mean cost of the therapy was $559 in Group 2 and $433 in Group 1. Morbidity rates were similar, with no mortality in either group.
CONCLUSION
With its high success rate and cost effectiveness, medical treatment seems to be a good alternative to the gold standard therapy of surgery in management of acute appendicitis.

Akut apandisitte ameliyatsýz tedavi ve cerrahi tedavinin karþýlaþtýrýlmasý

AMAÇ
Bu prospektif çalýþmada, akut apandisitte konservatif tedavi ve cerrahi tedavinin güvenilirlik ve etkinlik açýsýndan karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Mart 2005 ile Mart 2006 arasý klinik olarak akut apandisit tanýsý alan 290 hasta acil servise baþvurdu. Bu hastalarýn 107’sine ameliyatsýz antibiyotik tedavisi (Grup 1), 183’üne cerrahi tedavi (Grup 2) uygulandý. Grup 1’de taburcu edilen hastalar 10. gün, 3. ay, 6 ay ve 1. yýlda rutin kontrollere çaðrýldýlar. Her iki grup yaþ, cinsiyet, ortalama hastanede kalýþ süresi, modifiye Alvarado skoru, morbidite, mortalite ve maliyet etkinliði açýsýndan deðerlendirildi.
BULGULAR
Grup 1 ve Grup 2’de erkek/kadýn oraný ve ortalama yaþlar sýrasýyla 65/42 ile 30,98±1,30 ve 125/58 ile 26,25±0,79 idi. Grup 1’de hastalarýn 19’u ameliyat edildi. Ameliyat endikasyonu tedaviye direnç, hastanýn kararý, baþka merkezlerde ameliyat idi. Ortalama hastanede kalýþ süresi Grup 1’de istatistiksel olarak daha uzun olsa da ortalama maliyet Grup 1’de 433 $ iken Grup 2’de 559 $ olarak hesaplandý. Morbidite oranlarý her iki grupta benzer olup hiç mortalite görülmedi.
SONUÇ
Günümüzde altýn standart tedavi þekli cerrahi giriþim olarak bilinen akut apandisitte, seçilen olgularda antibiyoterapi ile ameliyatsýz takibin baþarý oranýnýn yüksek ve düþük maliyetli bir alternatif olabileceðini düþünüyoruz.