Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach.

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  • Additional Information
    • Affiliation:
      Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar Ireland
      Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Introduction: Acute appendicitis represents the commonest cause of acute intra-abdominal pathology. Appendectomy and antibiotics are the mainstay of therapy for appendicitis. Evidence is emerging that antibiotics alone may adequately treat most cases of appendicitis. Decision analysis is a quantitative method of examining alternate treatment strategies. This study describes a modelled decision analysis comparing operative and conservative management of appendicitis.Methods: The base case patient is a healthy, 23-year-old male presenting with migratory pain to the right iliac fossa (RIF) and elevated inflammatory markers. A decision tree was constructed comparing operative and conservative treatment. Rates of complications, failure of conservative therapy, recurrence and utilities were calculated via a systematic literature review. Variables were tested for sensitivity.Results: Overall, conservative management gives a significantly better outcome (51.51 vs 49.87 QALYs). Three variables proved sensitive. Once operative complication rates are lower than 11.5 %, surgical treatment becomes the optimal strategy. If rates of failure of conservative management exceed 12.9 %, surgery becomes optimal. If the utility assigned to a post-operative complication exceeds 0.44, surgery becomes optimal.Conclusions: This decision analysis supports a conservative strategy, albeit with caveats. If operative complications are low or rates of failure of conservative management remain high, surgery is the preferable strategy.
    • Journal Subset:
      Biomedical; Continental Europe; Europe
    • ISSN:
      1091-255X
    • MEDLINE Info:
      PMID: 26361771 NLM UID: 9706084
    • Publication Date:
      20160622
    • Publication Date:
      20180702
    • Accession Number:
      http://dx.doi.org/10.1007/s11605-015-2934-9
    • Accession Number:
      110848905
  • Citations
    • ABNT:
      BOLGER, J. et al. Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach. Journal of Gastrointestinal Surgery, [s. l.], v. 19, n. 12, p. 2249–2257, 2015. Disponível em: . Acesso em: 12 nov. 2019.
    • AMA:
      Bolger J, Kelly M, Barry K, Bolger JC, Kelly ME. Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach. Journal of Gastrointestinal Surgery. 2015;19(12):2249-2257. doi:10.1007/s11605-015-2934-9.
    • APA:
      Bolger, J., Kelly, M., Barry, K., Bolger, J. C., & Kelly, M. E. (2015). Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach. Journal of Gastrointestinal Surgery, 19(12), 2249–2257. https://doi.org/10.1007/s11605-015-2934-9
    • Chicago/Turabian: Author-Date:
      Bolger, Jarlath, Michael Kelly, Kevin Barry, Jarlath Christopher Bolger, and Michael Eamon Kelly. 2015. “Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach.” Journal of Gastrointestinal Surgery 19 (12): 2249–57. doi:10.1007/s11605-015-2934-9.
    • Harvard:
      Bolger, J. et al. (2015) ‘Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach’, Journal of Gastrointestinal Surgery, 19(12), pp. 2249–2257. doi: 10.1007/s11605-015-2934-9.
    • Harvard: Australian:
      Bolger, J, Kelly, M, Barry, K, Bolger, JC & Kelly, ME 2015, ‘Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach’, Journal of Gastrointestinal Surgery, vol. 19, no. 12, pp. 2249–2257, viewed 12 November 2019, .
    • MLA:
      Bolger, Jarlath, et al. “Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach.” Journal of Gastrointestinal Surgery, vol. 19, no. 12, Dec. 2015, pp. 2249–2257. EBSCOhost, doi:10.1007/s11605-015-2934-9.
    • Chicago/Turabian: Humanities:
      Bolger, Jarlath, Michael Kelly, Kevin Barry, Jarlath Christopher Bolger, and Michael Eamon Kelly. “Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach.” Journal of Gastrointestinal Surgery 19, no. 12 (December 2015): 2249–57. doi:10.1007/s11605-015-2934-9.
    • Vancouver/ICMJE:
      Bolger J, Kelly M, Barry K, Bolger JC, Kelly ME. Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach. Journal of Gastrointestinal Surgery [Internet]. 2015 Dec [cited 2019 Nov 12];19(12):2249–57. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=110848905&custid=s6224580