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

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  • Additional Information
    • Publication Year:
      2015
    • Author-Supplied Keywords:
      Acute appendicitis
      Conservative management
      Decision analysis
    • NAICS/Industry Codes:
      NAICS/Industry Codes 325410 Pharmaceutical and medicine manufacturing
      424210 Drugs and Druggists' Sundries Merchant Wholesalers
      414510 Pharmaceuticals and pharmacy supplies merchant wholesalers
      325411 Medicinal and Botanical Manufacturing
    • 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. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Copyright of Journal of Gastrointestinal Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
    • ISSN:
      1091255X
    • 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, 2015. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580. Acesso em: 28 fev. 2020.
    • 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. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580. Accessed February 28, 2020.
    • 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.
    • 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. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580.
    • 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), p. 2249. Available at: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580 (Accessed: 28 February 2020).
    • 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, p. 2249, viewed 28 February 2020, .
    • 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, p. 2249. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580.
    • 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. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580.
    • 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 2020 Feb 28];19(12):2249. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edb&AN=110848905&custid=s6224580