2019, Vol. 1, Issue 2, Part B

Aim and objective: The aim of this study was to evaluate the efficacy and outcomes of the conservative management Vs Surgical management of selected cases of acute appendicitis with Alvarado score of five.

Patients and methods: This was a prospective study done at NIZAMS Institute of Medical sciences, Panjagutta and Bibinagar with duration of 24 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score 5 were included. The follow-up period was 6 months. They were divided into two groups (Group A & Group B).

Patients in Group A were subjected to non-operative management with antibiotics while patients in Group B were subjected to appendectomy. All patients were evaluated at hospital discharge, at 30-days and at a median follow-up on year. The primary outcome was the success rate of the non-operative management. Secondary outcomes were the difference of length of hospitalization, time to return to normal activity, and quality-of-life measures between both groups.

Results: The success rate of non-operative strategy was 95% (38 of 40) at hospital discharge, 90% (36 of 40) at 30-days and 85% (34 of 40) at a median follow-up of one year. Patients in Group A have a significantly shorter time to return to normal activities. They reported higher quality of life scores. The length of hospitalization was significantly shorter in Group B.

Conclusion: Giving intravenous antibiotics to some patients with Alvorado score of Five or less with uncomplicated acute appendicitis instead of having them undergo surgery may be safe and effective.