Antibiotics Versus Appendectomy for Adults with Suspected Uncomplicated Appendicitis: A Systematic Review and Meta-analysis of Randomized Trials (with Cohort Sensitivity Analyses)

Acute appendicitis is a common serious medical condition, and antibiotics are increasingly used for uncomplicated appendicitis (UA) management. Previous metaanalyses comparing antibiotics and appendectomy are limited by a high risk of bias. This meta-analysis assessed complications, reoperation after 1 year, and quality of life (QoL) among patients with UA. The two authors systematically searched the Web of Science, PubMed, and the Cochrane Library from inception to January 2025. The keywords “appendectomy,” “antibiotics,” “complications,” “failure rate,” and “quality of life” were used; 1090 studies were retrieved, 51 full texts were reviewed, and 13 studies were included in the meta-analysis. Complications and QoL were not different between the appendectomy and antibiotics groups; RR = 1.06; 95% CI = 0.96 to 1.16; and mean difference (MD) = –0.00; 95% CI = –0.0 to 02.01. However, reoperation (appendectomy) after 1 year is higher in the antibiotics group; RR = 0.86, 95% CI = 0.76 to 0.98. In a subgroup analysis, the complication rate and reoperation rate (appendectomy) at 1 year were higher in the appendectomy group than in the antibiotics group. Appendectomy and antibiotic treatment of acute appendicitis were similar in terms of total complications and QoL, with significant reoperation in the antibiotics group. Further controlled trials using sensitive imaging to improve the diagnosis of UA are needed.