Long-term outcomes of non-operative compared to operative management of acute uncomplicated appendicitis - a systematic review and meta-analysis
In brief
Non-operative treatment of uncomplicated appendicitis fails in about 44% of patients long term
A meta-analysis of nine studies with over 3,800 patients found that roughly four in ten patients managed without surgery experienced treatment failure after two years, and about one-third eventually required an appendectomy. While antibiotic-only care saved roughly €1,500 per patient, the high failure rate limits its appeal as a routine alternative to surgery.
- Journal
- American journal of surgery (Q1)
- Published
- 18 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Noam Kahana, Elad Boaz, Sameh Hany Emile, Petachia Reissman, Raul J Rosenthal, Steven D Wexner, et al.
- PMID
- 42636733
- DOI
- 10.1016/j.amjsurg.2026.117203
Why clinicians should know about it
- Picked for Surgery (paper of the day, 25 August 2026): Non‑operative vs operative appendicitis meta‑analysis, emergency surgery
Abstract
BACKGROUND: We evaluated long-term outcomes of non-operative management (NOM) versus surgical management of acute uncomplicated appendicitis. METHODS: Systematic review of studies comparing NOM versus surgery with ≥2 years follow-up. Primary outcome was long-term failure rate. RESULTS: 9/1635 studies were included (3 RCTs; 6 non-RCT studies), involving 3883 patients; 5 were in pediatric populations. Median follow-up was 33.6 (range 24-312) months. NOM pooled long-term failure rate was 38.9% (95% CI: 31.1%-46.7%), increasing to 44.4% (95% CI: 41.4%-47.4%) in RCTs. Pooled appendectomy rate after NOM was 36.3% (95% CI: 28.9%-43.7%). Incidence of appendiceal neoplasms was approximately 0.3%. Non-operative management had cost savings of €1535 (95% CI: -€1892 to -€1178) versus surgery. CONCLUSIONS: NOM of acute uncomplicated appendicitis was associated with high long-term failure rates and significant risk of subsequent appendectomy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.