Acute Appendicectomy or Conservative Treatment for Complicated Appendicitis (Phlegmon or Abscess)? A Systematic Review by Updated Traditional and Cumulative Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: The existing evidence on the treatment of complicated appendicitis favors conservative treatment rather than acute appendicectomy. Update traditional meta-analysis and consequently cumulative meta-analysis was performed to track the accumulation of evidence over time. METHODS: Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library and Google Scholar databases. The main outcome measures were duration of the first hospitalization, overall duration of hospitalization, duration of intravenous (IV) antibiotic treatment, overall complications, abdominal/pelvic abscesses, wound infections, re-admissions and unplanned re-operations. RESULTS: Overall complications, abdominal/pelvic abscesses, wound infections and unplanned procedures were significantly lower in the conservative treatment cohort. In contrast, subgroup analysis of three randomized controlled trials (RCTs) revealed no significant difference in abdominal/pelvic abscesses (odds ratio (OR): 0.46, 95% confidence interval (CI): 0.17 - 1.29, P = 0.14). No significant differences were found in the duration of the first and overall hospitalizations. Of the note, high-quality RCTs demonstrated a shorter hospital stay by 1 day for the laparoscopic appendicectomy cohort compared to conservative treatment (mean difference (MD): -0.99, 95% CI: -1.31 to -0.67, P < 0.0001). CONCLUSION: The present meta-analysis demonstrates that a shift in paradigm has begun, with a more widespread use of the laparoscopic approach for the management of complicated appendicitis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.027 | 0.005 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".