Every year more than 250,000 people undergo surgery for appendicitis, making it one of the 20 most common surgeries performed in the United States.
In the largest randomized US study of
appendicitis, researchers report that seven in 10 patients who received
antibiotics avoided surgery and that patients who took antibiotics for symptom
relief fared no worse in the short term than those who underwent surgery.
Still, researchers cautioned that taking
antibiotics for appendicitis is not for everyone and advised patients to
consult with their physician.
"The significance of this study
means that surgeons and patients now have more options for the treatment of
appendicitis," says J.H. "Pat" Patton, M.D., medical director of
Surgical Services for Henry Ford Health System and a study co-investigator.
"We now know that we can safely and effectively treat a significant number
of patients with antibiotics alone and avoid surgery. We encourage patients to
weigh their options based on their individual circumstances before deciding
which treatment is best for them."
Henry Ford was among 25 U.S. sites in 14
states that participated in the study, Comparing Outcomes of Antibiotic Drugs
and Appendectomy (CODA). With 1,552 patients studied between May 3, 2016 and
Feb. 2, 2020, CODA represents the largest study comparing surgery and
antibiotics in adults with appendicitis and is roughly three times larger than
the previous one. The study was funded by the Patient-Centered Outcome Research
Institute.
Unlike prior studies, CODA was the first
to include patients with severe appendicitis and a condition called
appendicolith, in which a small stone forms in the appendix. Researchers
originally planned to report their findings after patients recovered for one
year. With concern about limiting unneeded surgeries during the height of the
COVID-19 pandemic, researchers decided to reduce the time frame for reporting
results following either surgical or antibiotic intervention to 90 days in
order to give physician data on the effectiveness of this non-surgical option.
Key findings of the study:
- Seven
in ten patients who received antibiotics avoided surgery within the first
90 days following treatment, while three in ten did eventually need
surgery within the same time frame
- Four
in ten patients with an appendicolith who received antibiotics required
surgery within 90 days of receiving antibiotics as their first treatment
- Patients
treated with either antibiotics or surgery experienced symptoms of
appendicitis for about the same amount of time prior to treatment
- Patient
treated with antibiotics missed less time from work or school but reported
more visits to the Emergency Department and days spent in the hospital
overall than those who had surgery
Researchers acknowledge that the study's
timing in the middle of a pandemic could have broad implications for both
patients and hospitals. Risk of COVID-19 exposure or going to a hospital
continues to be a real concern for patients who may find antibiotic treatment a
preferred choice. The study also provides hospitals with clarifying options as
they prepare for a possible surge of COVID-19 cases this fall and winter.
Because of health care disparities highlighted in the pandemic, Dr. Patton
cautions that doctors be mindful of properly addressing vulnerable patient
populations on the implications of the study.
"We recognize some patients may not
want to come into a hospital environment during a pandemic. This study tells us
that antibiotics are a viable option for some of these patients," Dr.
Patton says. "And as the data are starting to show, patients who are COVID
positive and undergo general anesthetic may have more complications than they
may otherwise have. If we can treat patients successfully on an outpatient
basis, we can keep them out of the hospital and preserve resources for other
types of surgeries."
Jeffrey Johnson, M.D., medical director
of Trauma at Henry Ford Hospital and co-investigator on the CODA trial,
recommends that patients assess all their options with their doctor.
"Beyond the treatment itself,
patients need to fully explore their medical condition and personal factors
like time off from work and school, insurance coverage and caregiving
responsibilities when making their decision," Dr. Johnson says. "What
this study shows is there is no one-size-fits-all approach. Patients ought to
evaluate the benefits and risks of taking antibiotics or opting for surgery and
make an informed decision on what is important to them."
An appendectomy is the standard
treatment for treating appendicitis and most patients recover quickly and
without complications. The procedure is performed laparoscopically or by one incision
and involves surgically removing the appendix, a small tube-shaped pouch that
is attached to the large intestine in the lower right side of the abdomen.
Severe abdominal or stomach pain, low-grade fever and loss of appetite are
classic symptoms. An overnight hospital stay is typical for most patients.
In the study 776 patients were randomly
assigned to receive antibiotics and 776 patients to undergo appendectomy (776).
Patients' median age was 38 and 63 percent were men and 37 percent women. The
ethnic background was 60 percent white, 23 percent other, 5 percent Asian, 2
percent American Indian or Alaska Native and 1 percent Native Hawaiian or
Pacific Islander.
Patients in the antibiotics group
received a 10-day course of antibiotics based on guidelines from the Surgical
Infection Society and Infectious Diseases Society of America.
Of the 1,552 patients, 172 were enrolled
at Henry Ford Hospital, the health system's hospital in Detroit.
Researchers will be reporting on
additional findings from data that continues to be collected from patients.
Future analysis will examine long-term quality of life, recurrence of
appendicitis in the antibiotics group and predictors of outcomes based on
patient characteristics among other topics.
https://www.sciencedaily.com/releases/2020/10/201006114251.htm
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