Appendicitis, 7 years later: whether surgery or antibiotics, QoL is similar

  • Sippola S & al.
  • JAMA Surg
  • 19 Feb 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Years after treatment for acute uncomplicated appendicitis (AUA), QoL was similar for patients whether they had undergone successful antibiotic or surgical treatment.
  • Authors call for research to identify risk factors for surgery after initial antibiotic treatment.

Why this matters

  • Although criticized, results of the APPAC multicenter randomized clinical trial suggested that antibiotic treatment of AUA is safe and effective.

Key results

  • QoL after appendectomy vs antibiotics:
    • Similar median health index value between groups (P=.96).
    • Similar self-rated health on 100-point scale: 79.7 with surgery (95% CI, 77.7-81.7) vs 79.5 (77.5-81.4) with antibiotics (P=.65).
  • Of 206 patients who took antibiotics, 81 (39%) later underwent appendectomy.
  • Satisfaction with care:
    • Higher for appendectomy vs antibiotic group overall (P=.001).
    • No different between the appendectomy group and successful-antibiotic subgroup (P=.36).
    • Higher for the appendectomy group overall vs later-appendectomy subgroup (P<.001>
    • Higher for successful-antibiotic subgroup vs later-appendectomy subgroup (P<.001>

Study design

  • Secondary analysis of APPAC (n=423).
  • Adults with CT-confirmed AUA had been randomly assigned to antibiotic treatment vs open appendectomy.
  • Outcome: QoL at median 7 years after intervention. 
  • Funding: Mary and Georg C. Ehrnrooth Foundation; Finnish government.

Limitations

  • Laparoscopic appendectomy is now standard of care.
  • Post hoc QoL measure, with no baseline for comparison.