A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Collaborative, Coda; Flum, David R.; Davidson, Giana H.; Monsell, Sarah E.; Shapiro, Nathan I.; Odom, Stephen R.; Sanchez, Sabrina E.; Drake, Frederick Thurston; Fischkoff, Katherine; Johnson, Jeffrey; Patton, Joe H.; Evans, Heather L.; Cuschieri, Joseph; Sabbatini, Amber K.; Faine, Brett; Skeete, Dionne; Liang, Mike K.; Sohn, Vance Y.; McGrane, Karen; Kutcher, Matthew; Chung, Bruce; Carter, Damien; Ayoung-Chee, Patricia; Chiang, William K.; Rushing, Amy P.; Steinberg, Steven; Foster, Careen; Schaetzel, Shaina; Price, Thea P.; Mandell, Katherine; Ferrigno, Lisa; Salzberg, Matthew; DeUgarte, Daniel A.; Kaji, Amy H.; Moran, Gregory J.; Saltzman, Darin J.; Alam, Hasan B.; Park, Pauline K.; Kao, Lillian S.; Thompson, Callie M; Self, Wesley H.; Yu, Julianna; Wiebusch, Abigail; Winchell, Robert J.; Clark, Sunday; Krishnadasan, Anusha; Fannon, Erin; Lavallee, Danielle C.; Comstock, Bryan A.; Bizzell, Bonnie; Heagerty, Patrick J.; Kessler, Larry G.; Talan, David A.

doi:10.1056/nejmc2035865

Cited by 89 publications

(6 citation statements)

References 10 publications

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“…Laparoscopic appendicectomy is now unanimously recommended for its advantages, including shorter recovery time, better diagnostic accuracy and the possibility to be performed as ambulatory appendectomy [ 24 – 26 ] to reduce the risk of system overburden. In the light of the long-term pandemic, a 30% of recurrence in the NOM patients as reported by the CODA trial [ 27 ] may represents a further point in favor of laparoscopy, reducing costs and risk of SARS-CoV-2 exposure in patients attending emergency department [ 28 ]. In comparison with the previous survey, the proportion of centers performing 76–100% of appendicectomy by open approach declined significantly moving from 22.5 to 10.9%, a percentage similar to the declared 9.1% of pre-pandemic times [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

et al. 2022

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Background In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide.

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Section: Discussionmentioning

confidence: 99%

Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

et al. 2022

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“…Moreover, in contrast to Iamwat J et al [ 28 ], the presence of an appendicolith in our study showed statistical significance both in univariate and multivariate logistic regression analyses, suggesting that an appendicolith is significantly associated with complicated AA. Bertrand et al [ 5 ] also showed that antibiotic treatment for patients with an appendicolith is more likely to fail. This suggests that operative management may be appropriate for AA with appendicolith.…”

Section: Discussionmentioning

confidence: 99%

“…These two different subtypes can be treated differently. Recent clinical trials [ [5] , [6] , [7] , [8] ] suggested a conservative treatment is effective and safe in uncomplicated AA, avoiding surgery related morbidity, and possible periprocedural complications. Accordingly, accurate differentiation between complicated and uncomplicated AA is important for treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Parsimonious clinical prediction model for the diagnosis of complicated appendicitis

Cai

Zhou

Liang

et al. 2023

Heliyon

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“…Appendectomy is a standard surgical procedure on patients experiencing appendicitis. In 2014, more than 95% of appendicitis patients in the United States have this appendectomy procedure (Flum & Davidson, 2021). In this current condition, more than 180,000 adults and 70,000 children in the country are having appendectomy procedures each year.…”

Section: Introductionmentioning

confidence: 99%

“…Conservative or non-operative management is one of the alternatives way that can be done in patients with appendicitis. The success of antibiotic therapy as an alternative therapy in appendicitis patients has been reported since 60 years ago (Awayshih et al, 2019;Ceresoli et al, 2021;Flum & Davidson, 2021). Several studies have shown that non-operative therapy in the form of antibiotics can be safer or minim risk with a higher level of efficacy rather than the appendectomy (Bom et al, 2021;Minneci et al, 2020;Shimoda et al, 2018;Vaos et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

The effectiveness comparison of appendectomy action through the antibiotic therapy administration in acute appendicitis patients

Yuliavita,

Fu Nakamura,

Priscilla Caroline Simatupang

et al. 2023

midwifery

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The purpose of this research to compare the effectiveness of appendectomy by administering non-operative management in the form of antibiotics in acute appendicitis patients. The research method used descriptive qualitative through the Literature Review (LR) approach. The data source used a secondary source. Data analysis technique selects literature based on title, year, and indexed articles, then reviews articles that match the subject matter. the articles from those journals are compared to find the differences and similarities. A literature review of four PubMed, DOAJ, Cochrane, and Google Scholar databases published in the last five years, i.e. from 2018-2022. Twelve pieces of literature were obtained and reported the advantages and disadvantages of each procedure. Apshortextomy keeps the gold standard with a lower risk of recurrence and severity and a higher treatment success rate. Appendectomy is also required for appendicitis cases with complications. However, antibiotic therapy has advantages with lower levels of complications, fewer costs, and fewer hospital stays. The success rate of non-operative therapy in the form of antibiotics can reach 65-75%, while it can reach 67,1% in children. There are differences in research results related to the effectiveness of appendectomy and antibiotic therapy in acute appendicitis patients. Each of these therapeutic procedures has its advantages and disadvantages. It is very important to be concerned about the urgency and expectations of the patient in selecting this therapy.

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A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Cited by 89 publications

References 10 publications

Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

Parsimonious clinical prediction model for the diagnosis of complicated appendicitis

The effectiveness comparison of appendectomy action through the antibiotic therapy administration in acute appendicitis patients

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