Surgery versus Antibiotics for Uncomplicated Appendicitis: Which Would a Medical Student Want?

Althans, Alison R.; Tamer, Pierre; Brady, Justin T.; Steinhagen, Emily; Ho, Vanessa P.

doi:10.1089/sur.2017.129

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…25 Another study showed that after information about the risks and advantages of surgery and antibiotic treatment for uncomplicated acute appendicitis, a population of medical students were more inclined to choose surgery, also noting that the answers may have been influenced by the manner in which the summary data of each treatment arm were presented. 26 A recent guideline 27 states that nonoperative management of uncomplicated acute appendicitis is feasible in patients wishing to avoid surgery and accept the risk of recurrence. With an increasing amount of studies, [4][5][6][7][8] meta-analyses, 9-11 and long-term follow-up results 12 indicating the feasibility of antibiotic therapy in the treatment of uncomplicated acute appendicitis, future studies should focus on a more multifactorial approach to making the treatment decision, including patient information and involvement in shared decision-making.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis

et al. 2020

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IMPORTANCELong-term results support antibiotics for uncomplicated acute appendicitis as an alternative to appendectomy. To our knowledge, treatment-related long-term patient satisfaction and quality of life (QOL) are not known.OBJECTIVE To determine patient satisfaction and QOL after antibiotic therapy and appendectomy for treating uncomplicated acute appendicitis.INTERVENTIONS Open appendectomy vs antibiotics with intravenous ertapenem, 1 g once daily, for 3 days followed by 7 days of oral levofloxacin, 500 mg once daily, and metronidazole, 500 mg 3 times per day. DESIGN, SETTING, AND PARTICIPANTSThis observational follow-up of the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotics included 530 patients age 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis who were randomized to undergo appendectomy (273 [52%]) or receive antibiotics (257 [49%]). The trial was conducted from November 2009 to June 2012; the last follow-up was May 9, 2018. The data were analyzed in February 2019. MAIN OUTCOMES AND MEASURESIn this analysis, post hoc secondary end points of postintervention QOL (EQ-5D-5L) and patient satisfaction and treatment preference were evaluated. RESULTSOf the 530 patients enrolled in the trial (appendectomy group: 273 [174 men (64%)] with a median age of 35 years; (antibiotic group: 257 [155 men (60%)] with a median age of 33 years), 423 patients (80%) were available for phone interview at a median follow-up of 7 years; 206 patients (80%) took antibiotics and 217 (79%) underwent appendectomy. Of the 206 patients taking antibiotics, 81 (39%) had undergone appendectomy. The QOL between appendectomy and antibiotic group patients was similar (median health index value, 1.0 in both groups; 95% CI, 0.86-1.0; P = .96). Patients who underwent appendectomy were more satisfied in the treatment than patients taking antibiotics (68% very satisfied, 21% satisfied, 6% indifferent, 4% unsatisfied, and 1% very unsatisfied in the appendectomy group and 53% very satisfied, 21% satisfied, 13% indifferent, 7% unsatisfied, and 6% very unsatisfied in the antibiotic group; P< .001) and in a subgroup analysis this difference was based on the antibiotic group patients undergoing appendectomy. There was no difference in patient satisfaction after successful antibiotic treatment compared with appendectomy (cumulative odds ratio [COR], 7.8; 95% CI, 0.5-1.3; P< .36). Patients with appendectomy or with successful antibiotic therapy were more satisfied than antibiotic group patients who later underwent appendectomy (COR, 7.7; 95% CI, 4.6-12.9; P < .001; COR, 9.7; 95% CI, 5.4-15.3; P < .001, respectively). Of the 81 patients taking antibiotics who underwent appendectomy, 27 (33%) would again choose antibiotics as their primary treatment. CONCLUSIONS AND RELEVANCEIn this analysis, long-term QOL was similar after appendectomy and antibiotic therapy for the treatment of uncomplicated acute appendicitis. Patients taking antibiotics who later underwent append...

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Section: Discussionmentioning

confidence: 99%

Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis

et al. 2020

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“…A small number of previous similar studies have investigated knowledge about appendicitis and its treatment, as well as attitudes towards non-operative treatment of appendicitis, with mixed observations [ 14 , 15 , 16 , 17 , 18 ]. To the best of our knowledge, no previous investigation has been undertaken in the UK, with the majority conducted in the USA.…”

Section: Discussionmentioning

confidence: 99%

“…They reasoned that medical students were in a unique position of being potential patients with greater medical knowledge than the general public and, possibly, less bias than practicing physicians. Two-thirds of respondents expressed a preference for surgical treatment, while 24% expressed a preference for non-operative treatment [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Parental Knowledge of Appendicitis and Preference for Operative or Non-Operative Treatment at a United Kingdom Children’s Hospital

Monks

Hall

2022

Children

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Appendicitis is a common cause of abdominal pain in children, and is the most common reason for children to undergo emergency abdominal surgery. To guide our research program in this field, we aimed to determine parental understanding with regard to appendicitis and its treatment. We also wished to assess parental preference for non-operative or surgical treatment of children with uncomplicated appendicitis. We asked parents attending a children’s outpatient clinic to complete a brief questionnaire that was interspersed with educational content to rectify any knowledge gaps. A total of 396 parents (of 414 approached) agreed to participate. There were gaps in parental knowledge, including not knowing where the appendix is located (one-third of respondents), not knowing what appendicitis is (40% of respondents), and underestimating the incidence of appendicitis. Parents typically overestimated the risks of complications and dying from both uncomplicated and complicated appendicitis. There was no influence of gender, age, or previous experience of appendicitis on these findings. When presented with the scenario of equal effectiveness of non-operative treatment and surgery for uncomplicated appendicitis, 59% of respondents expressed a preference for non-operative treatment over surgery, while 21% expressed a preference for surgery (20% expressed no preference). These findings are important for clinicians and researchers when discussing appendicitis and treatment options with families, and justify ongoing research into the comparative effectiveness of non-operative treatment and surgery.

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“…In selecting the right treatment option, it is important to acknowledge the patient’s preferences for non-operative or operative treatment. Few studies have described the patient’s choice for treatment of uncomplicated appendicitis, and a wide range of patients preferring non-operative treatment has been reported, varying from 9.4% to 57% 22–24. This wide range may be explained by the different ways of informing the participants and by the type of the included patients.…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have described the patient’s choice for treatment of uncomplicated appendicitis, and a wide range of patients preferring non-operative treatment has been reported, varying from 9.4% to 57%. 22–24 This wide range may be explained by the different ways of informing the participants and by the type of the included patients. To facilitate shared decision making for uncomplicated appendicitis, the correct group of participants should be surveyed, and accurate information must be provided about the risks and advantages of both antibiotic and surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Optimising diagnostics to discriminate complicated from uncomplicated appendicitis: a prospective cohort study protocol

et al. 2022

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IntroductionGrowing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary.Methods and analysisThe SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient’s preferences for different treatment options will be assessed.Ethics and disseminationEthical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.

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Surgery versus Antibiotics for Uncomplicated Appendicitis: Which Would a Medical Student Want?

Abstract: When informed of the benefits and risks of surgery and antibiotics to treat AUA, medical students in our study were more likely to choose surgery.

Cited by 8 publications

References 16 publications

Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis

Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis

Parental Knowledge of Appendicitis and Preference for Operative or Non-Operative Treatment at a United Kingdom Children’s Hospital

Optimising diagnostics to discriminate complicated from uncomplicated appendicitis: a prospective cohort study protocol

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