August 23, 2023
2 minute read
Important points:
- Initial antibiotic treatment was successful in 88% to 95% of patients.
- At age 25, 60% of those treated with antibiotics had not undergone appendectomy, and 71% were discharged without appendectomy and remained without surgery.
More than half of patients treated with antibiotics for acute appendicitis avoid surgery for up to 25 years, and researchers report that there is no evidence of long-term risks from nonoperative management other than recurrence.
“The longest reported outcome for patients treated nonsurgically for acute appendicitis was 5 years.” Dr. Barbora Patcova, Researchers from Sweden’s Karolinska Institute and Uppsala University Hospital wrote: JAMA surgery.
To determine long-term outcomes for 19- to 26-year-olds, researchers analyzed data from the Swedish National Registry of participants in two randomized clinical trials comparing appendectomy with nonsurgical treatment for acute appendicitis. . The first study included 40 patients (33% women) assigned to either appendectomy or antibiotics from May 1992 to March 1994, and the second study included 40 patients (33% women) from May 1992 to March 1994. 252 male patients randomly assigned to either treatment between March 2006 and June 1999 were included.
Success of initial non-surgical treatment was reported in 95% (19 of 20) of patients in the first trial and 88% (113 of 128) in the second trial, with a 1-year recurrence rate of 36.8, respectively. % and 14.4%.
Of the initial 292 participants, researchers were able to follow up 259 in the registry, of whom 92.6% were in the non-surgery group and 84.7% had appendectomy. Twenty-one participants underwent appendectomy as a result of failure of initial nonoperative treatment, and 34 subsequently underwent appendectomy for acute appendicitis.
At the end of follow-up, 60% of patients had not undergone appendectomy, and 71% of patients who were successfully discharged without appendectomy did not return for surgery.
“While the incidence of appendectomy was low after the first year, appendectomies continued to occur up to 20 years later,” the researchers wrote.
In addition to patients undergoing surgery after initial nonsurgical treatment failed, 9.5% of patients in the antibiotic group visited the outpatient clinic for abdominal pain, compared with 0.01% in the surgical group.
“More than half of patients treated nonsurgically did not experience recurrence and avoided surgery for approximately 20 years,” the researchers wrote. “Other than recurrence of appendicitis, there is no evidence of long-term risks from non-surgical management. These data will further inform treatment decisions, not only for patients with acute appendicitis, but also for clinicians. Sho.”
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Disclosure: Ms. Patkova has not reported any relevant financial disclosures. Please refer to this study for relevant financial disclosures of all other authors.
perspective
Dr. Diya Aladeen, FACS
Although this is interesting data regarding the long-term outcomes of nonoperative treatment of appendicitis, the results require more scrutiny and interpretation. We need to continue to look for predictors of non-surgical failure (patients returning to surgery after antibiotic treatment).
The more data we can collect on this topic through high-fidelity research protocols, the better we can consult with patients about treatments that will ensure the best long-term outcomes and reduce the likelihood of disease recurrence and complications. It will be like this.
Dr. Diya Aladeen, FACS
Chief of Surgery, Cleveland Clinic Fairview Hospital
Medical Director, Cleveland Clinic Fairview Ambulatory Surgery Center
Cleveland Clinic Digestive Disease Institute General Surgeon
Disclosure: Alaedeen does not report any relevant financial disclosures.