Discoveries
Outpatient antibiotic treatment of selected patients with appendicitis is safe, allowing many patients to avoid surgery and hospitalization, and should be considered as part of physician-patient shared decision-making. Of the 726 participants who were randomized to receive antibiotics, 46% were discharged from the emergency department within 24 hours. Outpatient treatment was associated with less than 1 severe adverse effect per 100 patients the week after discharge. Outpatient management was shown to be safe in a wide range of patients and was done in up to 90% of patients treated with antibiotics at all study sites. Compared with hospitalization, outpatient management was not associated with more subsequent appendicectomies and patients lost fewer workdays.
Fund
This study is an ongoing analysis of the findings of the Comparison of Antibiotic Drug Results and Appendectomy (CODA) trial, which found that antibiotic treatment was not inferior to urgent appendectomy. After the trial, the American College of Surgeons stated that high-quality evidence indicated that most patients can be treated with antibiotics.
Methods
The researchers examined data from 726 people with image-confirmed appendicitis who were treated with antibiotics in 25 hospitals between May 1, 2016 and February 28, 2020.
Impact
Outpatient treatment of appendicitis is safe for many people and could reduce the use and costs of health care.
Source:
University of California – Los Angeles Health Sciences
Magazine reference:
Writing Group for the CODA Collaborative., (2022) Analysis of Outcomes Associated with Outpatient Management of Patients with Non-Surgical Treated Appendicitis. JAMA network open. doi.org/10.1001/jamanetworkopen.2022.20039.