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ACS: Surgery May Follow Initial Antibiotic Therapy for Appendicitis

At one and two years, 40 and 46 percent of patients initially receiving antibiotics underwent subsequent appendectomy

THURSDAY, Oct. 28, 2021 (HealthDay News) — Many patients with appendicitis who initially receive antibiotic treatment will subsequently undergo an appendectomy, according to a correspondence published online Oct. 25 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Surgeons, held virtually from Oct. 23 to 27.

Giana H. Davidson, M.D., M.P.H., from the University of Washington Medical Center in Seattle, and colleagues reported longer-term outcomes from a trial involving 1,552 patients with appendicitis, in which antibiotic treatment was found to be noninferior to appendectomy at 30 days.

The researchers found that the percentage of patients in the antibiotics group who underwent subsequent appendectomy was 40 and 46 percent at one and two years, respectively, and 49 percent at both three and four years. The risk for appendectomy was 27 percent at 30 days after randomization through one year. Patients who had an appendicolith more often had appendectomy, but this elevated risk was attenuated over time. Complications were uncommon in the two treatment groups after 30 days, regardless of the presence of an appendicolith. Perforation was reported in 20 percent of patients with recurrence in the antibiotics group and in 16 percent in the appendectomy group. Of the patients with two-year follow-up, 14 percent in the antibiotics group received an additional course of antibiotics; 66 percent of these patients underwent subsequent appendectomy.

“The present data will further inform shared decision making between clinicians and their patients with appendicitis, including those with an appendicolith,” the authors write.

Several authors disclosed financial ties to the biopharmaceutical and health insurance industries.

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