TOPLINE:
Most patients who receive antibiotics rather than surgical treatment for appendicitis have successful long-term outcomes, but some may require surgery up to 20 years later.
METHODOLOGY:
- Follow-up on 292 patients involved in two randomized controlled trials conducted in the 1990s by the Swedish National Patient Registry
- Both trials divided patients into two groups: those who underwent appendectomy and those who received antibiotic treatment for appendicitis.
- Researchers looked at rates of recurrent appendicitis that required surgery later in life.
- 29% of patients in the nonoperative group who were discharged successfully during the initial study eventually underwent surgery.
- Some patients who initially received antibiotics required surgery up to 20 years later.
- 9.5% of patients who didn't undergo surgery went to a surgical outpatient clinic for abdominal pain, compared with 0.01% of those who had surgery
IN PRACTICE:
"More than half of the patients treated nonoperatively did not experience recurrence and avoided surgery over approximately two decades. There is no evidence for long-term risks of nonoperative management other than that of recurrence of appendicitis," the authors report.
SOURCE:
Simon Eaton, PhD, of UCL Great Ormond Street Institute of Child Health in London, was the corresponding author of the study, published online today in JAMA Surgery. The study was funded by the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Swedish Research Council.
LIMITATIONS:
The data were retrospective, so the researchers could not track how patients' circumstances and characteristics changed over time. Most patients were male, and the researchers lacked histopathology results for patients for whom nonsurgical treatment succeeded initially but who later required appendectomy. They also relied on diagnostic standards used in the 1990s, when the initial studies were performed; these were less sophisticated and accurate than recent standards.
DISCLOSURES:
Co-author Jan Svensson, MD, PhD, reported receiving grants from the Lovisa Foundation during the conduct of the study. No other disclosures were reported.
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