A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis
RCT (n=1552) found antibiotics (ABs) non noninferior to appendectomy in terms of 30-day EQ-5D scores. Complications were more common with ABs (8.1% vs 3.5%, p<0.05), mainly in those with an appendicolith (calcified deposit). There was no difference in serious adverse event rate
Source:
New England Journal of Medicine
SPS commentary:
The primary outcome of study was 30-day health status, as assessed with the European Quality of Life–5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points).
A related editorial discusses this research, detailing that the COVID-19 pandemic has led to more rigorous triaging of some surgical procedures, with many being delayed owing to reduced theatre capacity. It states however, that despite positive results, the adverse effect rate for antibiotics was not solely driven by appendicolith, and that It will be important to ensure that some people, in particular vulnerable populations, are not offered antibiotic therapy preferentially or without adequate education regarding the longer-term implications. Individual characteristics, preferences, and circumstances are important factors in the decision making process.