Effectively, that is the question raised by this study – regarding antibiotics vs. surgery for acute, uncomplicated appendicitis.
This is a pragmatic, prospective study conducted in the pediatrics population at Nationwide Children’s Hospital. The intervention and comparison were simple: qualifying patients with objectively mild appendicitis were offered a choice between hospitalization and intravenous antibiotics alone, or appendectomy with 12 hours.
And, as generally expected, not every patient choosing antibiotics successfully completed follow-up without crossover. Of the 37 patients and families choosing antibiotics, 2 failed initial hospitalization, another 2 failed within 30 days, and 5 more failed within a year. Median follow-up was 21 months at the time of article submission, and no further patients had undergone appendectomy. Of 65 children undergoing surgery, 5 had post-operative complications, two of which were major (re-hospitalization, re-operation).
However, as I stated above, the question raised regarding antibiotics and appendicitis – is it now necessary it be discussed? Have we reached a critical mass in the literature where all patients with suspected uncomplicated disease be offered antibiotics-only? It is certainly unreasonable foundation for a complaint if an informed consent for surgical treatment of appendicitis did not include an antibiotics-only strategy as a legitimate alternative. It was, in this cohort, much less disabling, in general, and substantially cheaper.
If not now – the not-to-distant future.
“Effectiveness of Patient Choice in Nonoperative vs Surgical Management of Pediatric Uncomplicated Acute Appendicitis”