Patients Prefer Surgery for Appendicitis, Survey Shows

Veronica Hackethal, MD

January 10, 2018

Most people would choose surgery over antibiotics alone for treating appendicitis in themselves or their child, new survey data show. However, almost 10% would opt for antibiotics alone, suggesting that healthcare providers should discuss this option with patients.

"Patients should be presented with all viable treatment options, including antibiotics alone, while future research on antibiotic treatment for appendicitis should focus on improving failure rates," write Alexis Hanson, BA, from the University of North Dakota School of Medicine and Health Sciences in Grand Forks, and colleagues.

Noting that some surgeons resist treating with antibiotics alone, they add: "Surgeons should offer antibiotics to patients with appendicitis while feeling comfortable explaining why they prefer surgery."

The survey results were published online today in JAMA Surgery.

The traditional management for appendicitis includes surgery, with minimally invasive laparoscopic surgery increasingly used as a replacement for open surgery. New research suggests that antibiotics alone can eliminate the need for surgery in some people.

Yet studies also suggest that antibiotics alone may increase the risk for longer hospitalization, outpatient treatment, treatment failure, and complications. Discussing these treatment options as well as the risks and benefits of each is important for informed decision making. Most studies on the topic, however, have not considered the patient's perspective.

To assess how patients might choose between these options, Hanson and colleagues conducted an anonymous online survey between April 2016 and June 2016. The survey included 1728 individuals recruited via social media, email, and postering. It asked respondents to imagine that they or their child had acute uncomplicated appendicitis; described the risks for open surgery, laparoscopic surgery, and antibiotics alone; and asked them which treatment they would choose and their reasons for doing so.

Results showed that 85.8% (n = 1482) of respondents chose laparoscopic surgery for themselves, whereas 4.9% (n = 84) chose open surgery and 9.4% (n = 162) chose antibiotics alone.

When asked which option they would choose for their child, 79.4% (n = 1372) chose laparoscopic surgery, 6.1% (n = 106) chose open appendectomy, and 14.5% (n = 250) chose antibiotics alone.

Because so few people chose antibiotics alone, researchers surveyed an additional 220 people to try to understand what might influence their choice for antibiotics. Results suggested that decreasing short-term failure and long-term recurrence rates might make antibiotics alone more appealing.

Further research is needed on how to reduce failure and recurrence rates with antibiotics alone, the authors conclude.

They note several study limitations, including that decisions about a hypothetical scenario may differ from real-life decisions made during an acute illness. More than 90% of respondents were non-Hispanic white, about 70% were women, and 65% were from the Midwest. Therefore, it is not clear how generalizable these results may be in other populations. Specifically, people who identified as other than non-Hispanic white were more likely to choose antibiotics than non-Hispanic white respondents, suggesting the study may have some cultural bias.

The authors have disclosed no relevant financial relationships.

JAMA Surg. Published online January 10, 2018. Abstract

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