Patient Preference of Surgery vs Antibiotics for Acute Appendicitis

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Most patients would choose surgical intervention for treatment of acute appendicitis, but some would prefer antibiotics alone.
Most patients would choose surgical intervention for treatment of acute appendicitis, but some would prefer antibiotics alone.

HealthDay News — Although most patients would choose surgical intervention for treatment of acute uncomplicated appendicitis, some would opt for antibiotics alone, according to a study published online in JAMA Surgery.

Alexis L. Hanson, from the University of North Dakota School of Medicine and Health Sciences in Grand Forks, and colleagues administered an online survey to examine treatment preferences in a convenience sample of 1728 respondents who were asked to imagine that they or their child had acute uncomplicated appendicitis. Two hundred twenty respondents were given the same scenario in a sensitivity analysis.

The researchers found that 85.8% of survey respondents chose laparoscopic appendectomy for themselves, and 4.9% and 9.4% chose open appendectomy and antibiotics alone, respectively. Overall, 79.4%, 6.1%, and 14.5% chose laparoscopic appendectomy, open appendectomy, and antibiotics alone, respectively, for their child. Respondents were more likely to choose antibiotics for themselves if they had education beyond college, identified as other than non-Hispanic white, or did not know anyone who had previously been hospitalized; surgeons were less likely to choose antibiotics. In the sensitivity analysis, the desirability of choosing antibiotics appeared to be increased with improvements in the short- and long-term failure rates of antibiotic treatment.

"Most patients may choose surgical intervention over antibiotics alone in treatment of acute uncomplicated appendicitis, but a meaningful number may choose nonoperative management," the authors write. "Therefore, from a patient-centered perspective, this option should be discussed with patients."

Reference

Hanson AL, Crosby RD, Basson MD. Patient preferences for surgery or antibiotics for the treatment of acute appendicitis [published online January 10, 2018].  JAMA Surg. doi:10.1001/jamasurg.2017.5310

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