Many appendicitis patients prefer antibiotics over surgery
Most patients or parents of children with acute uncomplicated appendicitis would choose surgery over antibiotic therapy as their preferred treatment, but “a meaningful number” would choose antibiotics alone, according to survey results published in JAMA Surgery.
This finding led investigators to call for a patient-centered approach in which providers offer both surgical and nonsurgical options. Additionally, they identified key areas for improving patient acceptability of antibiotic treatment.
Prior research has shown that many patients with acute uncomplicated appendicitis can successfully avoid surgery with antibiotic treatment, but this carries a risk for short-term failure and long-term recurrence, according to Marc D. Basson, MD, PhD, MBA, professor of surgery, pathology, and biomedical science at University of North Dakota School of Medicine & Health Sciences, and colleagues. His team wanted to find out how patients might choose between these two treatment options.
“There has been and continues to be a great deal of discussion about which is ‘better,’ surgery or antibiotic therapy, as if there can be only one answer,” Basson told Healio Gastroenterology and Liver Disease. “We believed that in a patient-centered world, different people might reasonably come to a different decision about which is ‘better,’ not based upon different facts, but based upon differences in the way in which they approach those facts. Some people may value the quick relief of surgery highly while others might be afraid of surgery and might value avoiding surgery more highly than prolonged treatment, for instance.”
The investigators first conducted an online survey, in which they summarized the expected outcomes of surgical intervention or antibiotic therapy and asked participants which they would choose and why. Among the 1,728 who responded (70.9% women; most [22.6%] aged 50-59 years), 85.8% said they would choose laparoscopic appendectomy, 4.9% said they would choose open appendectomy and 9.4% said they would choose antibiotics alone. For their children, 79.4% said they would choose laparoscopic appendectomy, 6.1% said they would choose open appendectomy and 14.5% said they would choose antibiotics alone.
Respondents were more likely to choose antibiotics for themselves if they had a higher education level (P < .001), did not identify as non-Hispanic white (P < .001), or did not know anyone who had been hospitalized (P = .02). In contrast, surgeons were less likely to choose antibiotics (P < .001).
“The bottom line is that while most people said they would choose surgery, about 10% said they would choose antibiotics,” Basson said. “The takeaway here is that both surgery and antibiotic therapy alone are likely to be reasonable choices for some individuals, and we believe that surgeons ought to offer both to patients, giving them the appropriate information to let them make their own choice based on their values.”
Basson and colleagues also performed a sensitivity analysis involving 220 individuals who participated in an in-person survey (54.5% women, most [24.1%] aged 18-24 years), which showed similar results to the web survey. However, when queried about the reasons for their choices, these respondents indicated that improvements in antibiotic failure rates, rather than reduced length of hospitalization or treatment duration, would make this option more desirable.
“We determined that the failure and recurrence rates were more influential in pushing patients away from antibiotic therapy than the need for prolonged treatment, suggesting that further research ought to investigate ways to reduce that failure rate,” Basson said. – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.