Journal article
Patient Factors Associated With Appendectomy Within 30 Days of Initiating Antibiotic Treatment for Appendicitis
JAMA surgery, Vol.157(3), e216900
03/01/2022
DOI: 10.1001/jamasurg.2021.6900
PMCID: PMC8756360
PMID: 35019975
Abstract
IMPORTANCE Use of antibiotics for the treatment of appendicitis is safe and has been found to be noninferior to appendectomy based on self-reported health status at 30 days. Identifying patient characteristics associated with a greater likelihood of appendectomy within 30 days in those who initiate antibiotics could support more individualized decision-making.
OBJECTIVE To assess patient factors associated with undergoing appendectomy within 30 days of initiating antibiotics for appendicitis.
DESIGN, SETTING, AND PARTICIPANTS In this cohort study using data from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) randomized clinical trial, characteristics among patients who initiated antibiotics were compared between those who did and did not undergo appendectomy within 30 days. The study was conducted at 25 US medical centers; participants were enrolled between May 3, 2016, and February 5, 2020. A total of 1552 participants with acute appendicitis were randomized to antibiotics (776 participants) or appendectomy (776 participants). Data were analyzed from September 2020 to July 2021.
EXPOSURES Appendectomy vs antibiotics.
MAIN OUTCOMES AND MEASURES Conditional logistic regression modelswere fit to estimate associations between specific patient factors and the odds of undergoing appendectomy within 30 days after initiating antibiotics. A sensitivity analysis was performed excluding participants who underwent appendectomy within 30 days for nonclinical reasons.
RESULTS Of 776 participants initiating antibiotics (mean [SD] age, 38.3 [13.4] years; 286 [37%] women and 490 [63%] men), 735 participants had 30-day outcomes, including 154 participants (21%) who underwent appendectomy within 30 days. After adjustment for other factors, female sex (odds ratio [OR], 1.53; 95% CI, 1.01-2.31), radiographic finding of wider appendiceal diameter (OR per 1-mm increase, 1.09; 95% CI, 1.00-1.18), and presence of appendicolith (OR, 1.99; 95% CI, 1.28-3.10) were associated with increased odds of undergoing appendectomy within 30 days. Characteristics that are often associated with increased risk of complications (eg, advanced age, comorbid conditions) and those clinicians often use to describe appendicitis severity (eg, fever: OR, 1.28; 95% CI, 0.82-1.98) were not associated with odds of 30-day appendectomy. The sensitivity analysis limited to appendectomies performed for clinical reasons provided similar results regarding appendicolith (adjusted OR, 2.41; 95% CI, 1.49-3.91).
CONCLUSIONS AND RELEVANCE This cohort study found that presence of an appendicolith was associated with a nearly 2-fold increased risk of undergoing appendectomy within 30 days of initiating antibiotics. Clinical characteristics often used to describe severity of appendicitis were not associated with odds of 30-day appendectomy. This information may help guide more individualized decision-making for people with appendicitis.
Details
- Title: Subtitle
- Patient Factors Associated With Appendectomy Within 30 Days of Initiating Antibiotic Treatment for Appendicitis
- Creators
- Sarah E. Monsell - University of WashingtonEmily C. Voldal - University of WashingtonGiana H. Davidson - University of WashingtonKatherine Fischkoff - Columbia University Irving Medical CenterNatasha Coleman - Columbia University Irving Medical CenterBonnie Bizzell - University of WashingtonThea Price - Rush University Medical CenterMayur Narayan - Cornell UniversityNicole Siparsky - Rush University Medical CenterCallie M. Thompson - University of UtahPatricia Ayoung-Chee - Tisch HospitalStephen R. Odom - Beth Israel Deaconess Medical CenterSabrina Sanchez - Boston Medical CenterF. Thurston Drake - Boston Medical CenterJeffrey Johnson - Henry Ford Health SystemJoseph Cuschieri - Harborview Medical CenterHeather L. Evans - Harborview Medical CenterMike K. Liang - Lyndon Baines Johnson HospitalKaren McGrane - Madigan Army Medical CenterQuinton Hatch - Madigan Army Medical CenterJesse Victory - Bellevue Hospital CenterJon Wisler - The Ohio State University Wexner Medical CenterMatthew Salzberg - University of Colorado HospitalLisa Ferrigno - University of Colorado HospitalAmy Kaji - Ronald Reagan UCLA Medical CenterDaniel A. DeUgarte - Ronald Reagan UCLA Medical CenterMelinda Maggard Gibbons - Olive View-UCLA Medical CenterHasan B. Alam - Northwestern UniversityJohn Scott - University of Michigan–Ann ArborLillian S. Kao - The University of Texas Health Science Center at HoustonWesley H. Self - Vanderbilt University Medical CenterRobert J. Winchell - Cornell UniversityCassandra M. Villegas - Cornell UniversityDavid A. Talan - Olive View-UCLA Medical CenterLarry G. Kessler - University of WashingtonDanielle C. Lavallee - University of WashingtonAnusha Krishnadasan - Olive View-UCLA Medical CenterSarah O. Lawrence - University of WashingtonBryan Comstock - University of WashingtonErin Fannon - University of WashingtonDavid R. Flum - University of WashingtonPatrick J. Heagerty - University of WashingtonWriting Group for the CODA Collaborative
- Resource Type
- Journal article
- Publication Details
- JAMA surgery, Vol.157(3), e216900
- Publisher
- Amer Medical Assoc
- DOI
- 10.1001/jamasurg.2021.6900
- PMID
- 35019975
- PMCID
- PMC8756360
- ISSN
- 2168-6254
- eISSN
- 2168-6262
- Number of pages
- 9
- Grant note
- 1409-240099 / Patient-Centered Outcomes Research Institute; Patient-Centered Outcomes Research Institute - PCORI
- Language
- English
- Date published
- 03/01/2022
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984296972402771
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