Patient Factors Associated With Appendectomy Within 30 Days of Initiating Antibiotic Treatment for Appendicitis
Authors: Charles Parsons, Nathan I. Shapiro, Randall Cooper, Aleksandr Tichter, Arden Morris, Bruce Wolfe, Donald M. Yealy, Karla Ballman, Kathleen O’Connor, Olga Owens, Thomas Diflo, Alyssa Hayward, Lillian Adrianna Hayes, Joe H. Patton, Hikmatullah Arif, Laura Hennessey, Erika Wolff, Farhood Farjah, Kelsey Pullar, Brett Faine, Cathy Fairfield, Dionne Skeete, Debbie Lew, Karla Bernardi, Naila Dhanani, Oscar Olavarria, Stephanie Marquez, Tien C. Ko, Vance Sohn, Alan Jones, Deepti Patki, Matthew Kutcher, Rebekah K. Peacock, Bruce Chung, Damien Carter, David MacKenzie, Debra Burris, Joseph Mack, Terilee Gerry, Emily E. Anderson, Darrell A. Campbell, Fergal Fleming, David B. Hoyt, J.J. Tepas, Richard W. Whitten, SreyRam Kuy, Daniel S. Lessler, Jason Maggi, Kristyn Pierce, Marcovalerio Melis, Mohamad Abouzeid, Paresh Shah, Prashant Sinha, William Chiang, Amy Rushing, Steven Steinberg, Elliott Skopin, Heather VanDusen, Kimberly Deeney, Mary Guiden, Meridith Weiss, Miriam Hernandez, Brandon Tudor, Careen Foster, Shaina Schaetzel, Dayna Morgan, John Tschirhart, Julie Wallick, Katherine Mandell, Ryan Martinez, Sean Wells, Brant Putnam, Dennis Kim, Erin C. Howell, Lara H. Spence, Ross Fleischman, Darin Saltzman, Debbie Mireles, Formosa Chen, Gregory Moran, Kavitha Pathmarajah, Lisandra Uribe, Paul J Schmit, Robert Bennion, Cindy Hsu, Krishnan Raghavendran, Nathan Haas, Norman Olbrich, Pauline Park, Amber Sabbatini, Daniel Kim, Estel Williams, Karen Horvath, Zoe Parr, Karen F. Miller, Kelly M. Moser, Abigail Wiebusch, Julianna Yu, Scott Osborn, Billie Johnsson, Lauren Mount, Robert J. Winchell, Sunday Clark, Sarah E. Monsell, Emily C. Voldal, Giana H. Davidson, Katherine Fischkoff, Natasha Coleman, Bonnie Bizzell, Thea Price, Mayur Narayan, Nicole Siparsky, Callie M. Thompson, Patricia Ayoung-Chee, Stephen R. Odom, Sabrina Sanchez, F. Thurston Drake, Jeffrey Johnson, Joseph Cuschieri, Heather L. Evans, Mike K. Liang, Karen McGrane, Quinton Hatch, Jesse Victory, Jon Wisler, Matthew Salzberg, Lisa Ferrigno, Amy Kaji, Daniel A. DeUgarte, Melinda Maggard Gibbons, Hasan B. Alam, John Scott, Lillian S. Kao, Wesley H. Self, Robert J. Winchell, Cassandra M. Villegas, David A. Talan, Larry G. Kessler, Danielle C. Lavallee, Anusha Krishnadasan, Sarah O. Lawrence, Bryan Comstock, Erin Fannon, David R. Flum, Patrick J. Heagerty
Journal: JAMA Surgery (2022)

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.To assess patient factors associated with undergoing appendectomy within 30 days of initiating antibiotics for appendicitis.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.Appendectomy vs antibiotics.Conditional logistic regression models were 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.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).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.