Hay Bach! Appendectomies?
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Researchers randomized 1,552 patients with appendicitis to surgery or antibiotics, which were delivered intravenously for 24 hours and then orally for 10 days. The noninferiority trial included patients with perforation and those with appendicoliths, groups historically considered too at risk to be part of a randomized trial of antibiotics.
Analysis showed that 31% of patients who had antibiotics as a first-line treatment underwent an appendectomy by 90 days, 40% by one year and 49% by four years.
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Researchers randomized 1,552 patients with appendicitis to surgery or antibiotics, which were delivered intravenously for 24 hours and then orally for 10 days. The noninferiority trial included patients with perforation and those with appendicoliths, groups historically considered too at risk to be part of a randomized trial of antibiotics.
Analysis showed that 31% of patients who had antibiotics as a first-line treatment underwent an appendectomy by 90 days, 40% by one year and 49% by four years.
@george-k If I am reading correctly, antibiotics are not very effective in this case, correct?
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@george-k If I am reading correctly, antibiotics are not very effective in this case, correct?
@taiwan_girl said in Hay Bach! Appendectomies?:
@george-k If I am reading correctly, antibiotics are not very effective in this case, correct?
That's the way I read it. THere's been a big push to avoid surgical intervention in acute appendicitis. Several studies have been done suggesting that IV antibiotics are a reasonable thing to try.
But, as I put it...
"We can treat you surgically with a 98% chance of complete recovery in 3-4 days, or....
...we can hospitalize you for a day, you take antibiotics for another 10, and there's a 50% chance we'll see you within 4 years."
Other comments:
What other treatment with a 30% failure rate within 90 days is accepted in surgical practice?
Just explain the cancer rate of 1% or so in specimens and everyone wants it out
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This often comes up at staff meetings and teaching rounds
Trust the science.
the best way to treat an appendix is to put it in a vial of formalin.
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This often comes up at staff meetings and teaching rounds
Trust the science.
the best way to treat an appendix is to put it in a vial of formalin.
@bachophile said in Hay Bach! Appendectomies?:
This often comes up at staff meetings and teaching rounds
Trust the science.
the best way to treat an appendix is to put it in a vial of formalin.
For a while I worked with a fine surgeon who did his colo-rectal fellowship at Oxford. We were discussing "urgencies" of appendectomies, and, this must be 20 years ago now, he said that when he had an appendix in A&E and wanted to get it done in the middle of the night, the nurse would flatly refuse.
"That's OK Dr. Stephens, we'll get to your appendicectomy in the morning."
He was flabbergasted that they would wait 6 hours on a hot appendix. I remember surgeons bumping the schedule so they could get their "about to burst" appendix done (before office hours, of course).
How times have changed, eh?
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It’s reasonable to wait overnight, not every appy needs to be done at 2 am. Ive asked for cases to be brought in at 7 am, and by 8 I’m on rounds upstairs. No harm done.
Usually the perforations are a result of patient delay, coming in after sitting at home for a few days. The several hour wait for an OR is not what does it.
Nonetheless surgery is still really the best option. Antibiotics will work and you can get away with it, but not everything you can get away with is correct.
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It’s reasonable to wait overnight, not every appy needs to be done at 2 am. Ive asked for cases to be brought in at 7 am, and by 8 I’m on rounds upstairs. No harm done.
Usually the perforations are a result of patient delay, coming in after sitting at home for a few days. The several hour wait for an OR is not what does it.
Nonetheless surgery is still really the best option. Antibiotics will work and you can get away with it, but not everything you can get away with is correct.
@bachophile said in Hay Bach! Appendectomies?:
you can get away with it
Half the time, in the long run.
