A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial
Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis. Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable...
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| Veröffentlicht in: | Annals of surgery 2021-08, Vol.274 (2), p.240-247 |
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| creator | O’Leary, D. Peter Walsh, Siun M. Bolger, Jarlath Baban, Chwanrow Humphreys, Hilary O’Grady, Sorcha Hegarty, Aisling Lee, Aoife M. Sheehan, Mark Alderson, Jack Dunne, Ruth Morrin, Martina M. Lee, Michael J. Power, Colm McNamara, Deborah McCawley, Niamh Robb, Will Burke, John Sorensen, Jan Hill, Arnold D. |
| description | Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.
Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.
Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.
One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).
Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition. |
| doi_str_mv | 10.1097/SLA.0000000000004785 |
| format | Article |
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Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.
Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.
One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).
Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000004785</identifier><identifier>PMID: 33534226</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Aged ; Anti-Bacterial Agents - therapeutic use ; Appendectomy ; Appendicitis - drug therapy ; Appendicitis - surgery ; Female ; Humans ; Ireland ; Male ; Middle Aged ; Quality of Life ; Recurrence</subject><ispartof>Annals of surgery, 2021-08, Vol.274 (2), p.240-247</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3521-f67a669e98aa3ba14fee2665f008235dfe7fa3088551dccda6e7709c7d12b1fe3</citedby><cites>FETCH-LOGICAL-c3521-f67a669e98aa3ba14fee2665f008235dfe7fa3088551dccda6e7709c7d12b1fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33534226$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O’Leary, D. Peter</creatorcontrib><creatorcontrib>Walsh, Siun M.</creatorcontrib><creatorcontrib>Bolger, Jarlath</creatorcontrib><creatorcontrib>Baban, Chwanrow</creatorcontrib><creatorcontrib>Humphreys, Hilary</creatorcontrib><creatorcontrib>O’Grady, Sorcha</creatorcontrib><creatorcontrib>Hegarty, Aisling</creatorcontrib><creatorcontrib>Lee, Aoife M.</creatorcontrib><creatorcontrib>Sheehan, Mark</creatorcontrib><creatorcontrib>Alderson, Jack</creatorcontrib><creatorcontrib>Dunne, Ruth</creatorcontrib><creatorcontrib>Morrin, Martina M.</creatorcontrib><creatorcontrib>Lee, Michael J.</creatorcontrib><creatorcontrib>Power, Colm</creatorcontrib><creatorcontrib>McNamara, Deborah</creatorcontrib><creatorcontrib>McCawley, Niamh</creatorcontrib><creatorcontrib>Robb, Will</creatorcontrib><creatorcontrib>Burke, John</creatorcontrib><creatorcontrib>Sorensen, Jan</creatorcontrib><creatorcontrib>Hill, Arnold D.</creatorcontrib><title>A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.
Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.
Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.
One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).
Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Appendectomy</subject><subject>Appendicitis - drug therapy</subject><subject>Appendicitis - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Ireland</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Quality of Life</subject><subject>Recurrence</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUdlu1DAUtRCIDoU_QMiPvKR4j8NbNBoWaaqK0j5HHueaMThxiB2q4Xv4UDxMWYQl--r6nsXyQeg5JReUNPWrj9v2gvyzRK3lA7SikumKUkEeolW55ZVoODtDT1L6TAgVmtSP0RnnkgvG1Ar9aPG1Gfs4-O_Q43Xwo7cm4JvZl3PzzYTFZD9-wnkPeONcGdoDLgT8YTHB5wOODm-9g2Ntx-x3PmZvqziGQxEBkwcY86-hXTLg29HGYQpFJhe7dppg7L312afX-BrSEnI6go9u66vLy_b0kKfokTMhwbP7eo5u32xu1u-q7dXb9-t2W1kuGa2cqo1SDTTaGL4zVDgAppR0hGjGZe-gdoYTraWkvbW9UVDXpLF1T9mOOuDn6OVJd5rj1wVS7gafLIRgRohL6pjQipafI6JAxQlq55jSDK6bZj-Y-dBR0h3z6Uo-3f_5FNqLe4dlN0D_h_Q7kL-6dzFkmNOXsNzB3O3BhLw_6SmpK0YYJbo0VdmU8p--n5ww</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>O’Leary, D. 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Peter</au><au>Walsh, Siun M.</au><au>Bolger, Jarlath</au><au>Baban, Chwanrow</au><au>Humphreys, Hilary</au><au>O’Grady, Sorcha</au><au>Hegarty, Aisling</au><au>Lee, Aoife M.</au><au>Sheehan, Mark</au><au>Alderson, Jack</au><au>Dunne, Ruth</au><au>Morrin, Martina M.</au><au>Lee, Michael J.</au><au>Power, Colm</au><au>McNamara, Deborah</au><au>McCawley, Niamh</au><au>Robb, Will</au><au>Burke, John</au><au>Sorensen, Jan</au><au>Hill, Arnold D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>274</volume><issue>2</issue><spage>240</spage><epage>247</epage><pages>240-247</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.
Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.
Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.
One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).
Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33534226</pmid><doi>10.1097/SLA.0000000000004785</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Anti-Bacterial Agents - therapeutic use Appendectomy Appendicitis - drug therapy Appendicitis - surgery Female Humans Ireland Male Middle Aged Quality of Life Recurrence |
| title | A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial |
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