For decades, emergency surgery has been considered the first-line treatment for appendicitis in order to remove the inflamed appendix quickly before it bursts and sends infection throughout the body. But recently, new scientific studies out of Europe are showing positive results for the use of antibiotics alone as an alternative treatment.
Now, a study by Stanford surgeons finds that surgery should indeed remain the primary treatment for appendicitis for multiple reasons including higher rates of hospital readmissions and higher costs associated with patients treated with antibiotics alone.
I asked Lindsay Sceats, MD, a surgical resident at Stanford, and lead author what motivated the study and she told me: "More and more patients in the Stanford emergency room have been asking about whether they can just take antibiotics when they come in with appendicitis instead of having surgery." This study was designed, in part, to help answer those questions.
It's not surprising patients have begun asking questions considering recent media coverage of the those European studies such as a CBS News story headlined "Study finds surgery often not needed for appendicitis" and a Smithsonian article, "Antibiotics may treat appendicitis without surgery."
Sceats said that because these studies have been relatively small, closed trials, her team chose to examine the issue using a different method. They wanted to compare the two treatments in a “large, real world population,” she said. As my release explains:
To conduct the study, researchers used claims data from a private insurance database to compare patients admitted with appendicitis from 2008 through 2014. Of the 58,329 patients with appendicitis, 55,790, or 95.5 percent, underwent appendectomy. The remaining 4.5 percent were treated with drug therapy alone.
Researchers found that, in addition to showing a slightly higher rate of abdominal abscesses post-treatment for those who didn’t have surgery, results also showed higher hospital readmissions rates which contributed to higher overall costs:
Results showed that, surprisingly, overall costs were 5.5 percent higher for patients who didn't have the surgery. The average cost of care was $14,932 for these patients. For patients who underwent the surgery, the average cost of care was $14,186.
Sceats discussed with me how both patients and doctors seem to be extra cautious when no surgery is done, and are quick to seek care if there are any abdominal pains due to worry about the appendicitis returning. This extra caution can be expensive, she said. The takeaway, she said, is that surgery is the preferred line of treatment:
These results tell us that, in most cases, surgery is still the best strategy. For your average, healthy 30-year-old, the alternative treatment is no cheaper, and it's easier to have the surgery. You also no longer have an appendix, so you’re no longer at risk of having appendicitis again."
Photo of Wilson Alobuia, MD, surgery resident, and Brooke Gurland, clinical professor of surgery, by Rachel Baker