A Randomised Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic Only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA trial

Link to article at PubMed

Ann Surg. 2021 Feb 1. doi: 10.1097/SLA.0000000000004785. Online ahead of print.


OBJECTIVE: Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.

SUMMARY BACKGROUND DATA: 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.

METHODS: Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomised to either intravenous antibiotics only or undergo appendectomy.

RESULTS: 186 patients underwent randomisation. In the antibiotic only group, 23 patients (25.3%) experienced a recurrence within one year following randomisation. There was a significantly better EQ-VAS quality of life score in the surgery group compared to the antibiotic only group at 3 months (94.3 v 91.0, p < 0.001) and 12 months post intervention (94.5 v 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 v 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 v 2.8 days, p = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 v €3,077, p < 0.001).

CONCLUSIONS: 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.

PMID:33534226 | DOI:10.1097/SLA.0000000000004785

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