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It’s one of the most common medical emergencies – an inflamed or ruptured appendix. It usually ends with a trip to the operating room and the removal of the organ.
But some patients can do just fine with infusions of antibiotics, and more doctors have considered non-surgical treatment of what’s called uncomplicated appendicitis: an inflammation of the appendix that’s not immediately life-threatening. The thinking has been that it must be safer and cheaper if the skin isn’t cut open and a piece of the body removed.
A new study out Wednesday contradicts this idea. People who got antibiotics instead of surgery did not fare better, and they ended up racking up higher medical bills. They were twice as likely to have to come back with a flare-up, a team at Stanford University found.
“People treated with antibiotics alone have a higher chance of coming back needing further treatment for appendicitis-related problems, such as abdominal abscesses,” said Dr. Lindsay Sceats, who led the study team.
Sceats and colleagues studied the issue because patients often prefer skipping the scalpel if they can. “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,” Sceats, a surgeon at Stanford Hospital, said in a statement.
They looked at the medical records of more than 58,000 people with uncomplicated appendicitis. Most had their appendix removed, but just under 5 percent of them, about 2,600, opted for infusions of antibiotics instead.
Most patients in both groups did fine but those who got antibiotics alone were twice as likely to have to come back and 42 percent more likely to develop an abscess, the team reported in the Journal of the American Medical Association’s JAMA Surgery.
Most of the patients treated with antibiotics alone were cured. Only 4 percent needed appendectomies later, the researchers found. But their risk of a new flare-up of appendicitis lasted for as long as four years, the team found.
“Even if the initial hospitalization is cheaper, when you look at long-term cost, which our study did, it ends up being more expensive,” Sceats said.
Appendectomies are very common. An estimated 5 percent of the U.S. population will suffer acute appendicitis at some time in their lives.
“Due to sheer volume, appendectomy is the sixth leading cause of morbidity and mortality owing to emergency general surgery in the United States,” the researchers wrote.
An inflamed appendix can rupture and cause gangrene. “As such, urgent appendectomy has historically been considered the mainstay of treatment,” the researchers wrote. Any kind of surgery can cause problems and appendectomies are no exception. Up to 23 percent of patients have some sort of postoperative complication.
But using antibiotics alone did not reduce the rate of problems.
“People treated with antibiotics are more likely to come back and be hospitalized for any sort of belly pain,” Sceats said. “Doctors may also be more cautious when the appendix isn’t removed.” That may mean patients get hospitalized fast, just in case it is a new flare-up of appendicitis.
“These results tell us that, in most cases, surgery is still the best strategy,” Sceats said. “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.”
The appendix is a small pouch found near where the large and small intestines meet. For decades it was considered to be of no use at all, but doctors now believe it’s important to the immune system and may serve as a reservoir for “good” bacteria.