Outpatient antibiotic management of selected patients with appendicitis is safe, allowing many patients to avoid surgery and hospitalization, and should be considered as part of shared decision-making between doctor and patient. Of 726 participants who were randomized to receive antibiotics, 46% were discharged from the emergency department within 24 hours. Outpatient management was associated with fewer than 1 serious adverse effect per 100 patients in the week after their discharge. Outpatient management was shown to be safe across a wide range of patients and was done in up to 90% of antibiotic-treated patients across all study sites. Compared to hospitalization, outpatient management was not associated with any more subsequent appendectomies and patients missed fewer workdays.
This study is a continuing analysis of findings from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which found that antibiotic treatment was non-inferior to urgent appendectomy. Following the trial, the American College of Surgeons stated that high-quality evidence indicated that most patients can be treated with antibiotics.
The researchers examined data from 726 people with imaging-confirmed appendicitis who were treated with antibiotics at 25 hospitals between May 1, 2016 and February 28, 2020
Outpatient management of appendicitis is safe for many people and could decrease healthcare use and costs.
Dr. David Talan, professor of emergency medicine and of medicine/infectious diseases at the David Geffen School of Medicine at UCLA, is co-principal investigator of the CODA Trial. The trial comprised dozens of researchers across the U.S., including UCLA investigators from the departments of surgery and emergency medicine at Olive View-UCLA Medical Center and Harbor-UCLA Medical Center: Dr. Dan DeUgarte, Dr. Gregory Moran, and Dr. Amy Kaji.
The study was published in the peer-reviewed journal JAMA Network Open.
The Patient-Centered Outcomes Research Institute (PCORI) funded this study.