A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial.

Autor:	O'Leary DP; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Walsh SM; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Bolger J; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Baban C; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Humphreys H; Department of Microbiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., O'Grady S; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Hegarty A; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Lee AM; Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Sheehan M; Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Alderson J; Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Dunne R; Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Morrin MM; Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Lee MJ; Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Power C; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., McNamara D; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., McCawley N; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Robb W; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Burke J; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland., Sorensen J; Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland., Hill AD; Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2021 Aug 01; Vol. 274 (2), pp. 240-247.
DOI:	10.1097/SLA.0000000000004785
Abstrakt:	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 randomized to either intravenous antibiotics only or undergo appendectomy. Results: 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). 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. Competing Interests: The authors report no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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