Turku University Hospital, Division of Digestive Surgery and Urology, University of Turku, Turku, Finland.
Department of Surgery, University of Turku, Turku, Finland.
JAMA Surg. 2020 Apr 1;155(4):283-289. doi: 10.1001/jamasurg.2019.6028.
Long-term results support antibiotics for uncomplicated acute appendicitis as an alternative to appendectomy. To our knowledge, treatment-related long-term patient satisfaction and quality of life (QOL) are not known.
To determine patient satisfaction and QOL after antibiotic therapy and appendectomy for treating uncomplicated acute appendicitis.
Open appendectomy vs antibiotics with intravenous ertapenem, 1 g once daily, for 3 days followed by 7 days of oral levofloxacin, 500 mg once daily, and metronidazole, 500 mg 3 times per day.
DESIGN, SETTING, AND PARTICIPANTS: This observational follow-up of the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotics included 530 patients age 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis who were randomized to undergo appendectomy (273 [52%]) or receive antibiotics (257 [49%]). The trial was conducted from November 2009 to June 2012; the last follow-up was May 9, 2018. The data were analyzed in February 2019.
In this analysis, post hoc secondary end points of postintervention QOL (EQ-5D-5L) and patient satisfaction and treatment preference were evaluated.
Of the 530 patients enrolled in the trial (appendectomy group: 273 [174 men (64%)] with a median age of 35 years; (antibiotic group: 257 [155 men (60%)] with a median age of 33 years), 423 patients (80%) were available for phone interview at a median follow-up of 7 years; 206 patients (80%) took antibiotics and 217 (79%) underwent appendectomy. Of the 206 patients taking antibiotics, 81 (39%) had undergone appendectomy. The QOL between appendectomy and antibiotic group patients was similar (median health index value, 1.0 in both groups; 95% CI, 0.86-1.0; P = .96). Patients who underwent appendectomy were more satisfied in the treatment than patients taking antibiotics (68% very satisfied, 21% satisfied, 6% indifferent, 4% unsatisfied, and 1% very unsatisfied in the appendectomy group and 53% very satisfied, 21% satisfied, 13% indifferent, 7% unsatisfied, and 6% very unsatisfied in the antibiotic group; P < .001) and in a subgroup analysis this difference was based on the antibiotic group patients undergoing appendectomy. There was no difference in patient satisfaction after successful antibiotic treatment compared with appendectomy (cumulative odds ratio [COR], 7.8; 95% CI, 0.5-1.3; P < .36). Patients with appendectomy or with successful antibiotic therapy were more satisfied than antibiotic group patients who later underwent appendectomy (COR, 7.7; 95% CI, 4.6-12.9; P < .001; COR, 9.7; 95% CI, 5.4-15.3; P < .001, respectively). Of the 81 patients taking antibiotics who underwent appendectomy, 27 (33%) would again choose antibiotics as their primary treatment.
In this analysis, long-term QOL was similar after appendectomy and antibiotic therapy for the treatment of uncomplicated acute appendicitis. Patients taking antibiotics who later underwent appendectomy were less satisfied than patients with successful antibiotics or appendectomy.
Clinicaltrials.gov Identifier: NCT01022567.
背景：长期结果支持将抗生素治疗用于单纯性急性阑尾炎，作为阑尾切除术的替代方法。据我们所知，治疗相关的长期患者满意度和生活质量（QOL）尚不清楚。
目的：确定抗生素治疗和阑尾切除术治疗单纯性急性阑尾炎后患者的满意度和 QOL。
干预措施：开腹阑尾切除术与静脉注射厄他培南（1 g 每日 1 次）、3 天，随后口服左氧氟沙星（500 mg 每日 1 次）和甲硝唑（500 mg 每日 3 次）7 天进行对比。
设计、地点和参与者：这是一项对 APPAC 多中心随机临床试验的观察性随访，该试验比较了阑尾切除术和抗生素治疗，共纳入 530 名年龄在 18 至 60 岁之间、经计算机断层扫描证实为单纯性急性阑尾炎的患者，随机分为阑尾切除术组（273 例[52%]）或接受抗生素治疗组（257 例[49%]）。试验于 2009 年 11 月至 2012 年 6 月进行，最后一次随访是在 2018 年 5 月 9 日。数据分析于 2019 年 2 月进行。
主要结果和措施：在本次分析中，作为次要的治疗后终点，评估了干预后 QOL（EQ-5D-5L）和患者满意度和治疗偏好。
结果：在该试验中，530 名入组患者（阑尾切除术组：273 名[174 名男性（64%）]，中位年龄 35 岁；抗生素组：257 名[155 名男性（60%）]，中位年龄 33 岁）中，423 名（80%）在中位随访 7 年后可通过电话进行访谈；206 名（80%）接受了抗生素治疗，217 名（79%）接受了阑尾切除术。在接受抗生素治疗的 206 名患者中，81 名（39%）接受了阑尾切除术。阑尾切除术组和抗生素组患者的 QOL 相似（中位健康指数值，两组均为 1.0；95%CI，0.86-1.0；P=0.96）。与接受抗生素治疗的患者相比，接受阑尾切除术的患者在治疗中更满意（阑尾切除术组 68%非常满意，21%满意，6%无所谓，4%不满意，1%非常不满意；抗生素组 53%非常满意，21%满意，13%无所谓，7%不满意，6%非常不满意；P<0.001），并且在亚组分析中，这种差异基于抗生素组中接受阑尾切除术的患者。与阑尾切除术相比，成功接受抗生素治疗的患者满意度无差异（累积优势比[COR]，7.8；95%CI，0.5-1.3；P<0.36）。与接受抗生素治疗的患者相比，接受阑尾切除术或成功接受抗生素治疗的患者更满意（COR，7.7；95%CI，4.6-12.9；P<0.001；COR，9.7；95%CI，5.4-15.3；P<0.001）。在接受抗生素治疗并随后接受阑尾切除术的 81 名患者中，有 27 名（33%）会再次选择抗生素作为主要治疗方法。
结论和相关性：在本分析中，单纯性急性阑尾炎采用阑尾切除术和抗生素治疗的长期 QOL 相似。接受抗生素治疗后又接受阑尾切除术的患者比成功接受抗生素治疗或阑尾切除术的患者满意度更低。
试验注册：Clinicaltrials.gov 标识符：NCT01022567。
