D Dante Yeh1, Joseph V Sakran2, Rishi Rattan3, Ambar Mehta4, Gabriel Ruiz5, Howard Lieberman6, Michelle Mulder7, Nicholas Namias8, Tanya Zakrison9, Gerd Daniel Pust10. 1. Ryder Trauma Center, USA. Electronic address: dxy154@miami.edu. 2. Johns Hopkins University, USA. Electronic address: jsakran1@jhmi.edu. 3. Ryder Trauma Center, USA. Electronic address: rrattan@miami.edu. 4. Johns Hopkins University, USA. Electronic address: amehta25@jhmi.edu. 5. Ryder Trauma Center, USA. Electronic address: gruiz3@med.miami.edu. 6. Ryder Trauma Center, USA. Electronic address: hlieberman@med.miami.edu. 7. Ryder Trauma Center, USA. Electronic address: mbm139@med.miami.edu. 8. Ryder Trauma Center, USA. Electronic address: nnamias@med.miami.edu. 9. Ryder Trauma Center, USA. Electronic address: tzakrison@med.miami.edu. 10. Ryder Trauma Center, USA. Electronic address: gpust@med.miami.edu.
Abstract
BACKGROUND: We surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. METHODS: A web-based survey was sent to the EAST membership. The primary composite endpoint was defined as 1-year incidence of perioperative complications, antibiotic failure, infections, ED visits, and readmissions. RESULTS: A total of 563 of 1645 surveys were completed (34% response). Mean age was 47 ± 10 years and 98% were from the United States. Most (72%) were employed at academic teaching hospitals and 66% practiced in an urban setting. There were significant differences in treatment recommendations for different presentations of appendicitis. Regarding the primary composite endpoint, surgeons would tolerate a median 17% [10%-25%] excess morbidity in order to avoid an operation (i.e. non-inferiority) and would require a median 24% [10%-50% lower morbidity for the surgical approach in order to declare it a superior treatment (i.e. superiority). CONCLUSIONS: To be considered non-inferior, antibiotic therapy of appendicitis cannot have >17% excess morbidity and appendectomy must have at least 24% lower morbidity to be considered superior.
BACKGROUND: We surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. METHODS: A web-based survey was sent to the EAST membership. The primary composite endpoint was defined as 1-year incidence of perioperative complications, antibiotic failure, infections, ED visits, and readmissions. RESULTS: A total of 563 of 1645 surveys were completed (34% response). Mean age was 47 ± 10 years and 98% were from the United States. Most (72%) were employed at academic teaching hospitals and 66% practiced in an urban setting. There were significant differences in treatment recommendations for different presentations of appendicitis. Regarding the primary composite endpoint, surgeons would tolerate a median 17% [10%-25%] excess morbidity in order to avoid an operation (i.e. non-inferiority) and would require a median 24% [10%-50% lower morbidity for the surgical approach in order to declare it a superior treatment (i.e. superiority). CONCLUSIONS: To be considered non-inferior, antibiotic therapy of appendicitis cannot have >17% excess morbidity and appendectomy must have at least 24% lower morbidity to be considered superior.
Authors: Joachim Wilfried Heise; Heiner Kentrup; Christoph Gerhart Dietrich; Ansgar Cosler; Dolores Hübner; Werner Krumholz Journal: Visc Med Date: 2020-10-05