Speaker
David R. Flum
Professor, Surgery, Health Services, and Pharmacy
Associate Chair for Research, Department of Surgery
University of Washington
Topic
Appendectomy Versus Antibiotics for Appendicitis–Early Results from the CODA Trial
Keywords
Appendectomy; Antibiotic therapy; CODA Collaborative; Comparative effectiveness research; Patient-centered outcomes research; Pragmatic clinical trial; Noninferiority; PCORI
Key Points
- The CODA (Comparing Outcomes of Drugs and Appendectomy) Collaborative involved 25 sites across 14 states. The Co-PIs included surgeons and emergency medicine physicians.
- The CODA pragmatic trial aimed to inform the health decision for appendicitis treatment by asking two research questions:
- Are antibiotics as effective as appendectomy for appendicitis?
- Which patients are most likely to have a successful outcome with antibiotics?
- Instead of appendectomy, the intervention group received antibiotics intravenously for 24 hours followed by pills for a total of 10 days. The primary outcome in the trial was 30-day health status, as assessed with the European Quality of Life-5 Dimensions questionnaire.
- The patients who received antibiotics cared about outcomes such as “Am I going to feel better,” followed by “Is it safe,” and “Will I return to work sooner?”
Discussion Themes
Antibiotics for appendicitis can be a good choice for some but not all. Decision-makers must weigh patient characteristics, preferences, and circumstances.
Can you comment on the relative “disappearance” of appendicitis during the COVID-19 pandemic?
Based on your results, how would you counsel a patient (or parent) in the emergency department with a diagnosis of appendicitis?
Will there eventually be a biomarker that’s predictive for appendectomy?
Read more about CODA results in the New England Journal of Medicine.
Tags
#pctGR, @Collaboratory1