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Appendicitis Trial Shows the Risks and Benefits of Treating Appendicitis with Antibiotics Instead of Surgery

October 05, 2020

Contact: Caroline Cornish
207-662-5146 / ccornish@mmc.org

PORTLAND, Maine – Antibiotics may be a good choice for some, but not all, patients with appendicitis, according to results from the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) Trial reported today in the New England Journal of Medicine.

Maine Medical Center (MMC) was among 25 hospitals taking part in the trial, which found that patients who took antibiotics instead of electing to have an appendectomy did not necessarily suffer a worse health outcome.

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Damien Carter, MD
“This data indicates that most people with uncomplicated appendicitis may be able to avoid surgery if their condition is initially managed with antibiotics,” said MMC surgeon Damien Carter, MD, who was the site Principal Investigator in Maine on this study. “However, there are advantages and disadvantages to both treatments, and it is important for surgeons and patients to discuss options together.”

While nearly half of the antibiotics group avoided hospitalization for their initial treatment, overall, the time spent in the hospital was similar between groups. “People treated with antibiotics more often returned to the emergency department but missed less time from work and school,” said Bonnie Bizzell, Chair of the CODA Patient Advisory Board. “Information like this can be important for individuals as they consider the best treatment option for their unique circumstance. The CODA Trial is really the first of its kind to capture these measures for appendicitis shared decision-making.”

Other initial findings of the CODA Trial include:

  • Patients treated with either surgery or antibiotics experienced symptoms of appendicitis for about the same amount of time.
  • Approximately 3 out of 10 patients in the antibiotic group underwent appendectomy by 90 days.
  • Patients with an appendicolith, a calcified deposit within the appendix, had twice the risk of complications than those without an appendicolith.
  • Participants with an appendicolith had an increased chance of appendectomy by 90 days (4 in 10 with appendicolith vs 3 in 10 without).

The CODA Trial, which was funded by the Patient-Centered Outcomes Research Institute, is the largest randomized clinical trial of appendicitis conducted to date. Across the United States, 1,552 participants were randomized to receive appendectomy or antibiotics-first for uncomplicated appendicitis. MMC enrolled 33 patients.

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About Maine Medical Center
Maine Medical Center (MMC), recognized as a Best Regional Hospital by U.S. News and World Report for 2020-2021, is a complete health care resource for the people of Greater Portland and the entire state, as well as northern New England. Incorporated in 1868, MMC is the state’s largest medical center, licensed for 637 beds and employing more than 9,600 people. MMC's unique role as both a community hospital and a referral center requires an unparalleled depth and breadth of services, including an active educational program and a world-class biomedical research center. As a nonprofit institution, Maine Medical Center provides nearly 23 percent of all the charity care delivered in Maine. MMC is part of the MaineHealth system, a growing family of health care services in northern New England. For more information, visit www.mmc.org.

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