A survey of the practice and attitudes of surgeons regarding the treatment of appendicitis

Abstract

BackgroundWe surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. MethodsA 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. ResultsA 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). ConclusionsTo 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.