Paulina Salminen MD PhD Chief and Professor of surgery Turku University, Finland

Uncomplicated Appendicitis: Patient Satisfaction of Surgery vs Antibiotics Interview with:

Paulina Salminen MD PhD Chief and Professor of surgery Turku University, Finland

Dr. Salminen

Paulina Salminen MD PhD
Chief and Professor of surgery
Turku University, Finland What is the background for this study?

Response: Appendectomy has been the standard treatment for uncomplicated acute appendicitis and currently one of the most commonly performed surgical procedures. We now know that there are two different forms of acute appendicitis: the more common milder uncomplicated acute appendicitis and the more severe complicated acute appendicitis. While the complicated form is primarily still treated surgically, in recent years evidence from randomised trials and meta-analyses show that antibiotics are a safe and efficient treatment of uncomplicated acute appendicitis  also at long-term follow-up.

Quality of life (QOL) and patient satisfaction after antibiotic therapy or appendectomy for uncomplicated acute appendicitis have been studied previously in a pediatric population but not in an adult population. Our aim was to compare long-term quality of life and patient satisfaction after antibiotic therapy and appendectomy for the treatment of uncomplicated acute appendicitis in patients enrolled in the original APPAC trial. What are the main findings?

Response: At 7-year follow-up, we found similar QOL between the two groups. Appendectomy patients were, however, more satisfied in the treatment than antibiotic group patients. This was explained by a subgroup analysis as the difference was was based on the antibiotic group patients later undergoing appendectomy for suspected recurrence, i.e.there was no difference in patient satisfaction between successful antibiotic therapy and appendectomy. Another interesting finding was that 33% of patients originally randomised to the antibiotic group later undergoing appendectomy would still again choose to have antibiotics as their primary treatment in order to avoid surgery. What should readers take away from your report?

Response: Our previous 5-year follow-up results showed that antibiotic therapy is a safe and efficient alternative to appendectomy in treating uncomplicated acute appendicitis while also being more cost-effective. This current study includes the aspects of quality of life and patient satisfaction illustrating that there are several factors affecting the decision of choosing the optimal treatment for uncomplicated acute appendicitis. Some patients are willing to avoid primary surgery and accept the risk of later recurrence. The importance of joint decision making has only been recognised and quality of life and patient preference play a role in determining how to treat a patient. What recommendations do you have for future research as a result of this work? 

Response: Because antibiotic patients later undergoing appendectomy were less satisfied than patients with successful antibiotic therapy or appendectomy, it is important to study potential parameters predictive of appendicitis recurrence. Future studies should focus on optimizing the antibiotic therapy to possibly only per oral therapy to decrease hospital stay in patients, which is likely to increase their treatment satisfaction. This would also be beneficial in terms of antibiotic spectrum, i.e. we would avoid using broad-spectrum i.v. antibiotics. Our study group has an ongoing APPAC II trial assessing these topics with approximately 600 patients and we will have the results this spring. It also has to be noted that even symptomatic therapy may be an effective treatment and we currently have an ongoing trial (APPAC III), which is a plasebo-controlled double blinded study antibiotics vs. plasebo in the treatment of CT-scan confirmed uncomplicated acute appendicitis. Future research should also focus on a more patient-centered approach providing the patients with unbiased information about the benefits and risks for different treatment options.

No disclosures.


Sippola S, Haijanen J, Viinikainen L, et al. Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Surg. Published online February 19, 2020. doi:10.1001/jamasurg.2019.6028



The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on February 23, 2020 by Marie Benz MD FAAD