Patient perspectives on nonoperative management of acute appendicitis

  • Hytham K. S. HamidEmail author
Letter to the Editor


Recently, there has been a growing interest in nonoperative management of acute appendicitis, and the dictum that surgical removal of the appendix is necessary has been largely challenged. Yet, little is known about patient perspectives regarding nonoperative management of appendicitis. We read the recent article by O’Connell and colleagues [1] with great interest. There are several aspects of the article with which one might take issue.

First, the results indicated that only 43% and 38% of patients would prefer to have antibiotics only as the treatment of choice for themselves and their child, respectively, and prior personal diagnosis of appendicitis is not associated with choosing operative or nonoperative management. Although the authors strived to assess patients’ knowledge regarding symptoms and management of appendicitis, no attempt was made to educate patients about the relative safety of an antibiotics-first or urgent appendectomy management approaches prior to survey. This is perhaps relevant considering that the knowledge of appendicitis management was variable among participants and only 20% were aware of nonoperative treatment. Studies have shown that patients who received education about the management options of appendicitis were more likely to choose nonoperative management (57%), particularly if they had previous appendicectomy or if they were parents of minors (74% and 63%, respectively) [2].

Second, it would have been relevant to stratify patients based on their level of education and private insurance status. Recent evidence has demonstrated that patients who had education beyond college were more likely to choose antibiotics treatment [3]. In addition, the failure rate of nonoperative management of appendicitis was shown to be lower among privately insured patients compared to the general population [4]. Improvement in the failure rate is the key factor to increase the desirability of choosing nonoperative treatment [3].

In conclusion, it would be interesting to see if authors plan to do a similar study, and including the level of education and insurance status as important covariates, to address the aforementioned points.


Compliance with ethical standards

Conflict of interest

The author declares no conflict of interest.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.


  1. 1.
    O'Connell EP, White A, Cromwell P, Carroll E, Khan W, Waldron R, Khan IZ, Barry K (2018) Non-operative treatment of appendicitis: public perception and decision-making. Ir J Med Sci 187(4):1029–1038. CrossRefPubMedGoogle Scholar
  2. 2.
    Kadera SP, Mower WR, Krishnadasan A, Talan DA (2016) Patient perspectives on antibiotics for appendicitis at one hospital. J Surg Res 201(2):253–257. CrossRefPubMedGoogle Scholar
  3. 3.
    Hanson AL, Crosby RD, Basson MD (2018) Patient preferences for surgery or antibiotics for the treatment of acute appendicitis. JAMA Surg 153(5):471–478. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sceats LA, Trickey AW, Morris AM, Kin C, Staudenmayer KL (2018) Nonoperative management of uncomplicated appendicitis among privately insured patients. JAMA Surg 154:141. CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Department of SurgerySoba University HospitalKhartoumSudan

Personalised recommendations