A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis (October 2020)
Publication (New England Journal of Medicine)
Plain Language Summary (PDF)
Infographic: Deciding Between Antibiotics and Surgery for Appendicitis: Findings from the CODA Study (download a PDF version here)
Short Video Summary (New England Journal of Medicine, requires set-up of free account to view)
Conclusions: "For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith."
Conclusions: "In the antibiotics groups, the percentage of patients who underwent subsequent appendectomy was 40% at 1 year and 46% at 2 years; the percentages were 49% at 3 and 4 years, according to limited longer-term follow-up. At 30 days after randomization, the risk of appendectomy was 27% through 1 year. Appendectomy was more common among patients who had an appendicolith, but this greater risk was attenuated with time."
Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial: a protocol for the pragmatic randomised study of appendicitis treatment (November 2017)
Publication (BMJ Open)
Methods for Incorporating Stakeholder Engagement into Clinical Trial Design (May 2017)
Evidence for an Antibiotics-First Strategy for Uncomplicated Appendicitis in Adults: A Systematic Review and Gap Analysis (December 2016)
Publication (Journal of the American College of Surgeons)
Engaging Stakeholders in Surgical Research: The Design of a Pragmatic Clinical Trial to Study Management of Acute Appendicitis (June 2016)