Work

Author response to: Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study

Year: 2021

Type: peer-review

Abstract: Dear Editor The authors were delighted that our article provoked discussion at Mr McCauley’s journal club1. Failure of non-operative management of appendicitis was defined as requiring an appendicectomy in the first 3 months following appendicitis diagnosis. A limitation of observational studies is that intervention in patient care is prohibited, making contacting patients to enquire about continued symptomology an impossibility. However, it is expected that patients with ongoing pain would be likely to represent and subsequently undergo appendicectomy. At the start of the pandemic, when this study was designed, it was impossible to predict how COVID-19 would impact the availability of services. It was conceivable that the burden of COVID-19 patients could have resulted in imaging being rationed, and a return to appendicitis being a clinical diagnosis. As such, the design of the study left both routes of diagnosis available, while recognising some patients may have been managed without a confirmed diagnosis. In total, 70 per cent of our patients had a CT; this reflects the ‘real world’ of surgical practice in the UK and is a valuable example of how antibiotic management could be applied in a resource constrained setting. With regards propensity score-matching, we did not include imaging confirmation and instead included AAS to determine the probability of having appendicitis. Because of this, the percentage with appendicitis on CT in each group after propensity score matching was similar (69 and 68 per cent, respectively). We did not collect data for individual components of the score so these could not be included separately. Moreover, the relationship between probability of appendicitis and CRP in AAS is not linear whereas we used it as a linear marker of severity. The result of this can be seen in subsequent improved matching in other markers of severity such as tachycardia and fever. The variability of faecalith reporting is something we intend to address in collaboration with our radiologist colleagues in upcoming treatment guidelines for adult appendicitis. The COVID: HAREM Collaborative: N. Kulkarni; I. Pereira; S. Barlow; S. Vanniasegaram (Lincoln County Hospital, Lincoln); F. Loro; N. S. Blencowe; B. E. Zucker; A. Tyler (Bristol Royal Infirmary, Bristol); M. Hollyman; A. Kosti; M. Wijeyaratne; T. Badenoch (Musgrove Hospital, Taunton); S. Wheatstone; M. Jaffer; H. Gerretsen; R. Menon (Guys and St. Thomas Hospital, London); M. S. Sajid; L. Kennedy; A. Malik; A. Nada; K. Ray; M. Khan (Royal Sussex County Hospital, Brighton); M. Varcada; F. Froghi; A. Khalil; D. Kyprianou (Royal Free Hospital, London); N. Tewari; D. R. Sarma; M. Baig; S. Sood; E. Yu Wen Ng; V. Ng; T. Shortland; G. Marangoni; S. Khan; J. Ahmad (University Hospital Coventry, Coventry); S. Brown; C. Steele; A. Pannu (Sheffield Teaching Hospital, Sheffield); E. Gemmill; H. Boyd-Carson; P. Herrod; S. Singh Shari; M. J. S. Mohammed; V. Narbad; N. Hanbali; A. Kushairi (Kings Mill Hospital, Mansfield); M. A. Mathew; C. Downey; A. Alamassi (Airedale NHS Foundation Trust, Steeton); T. Wheatley; K. Emslie; B. Alcocer; S. Lau (Derriford Hospital, Plymouth); R. Morgan; T. Gala; S. Ibrahim; M. Stephanos; R. Mithany; M. Abdelkarim; G. Venkatesan; A. Aqsalan (Glan Clwyd Hospital, Rhyl); J. Taylor; M. Fok; A. Kattakayam; K. Rajput (Liverpool University Hospitals NHS Trust, Liverpool); K. Bevan; H.-K. Kim; L. Salih; R. Sabaratnam (Bedford Hospital, Bedford); M. Creanga; A. Shafi; J. Law; M. Elniel; M. Walley; S. Ayyar (Pennine Acute Hospitals NHS Trust, Oldham); J. Cornish; N. Reeves; N. Mowbray; I. Mayo; M. Shinkwin (University Hospital of Wales, Cardiff); E. Chohda; W. McCaughran; E. Beck; S. Garikipati (Whittington Hospital, Whittington); B. E. Lovett; F. Alkistawi; S. Franklin; C. Hadjitoffi; A. Uddin (Basildon University Hospital, Basildon); P. K. Patel; S. Handa; J. Parker; D. Littlehales (Furness General Hospital, Furness); A. P. Belgaumkar; B. Oyewole; P. Narayan; Z. Elahi; A. Gaukroger (Surrey and Sussex Healthcare NHS Trust, Surrey); D. F. J. Dunne; G. E. Nita; R. D. Baron; D. Sochorova; P. Szatmary; S. A. K. Gahunia; A. J. Thomas; K. S. Mann (Royal Liverpool University Hospital, Liverpool); M. McFall; N. Farkas; H. Siddig (Worthing Hospital, Worthing); J. Camilleri-Brennan; D. Rutherford; M. Wilson; E. Massie; K. McGivern; J. McGuckin; C. McKee (Forth Valley Royal Hospital, Larbert); S. Marinos-Kouris; E. Gammeri; N. Patel; G. Cillo; A. J. Baldwin; T. Magro (Stoke Mandeville Hospital, Aylesbury); K. Krishna; J. Olivier; N. Anyaugo; K. Philip (Weston General Hospital, Weston-super-Mare); L. Pearce; A. Al-Amin; M. Thomas; I. Anderson; R. Clark (Salford Royal Hospital, Salford); M. Basamh; S. M. Navaratnam; A. Saunt; B. Bekhyat Karki; H. Jeong; B. Singh; A. Rajendirin; K. Boyle; S. Fahmy; J. H. Couch; H. Z. Butt (University Hospitals of Leicester NHS Trust, Leicester); G. Tierney; J. N. Lund; H. Javanmard-Emamghissi; B. Doleman; C. Hope; A. Gowda; D. Photiou; F. Malcolm; P. Daliya; N. Rye; Z. Chia; F. Anis (Royal Derby Hospital, Derby); P. Thomas; T. Urbonas; D. Centea; N. Husain (Burton Hospital, Burton); S. Moug; A. Ingham; N. Galbraith (Royal Alexandra Hospital, Glasgow); R. Alexander; C. Bisset (Inverclyde Hospital, Greenock); R. Clifford; L. Dickerson (The Countess of Chester Hospital, Chester); S. Lockwood; J. Johnston (Bradford Royal Infirmary, Bradford); R. Guy; T. Majeed; R. Young; S. Shamim; M. Mesri (Arrowe Park Hospital, Birkenhead); R. Date; M. P. Chaudhury; G. Zambas (Lancashire Teaching Hospital, Preston); R. Patel; S. Lewis; A. T. Eigbadon; D. Thakrar; E. Karamitsou; Y. Oyeyipo; U. Nadeem; S. Ndlovu; A. Fanshawe (Northwick Park Hospital, London); N. Henderson; C. Payne; D. Porter (Ninewells Hospital, Dundee); A. Brooks; R. X. N. Lee; J. Jackman; A. J. Morton; O. Ebunoluwa Oyende; D. Worku; A. Koh; T. Kanani; J. Blackwell; M. Shaw; C. Lewis-Lloyd; L. Blackburn; A. Adiamah (Queens Medical Centre, Nottingham); S. Shaikh; M. Ghazanfar; M. Elhusseini; A. Abdelhamid; J. Eley; A. Nassar (aberdeen Royal Infirmary, Aberdeen); R. Nunn; A. Gales; E. Farinella; Z. Mahmood; T. Policastro (Lister Hospital, Stevenage); N. M. Bagnall; U. Blyth (Victoria Royal Infirmary, Newcastle); R. J. McGregor; D. Damaskos; M. Drogouti; Z. Tuharska (Royal Infirmary of Edinburgh, Edinbugh); J. Davies; J. M. Bennett; R. Antakia; J. R. O’Neill; R. H. Hardwick; N. Fearnhead; A. Xanthis; F. Georgiades; V. Hudson; J. Ashcroft; A. A. Singh (Addenbrookes Hospital, Cambridge); S. M. U. Kabir; H. Huan; M. Sugrue (Letterkenny University Hospital, Letterkenny); M. Riera; J. Chang; A. Omosebi; E. Rigby; L. Kim; S. Ali; Z. Gates; H. Alasa; J. Y. N. Bo; A. Gangwar (Shrewsbury Hospital, Shrewsbury); L. Osborne; B. Perakath (Dr Gray’s Hospital, Elgin); M. Chandarana; M. Galea; A. Luhmann (Victoria Hospital, Kirkcaldy); O. Ryska (Royal Lancaster Infirmary, Lancaster); F. Searight; C. McCoss; B. Weber (Gilbert Bain Hospital, Lerwick); M. Sallam; R. Patel; M. Bignell; G. Bond-Smith; C. Lewis (John Radcliffe Hospital, Oxford); G. Williams; H. Whewell; L. Smith; R. Ooi; A. Powell-Chandler; A. M. Tang (Royal Gwent Hospital, Newport); S. K. Richards; D. B. Thompson; R. Cross (Royal United Hospital, Bath); J. van Dellen; V. Alberto; S. Shirazi; H. Arang; N. Rahman (Croydon University Hospital, Croydon); E. Monaghan; K. Dodds; O. Babalola; P. Airhunmwunde; C. Chinaka (South West Acute Hospital, Enniskillen); I. Wijetunga; T. Kidd; K. Nambiar; C. E. Ng; T. Collier; B. Ibrahim; K. Khan (University Hospital North Durham, Durham); K. Sriskandarajah; T. Pelly; J. Vance-Daniel (Kingston Hospital, Kingston); P. Nastro; A. Khan; O. Ekowo; A. Devadoss (Darent Valley Hospital, Dartford); P. D. Rao; K. Bateman; A. Gavrila (Glangwilli General Hospital, Glangwilli); E. Hannan; D. Winter; S. Martin; R. Kennelly; A. Hanly (St Vincent’s University Hospital, Dublin); M. I. Aslam; V. Amin; R. Wilkins; S. Zafar; C. Konstantinou; S. Mcdonald; A. Baker; A. Fardie (Warwick Hospital, Warwick); A. Hill; J. De Marchi; S. O’Grady (Beaumont Hospital, Dublin); G. Faulkner; H. Sekhar; M. Martinez-Iglesias; C. Alexander; E. Lawrence; S. Argyropoulos (Royal Bolton Hospital, Bolton); G. Williams; S. Bhasin (Royal Wolverhampton Hospital, Wolverhampton); M. Paduraru; K. Pawelec; S. Bylapudi (Milton Keynes University Hospital, Milton Keynes); H. Byrne; E. R. Da Silva Bento; F. Zahari; F. Roslan; M. Rao (Pilgrim Hospital, Boston); S. Hudson-Phillips; C. Kenington; S. Tellman; P. Abraham; A. Dhillon; Z. Vinnicombe (St George’s Hospital, London); M. Giles; M. Abbakar; N. Khadem; E. Buckley; L. Macdonald; J. Norman; R. Bond (York NHS Foundation Trust, York); T. White; T. Gana; S. Kotecha; S. Rajain (Chesterfield Royal Hospital, Chesterfield); S. Ahmad; B. Wadham; L. Hancock (Wythenshaw Hospital, Manchester); A. Liyanage; I. Dorrington; A. Mian; R. Y. Satchidanand; C. Weerasinghe (Southport Hospital, Southport); K. J. Etherson; H. Hidayat; M. Bhandari; A. Agarwal (The University Hospital of North Tees, Stockton-on-Tees); J. Sagar; S. Kudchadkar; A. Ghosh; N. Cirocchi; A. Rai; O. AlHabsha; S. S. Mujtaba (Luton and Dunstable Hospital, Luton); F. Ejtehadi; I. Warrag; B. Ivanov; J. Refson; C. Boateng (The Princess Alexandra Hospital, Harlow); R. Madani; M. M. Buksh; D. Kesharwani; L. Kumar; V. Prakash; S. Zulfiqar; A. Jayakumar(St Peter’s Hospital, Chertsey); A. Payne; C. Davies (Barnsley Hospital, Barnsley); R. Buhain; D. Osilli; T. Rashid; I. Elzayat (Queens Hospital, Romford); V. Kanakala; E. J. Nevins; A. Madhavan; E. Oates; K. France; S. Cowie (James Cook University Hospital, Middlesbrough); J. Bowen; Y.-J. Nam; M. Bradbury; V. Mitchell (Torbay Hospital, Torbay); S. M. Mirza; M. M. Raiz; E. Weatherstone; R. Wilson (Hinchingbrooke Hospital, Hinchingbrooke); K. Sasapu; M. M. A. Rahman; E. Chan; K. Y. Ko; M. Sharman (Diana Princess of Wales Hospital, Grimsby); K. Thiruppathy; J. Hodgkinson; R. Chadha; T. Pilpel; J. Dale (Royal Berkshire Hospital, Reading); N. Carter; A. Botros; I. Bondoqa; S. Sandabah; K. Sherwood (Queens Alexandra Hospital, Portsmouth); R. Harries; L. Hurt; R. Egan; L. Gauntlett; V. Bevan (Swansea Bay Hospital, Swansea); M. Vipond; P. Ireland; S. Granger; R. Preece (Gloucestershire Hospitals NHS Foundation Trust, Gloucester); D. Frith; J. Eves; A. Abuown (Imperial College Healthcare NHS Trust, London); J. Apollos; A. Macleod; N. Hemadasa (Dumfries & Galloway Royal Infirmary, Dumfries); C. McNaught; R. Mir; G. Cuthbert (Harrogate District Hospital, Harrogate); C. Valero (Norfolk and Norwich University Hospital, Norwich); D. Williams; M. Fakhrul-Aldeen; K. Willis; L. Kelly (North Devon District Hospital, Barnstaple); D. Lawes; L. Poynter; H. Knowles; S. Saeed; M. Shehata; I. Rafiq; M. Boshnaq; F. Ayoub (Tunbridge Wells Hospital, Royal Tunbridge Wells); A. Mcnair; D. J. Pournaras; S. Lawday; R. Martin; H. Cohen; M. Okocha (Soutmead Hospital, Southmead); K. Shalli; M. Chin; S. Joliffe (Wishaw General Hospital, Wishaw); F. Taylor; E. O. Argyriou; M. Dornseifer; E. Schembari; S. Surandran; L. Roberts; G. Kakaniaris (Whipps Cross University Hospital, London); E. Mallidis; G. Karagiannidis (Ipswich Hospital, Ipswich); F. Youssef; A. Chan; C. Macutkiewicz; M. Davenport; S. Hodge; A. Clarke (Manchester Royal Infirmary, Manchester); G. Branagan; R. Thakkar (Salisbury District Hospital, Salisbury); C. Harris (Northumbria Specialist Emergency Care Hospital, Cramlington); C. Brown; M.-C. McGuigan (Queen Elizabeth University Hospital, Glasgow); I. Alam; K. Wang; F. Artemis (Royal Albert Edward Infirmary, Manchester).

Source: British journal of surgery

DOI: 10.1093/bjs/znab456