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

Background: We surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. Methods: A 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. Results: A 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). Conclusions: To 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.