To the Editor I commend Minneci and colleagues1 for taking an efficacious treatment and studying its effectiveness. They developed a unique study design in which patients were not randomly assigned to a treatment but were prospectively enrolled (if they met inclusion criteria) and then allowed to choose which treatment they preferred. This very likely aligns with the “real-world” nonoperative management of appendicitis, and experts have called for such investigations so that we may begin to understand whether outcomes are meaningfully improved when an antibiotics-first approach is compared with a therapy as safe and definitive as laparoscopic appendectomy.2
Drake FT. Management of Acute Appendicitis, Comparative Effectiveness Research, and the Nuances of Study Design. JAMA Surg. 2016;151(8):783–784. doi:https://doi.org/10.1001/jamasurg.2016.0477
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