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Comment & Response
August 2016

Management of Acute Appendicitis, Comparative Effectiveness Research, and the Nuances of Study Design

Author Affiliations
  • 1Division of Endocrine Surgery, Department of Surgery, University of California–San Francisco, San Francisco
JAMA Surg. 2016;151(8):783-784. doi:10.1001/jamasurg.2016.0477

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

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