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Comment & Response
July 8, 2020

Quality of Life and Patient Satisfaction After Antibiotic Therapy vs Appendectomy for Uncomplicated Appendicitis—Reply

Author Affiliations
  • 1Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
  • 2Department of Surgery, University of Turku, Turku, Finland
JAMA Surg. Published online July 8, 2020. doi:10.1001/jamasurg.2020.2193

In Reply We thank our colleagues for their interest in our study. We fully agree with Minneci and Deans regarding advocating shared decision-making and more patient-centric outcomes. However, the Appendicectomy Versus Antibiotics in the Treatment of Acute Uncomplicated Appendicitis (APPAC) trial was designed as a randomized clinical trial to test the hypothesis that uncomplicated acute appendicitis can be successfully treated with antibiotics by comparing antibiotic therapy with emergency appendectomy,1 which at that time had not yet been established. Because we know that even at long-term follow-up, antibiotic treatment is an effective, safe, and feasible alternative to surgery,2 the aspects of quality of life (QOL), patient satisfaction, and patient choice after receiving unbiased information all need to be recognized and assessed in future trials on adult patient populations. When designing the APPAC trial, such an evaluation was not yet possible, explaining why this OQL and patient satisfaction study was performed as a long-term secondary analysis.3

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