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Current evidence supports offering patients antibiotic therapy as an alternative to appendectomy when they present with acute uncomplicated appendicitis (defined as the absence of an appendicolith, perforation, or abscess on computed tomography). However, ≈30% of patients still will require appendectomy within 1 year.
In the recent APPAC II trial, conducted in nine Finnish hospitals, 583 adult patients with acute uncomplicated appendicitis were randomized to oral antibiotic monotherapy or intravenous antibiotics followed by oral antibiotics (NEJM JW Hosp Med Apr 2021 and JAMA 2021; 325:353); more than 70% of each group were able to avoid surgery at 1 year. These same researchers performed an additional analysis to try to identify risk factor…