Risk Factors for Early Appendectomy After Initial Antibiotic Treatment for Appendicitis

In a recent study, appendiceal diameter of ≥15 mm or fever >38°C predicted early failure of antibiotic therapy for uncomplicated appendicitis (NEJM JW Gen Med Feb 1 2022 and JAMA Surg 2021; 156:1179) Now, investigators have explored the same question in a secondary analysis of data from a previous randomized antibiotics-versus-surgery trial (NEJM JW Gen Med Dec 1 2020 and N Engl J Med 2020; 383:1907). They identified 735 patients who had been randomized to antibiotic treatment; 154 (21%) of these patients underwent appendectomy within 30 days.

In adjusted analyses, the strongest association with 30-day appendectomy was presence of an appendicolith (i.e., inspissated and mineralized stool; odds ratio, 1.99). Smaller and barely significant ass…