פוסט זה זמין גם ב:
עברית
Thomas L. Schwenk, MD, reviewing
When patients were treated with antibiotics instead of surgery, hospital discharge within 24 hours appeared to be safe.
The randomized CODA trial of U.S. patients with appendicitis showed that antibiotics were noninferior to appendectomy (according to quality-of-life scores at 30 days), albeit with a 30-day appendectomy rate of about 16% for those treated initially with antibiotics (NEJM JW Gen Med Dec 1 2020 and N Engl J Med 2020; 383:1907). For the antibiotic group, the protocol specified initial intravenous antibiotics followed by various oral regimens (total course, 10 days) and allowed patients to be discharged from the emergency department or hospital within 24 hours if they appeared to be clinically stable. In this secondary analysis, researchers examined the safety of early discharge.
Among the 726 patients who received antibiotics, researchers found no important baseline demographic or clinical differences between patients discharged within 24 hours and those discharged after 24 hours. Seven-day rates of serious adverse events (i.e., death, life-threatening event, substantial disability or incapacity, or non–appendicitis-related hospitalization) were ≈1 per 100 patients for both groups. Thirty-day rates of appendectomy for the two groups were 13% and 19%, respectively.
CITATIONS
Talan DA et al. Analysis of outcomes associated with outpatient management of nonoperatively treated patients with appendicitis. JAMA Netw Open 2022 Jul 1; 5:e2220039.
COMMENT
Although no important baseline differences between the early-discharge and later-discharge groups were found, subtle but important differences surely were present that influenced clinician judgment about discharge within 24 hours. These differences are reflected in the wide range of early-discharge decisions across the 25 study sites (range, 0% to ≈90%). The key issues in making the decision about discharge are the patient’s stability and the availability of early follow-up.