The CODA trial (2020) compared antibiotics versus appendectomy for uncomplicated acute appendicitis. Which of the following most accurately summarizes the 1-year outcomes?

• A Antibiotic therapy was superior to appendectomy in preventing complications at 1 year
• B 29% of antibiotic-treated patients required appendectomy within 1 year; antibiotics were non-inferior for health status outcomes but not superior to surgery ✓
• C Antibiotics cured uncomplicated appendicitis in >90% without appendectomy at 1 year
• D Antibiotic failure leading to perforation was significantly higher in the antibiotic group

Explanation

The CODA trial (Flum et al., NEJM 2020) randomized 1552 patients with CT-confirmed uncomplicated acute appendicitis to antibiotics (10-day course, IV then oral) vs. appendectomy. At 1 year, 29% of patients initially assigned to antibiotics had undergone appendectomy. The antibiotics group was non-inferior for health outcomes (EQ-5D-5L score) but not superior. Importantly, 41% of patients with appendicolith (fecalith) on CT failed antibiotic therapy vs. 25% without, suggesting appendicolith status should guide treatment choice. Perforation rates were not significantly different.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.