The CODA trial (2020) compared antibiotics vs appendectomy for uncomplicated acute appendicitis in adults. Which statement most accurately reflects its findings at 90 days?

• A Antibiotics were non-inferior to appendectomy for health status at 90 days; 29% of antibiotics group needed appendectomy within 90 days ✓
• B Antibiotics were inferior; 60% of antibiotic-treated patients needed surgery within 90 days
• C Appendectomy caused significantly more complications than antibiotic therapy at 90 days
• D Antibiotics were superior in patients with appendicolith; recurrence was only 5%

Explanation

The CODA trial randomized adults with CT-confirmed uncomplicated appendicitis to 10 days of antibiotics vs laparoscopic appendectomy. At 90 days, antibiotics were non-inferior to appendectomy for health status (EQ-5D-5L score). However, 29% of the antibiotic group underwent appendectomy within 90 days (mostly within 30 days), and patients with appendicolith had a particularly high treatment failure rate (~41%). Patients who received antibiotics had fewer disability days and avoided surgery-related complications. This supports antibiotics as a viable option for shared decision-making in selected uncomplicated cases.

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

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Written and medically reviewed by the StethoPrep medical team.