CHICAGO (AP) — A new study says surgery isn't always needed for appendicitis and that antibiotics instead can often do the trick. 
 
 The results from Finland contradict decades of thinking about the best way to treat an inflamed appendix. The condition has long been thought to be a medical emergency because of the risk for a burst appendix, which can be life-threatening. But advances in imaging tests make it easy to determine which patients face that danger. 
 
 The study in 500 adults found that nearly two-thirds of patients treated with antibiotics fared well after five years. About one-third had another case of appendicitis and had surgery to take out their appendix. 
 
 The results were published Tuesday in the Journal of the American Medical Association. ||||| Following publication of the Appendicitis Acuta (APPAC) trial in 2015,1 some were quick to criticize the report. APPAC compared outcomes for open appendectomy with antibiotic therapy for acute uncomplicated appendicitis, finding that antibiotics were a reasonable alternative to appendectomy. The study failed to meet its prespecified noninferiority margin to demonstrate that antibiotic treatment resulted in clinical outcomes that were “no worse than” outcomes with surgery, the operations were open and not laparoscopic, expensive broad-spectrum antibiotics were used, and the hospital lengths of stay were too long in each group (median, 3 days in the antibiotic group and in the surgery group). Despite the study limitations, of the 257 patients in the antibiotic group, 186 (73%) initially treated with antibiotics did not require surgery at the 1-year end point. However, concerns were raised that these patients would eventually require surgery, and various experts recommended that the APPAC results for clinical decision making not be used until the long-term outcomes were known for the patients who received antibiotic treatment. Wait, they advised.
– A new study says surgery isn't always needed for appendicitis and that antibiotics instead can often do the trick, the AP reports. The results from Finland contradict decades of thinking about the best way to treat an inflamed appendix. The condition has long been thought to be a medical emergency because of the risk for a burst appendix, which can be life-threatening. But advances in imaging tests make it easy to determine which patients face that danger. The study in 500 adults found that nearly two-thirds of patients treated with antibiotics fared well after five years. About one-third had another case of appendicitis and had surgery to take out their appendix. "How should these results influence clinical decision-making?" asks Edward Livingston in the study, published Tuesday in the Journal of the American Medical Association. He explains that patients with acute uncomplicated appendicitis can choose to have surgery—which has "relatively few major complications" and the advantage of "removing the source of the disease"—or opt for antibiotics, which pose "little risk" and only a 39% chance of the appendicitis recurring over five years.