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SEATTLE — (Oct. 8, 2020) — Antibiotics may be a good choice for some, but not all, patients with appendicitis, according to results from the Comparing Outcomes of Antibiotic Drugs and Appendectomy (CODA) Trial reported this week in the New England Journal of Medicine.

“We found that antibiotics were not worse than surgery when measuring overall health status, allowing most people to avoid an operation in the short term,” said Julianna Yu, MD, Emergency Medicine, the CODA Trial site co-lead at Virginia Mason, one of 25 U.S. hospitals where the CODA Trial was conducted. “There were advantages and disadvantages to both treatments, and patients are likely to prioritize these in different ways based on their characteristics, concerns and perspectives.”

Julianna T. Yu, MD, FACEP
Julianna T. Yu, MD
 Jan Hendrickson
Abigail Wiebusch, MD

Abigail Wiebusch, MD, General Surgery, was also a CODA Trial site co-lead at Virginia Mason.

While nearly half the antibiotics group avoided hospitalization for their initial treatment, overall, time spent in the hospital was similar between groups. “People treated with antibiotics more often returned to the emergency department, but missed less time from work and school,” said Bonnie Bizzell, chair, CODA Patient Advisory Board. “Information like this can be important for individuals as they consider the best treatment option for their unique circumstance.”

Other initial findings of the CODA Trial include:

  • Patients treated with either surgery or antibiotics experienced symptoms of appendicitis for about the same amount of time.
  • Approximately three out of 10 patients in the antibiotic group underwent appendectomy by 90 days.
  • Patients with an appendicolith, a calcified deposit within the appendix, had twice the risk of complications than those without an appendicolith.
  • Participants with an appendicolith had an increased chance of appendectomy by 90 days (four in 10 with appendicolith vs. three in 10 without).

The CODA Trial is the largest randomized clinical trial of appendicitis conducted to date. Across the U.S., 1,552 participants were randomized to receive appendectomy or antibiotics-first for uncomplicated appendicitis. The trial was funded by the Patient-Centered Outcomes Research Institute (PCORI).

The CODA Collaborative – which includes clinicians at each of the 25 CODA Trial sites, patient advisors, and other stakeholders – will continue to share results from the trial as ongoing follow-up with participants is completed.

About Virginia Mason Health System
Virginia Mason, founded in 1920, is a nonprofit regional health care system based in Seattle that serves the Pacific Northwest. In the Puget Sound region, the system includes 336-bed Virginia Mason Hospital; a primary and specialty care group practice of more than 500 physicians; outpatient medical facilities and services in Seattle, Bainbridge Island, Bellevue, Edmonds, Federal Way, Kirkland, Issaquah and Lynnwood; Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the United States designed specifically to meet the needs of people with HIV/AIDS; Benaroya Research Institute, which is internationally recognized for autoimmune disease research; Virginia Mason Foundation; and Virginia Mason Institute, which trains health care professionals and others around the world in the Virginia Mason Production System, an innovative management method for improving quality and safety.

Virginia Mason Health System also includes Virginia Mason Memorial, a 226-bed hospital serving Yakima Valley in central Washington since 1950. Virginia Mason Memorial includes primary care practices and specialty care services, including high-quality cardiac care; cancer care through North Star Lodge; breast health at `Ohana Mammography Center; acute hospice and respite care at Cottage in the Meadow; pain management at Water’s Edge; an advanced NICU unit that offers specialty care for at-risk infants; advanced services for children with special health care needs at Children’s Village; and The Memorial Foundation.

Media Contact:
Gale Robinette
Media Relations Manager
Virginia Mason Health System
(206) 341-1509
Gale.Robinette@VirginiaMason.org

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