Dr. Basson publishes article on patient attitudes toward appendicitis treatment in JAMA Surgery

  • Friday, January 12, 2018
  • News

If you or your child had appendicitis, would you choose surgery or antibiotics for treatment? Why?

Such is the scenario that Marc D. Basson, MD, PhD, MBA, FACS, senior associate dean for Medicine and Research at the UND School of Medicine and Health Sciences (SMHS), presented to nearly 2,000 participants in a research study published this week by the medical journal JAMA Surgery.

According to Dr. Basson (right), most patients know that the traditional treatment for appendicitis is appendectomy, or surgical removal of the appendix. And although antibiotic treatment for appendicitis is emerging as an alternative to surgery, disadvantages of antibiotic-only therapy for appendicitis—which include longer hospitalization, prolonged recovery, and a higher rate of appendicitis recurrence—mean that some surgeons resist offering patients non-surgical treatment options.

For this reason, Dr. Basson went straight to the people making this decision in an effort to gauge patient knowledge and attitudes toward the use of antibiotics for appendicitis.

“We decided to come at the question differently, asking, ‘Well, what do patients actually want and why?’” explains Dr. Basson, whose co-authors were Ross Crosby, Ph.D., vice president for research and director of biomedical statistics at the Neuropsychiatric Research Institute in Fargo, N.D., and professor in the UND SMHS Department of Psychiatry and Behavioral Science; and Alexis Hanson, a third-year medical student at UND.

As it turns out, a commanding 86 percent of the 1,728 survey participants would choose laparoscopic appendectomy (a less invasive type of surgery) for themselves and their children in such a scenario. Comparatively, 9.4 percent of respondents would choose antibiotics alone, and only 5 percent a traditional open appendectomy.

“What’s interesting is that we took a subgroup of that 86 percent surgery-first cohort and asked what their concerns were with antibiotics,” Dr. Basson continues. “We asked them ‘What would get you to change?’ We found that the failure rate of the drugs was the primary problem. But when we reset those numbers—asking their response if the antibiotic failure rate was lowered by 5 percent, 10 percent, and so on—we saw a lot more people willing to choose antibiotics over surgery.”

So Dr. Basson’s team explored not only what patients know when it comes to their treatment options, but what they value—and how their values influence their decision-making process.

“This, we believe, should set the research agenda for the future in this area. If we could come up with a new way of reducing the failure rate of antibiotics, that might result in a lot more people choosing antibiotic therapy, which would be a huge advance in the field.”

Dr. Basson’s article is available online here.