Antibiotics or Appendectomy for Vulnerable Populations

To the Editor In their Invited Commentary addressing the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial ’s secondary analysis of its Spanish-speaking cohort, Peck and coauthors noted that in the appendectomy arm, Spanish-speaking patients missed 8 more workdays than English-speaking patients, which they asserted in the original text “suggests Spanish-speaking patients might do better with surgery from the onset.” However, when outcomes are compared between treatment groups, we see that Spanish-speaking participants who got urgent appendectomy missed substantially more work over 30 days than those treated with antibiotics, a mean time of 14.19 days (95% CI, 12.55-15.83) vs 6.69 days (95% CI , 5.51-7.87), respectively. This 7.50-day difference favoring antibiotics is greater than the between-group difference for the entire CODA population, 3.47 days at 90 days (mean, 8.73 vs 5.26 days, respectively). Therefore, in terms of disability, the results suggest that Spanish-speaking participan ts benefit relatively more from antibiotics than English-speaking participants. Eighty-three percent of Spanish speakers reported poverty-level income compared with 22% of English speakers. Poverty-associated poor health and nutrition may have contributed to differences in recovery. Patients with li ttle savings are more likely to miss income lost related to their appendicitis care.
Source: JAMA Surgery - Category: Sports Medicine Source Type: research