For more than a century, surgery has been the standard treatment for appendicitis. Conventional medical wisdom has been that an infected or inflamed organ should be surgically removed, especially when the human body seems to do fairly well without an appendix.

The conventional wisdom may be overturned by a clinical study being done at UCLA, where Dr. David Talan (board certified in both emergency medicine and infectious disease medicine) leads a team to address questions about drugs being an alternative to surgery. The importance of the study is that one in 10 people in the U.S. will be diagnosed with appendicitis, and the risks and costs of surgery are multiplied by the 300,000 appendectomies performed each year in the U.S. In fact, this is the most common emergency surgery.

It has been thought that, because appendicitis carries the risk of rupture and death, emergency surgery was always needed. But if caught early, physicians are learning that antibiotic treatment alone may be reasonable and adequate to treat the condition. A number of studies in the U.S. over the past several years have found that, although antibiotics worked for many patients, about 25% required surgery. But the number of patients studied was insufficient to allow broad conclusions to be reached.

The UCLA study will look at the outcomes of more than 1,500 patients at UCLA and other hospitals who are diagnosed with appendicitis. Randomly selected patients will be treated with antibiotics alone or with surgery. Tracked over a period of a year, the study will look at disease recurrence, length of hospital stay, and treatment costs. The hope is that lessons learned will allow patients to be treated with drugs on an outpatient basis, thus reducing the costs associated with hospitalization. The study will be completed in 2021.