Positive beliefs about antibiotic treatment success among patients with appendicitis were found to be associated with a decreased risk for appendectomy, according to study findings published in JAMA Surgery.
Researchers performed a secondary analysis of a randomized clinical trial that was conducted between May 2016 and February 2020 across 25 medical centers throughout the United States. They studied the effect of patients’ beliefs regarding the success of antibiotic treatment for appendicitis. Beliefs about antibiotic treatment success were captured in a baseline survey and used to assign patients to 1 of 3 different belief groups. Outcomes, including appendectomy, high decisional regret or dissatisfaction with treatment, and persistent signs and symptoms, were assessed at 30 days. The researchers compared outcomes among the 3 patient groups; adjustments for differences in sociodemographic and clinical factors made via propensity scoring.
A total of 425 patients were included in the analysis, of whom 415 completed the baseline survey. Among all patients, the mean [SD] age was 38.48 [13.60] years, 65% were men, 62% were White, and 27% had fever.
Of patients who completed the baseline survey, 212 (51%) believed in the intermediate success of antibiotic treatment, 111 (27%) believed that antibiotics would be completely successful, and 92 (22%) were either unsure or believed antibiotics would be unsuccessful.
The highest risk for appendectomy was observed among patients in the unsure/unsuccessful belief group (28%; 95% CI, 20%-39%), followed by those in the intermediate (19%; 95% CI, 14%-25%) and completely successful (14%; 95% CI, 8.6%-22%) belief groups.
The association between pretreatment beliefs and appendectomy risk was also observed in the adjusted analysis. Results showed that the risk for appendectomy was 13% lower among patients in the completely successful belief group vs those in the unsure/unsuccessful belief group (adjusted risk difference [aRD], -13.49; 95% CI, -24.57 to -2.40). For patients in the intermediate belief group, the risk for appendectomy was approximately 6% lower vs those in the unsure/unsuccessful belief group (aRD, -5.68; 95% CI, -16.57 to 5.20).
Further analysis showed an association between pretreatment beliefs and persistent signs and symptoms for up to 30 days following antibiotic treatment initiation. Of patients who reported persistent signs and symptoms at 30 days, 47% (95% CI, 37%-59%) were in the unsure/unsuccessful belief group, 29% (95% CI, 23%-36%) were in the intermediate belief group, and 30% (95% CI, 22%-41%) were in the completely successful group.
In both unadjusted and adjusted analyses, no associations were observed between pretreatment beliefs and high decisional regret or treatment dissatisfaction at 30 days when comparing patients in the unsure/unsuccessful belief group with those in the intermediate and completely successful belief groups.
Limitations include the use of a nonstandard scale for the survey that assessed patients’ beliefs, uncertainty in regard to patients’ interpretation of treatment success, potential residual confounding, and the possibility that patients’ beliefs were influenced by health care professionals or other parties.
According to the researchers, “pathways relating beliefs to outcomes and the potential modifiability of beliefs to improve outcomes merit further investigation.”
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Zhang IY, Voldal EC, Davidson GH, et al; on behalf of the Writing Group for the CODA Collaborative. Association of patient belief about success of antibiotics for appendicitis and outcomes: a secondary analysis of the CODA randomized clinical trial. JAMA Surg. Published online October 5, 2022. doi:10.1001/jamasurg.2022.4765