- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04168866
Operative Versus Non-Operative Management for Appendicitis With Abscess or Phlegmon
October 23, 2023 updated by: Yale University
The investigators aim to determine if early operative intervention is superior to non-operative management for adult patients with computerized tomography (CT)-proven complicated appendicitis with phlegmon or abscess.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Complicated appendicitis with abscess or phlegmon represents a challenging problem to emergency general surgeons, and the preferred treatment remains controversial.
A variety of therapies have been recommended including early operative intervention, delayed operative intervention, and non-operative management.
Recently, a prospective randomized controlled trial from a single center was conducted in Finland comparing operative and non-operative management of appendiceal abscess.
Patients managed in the operative arm were found to have a shorter length of stay, fewer re-admissions, and fewer additional interventions than those managed in the non-operative group, but there is no high-quality randomized control trial conducted in the United States to support this.
The investigators, therefore plan to carry out a multi-center, patient choice study comparing operative and non-operative management of complicated appendicitis with abscess or phlegmon in the United States.
Study Type
Interventional
Enrollment (Estimated)
180
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Kevin Schuster, MD, MPH
- Phone Number: 203 785 2572
- Email: kevin.schuster@yale.edu
Study Locations
-
-
Connecticut
-
New Haven, Connecticut, United States, 06512
- Recruiting
- Yale New Haven Hospital
-
Contact:
- Kevin Schuster, MD
- Phone Number: 203-785-2572
- Email: kevin.schuster@yale.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
1. Complicated appendicitis with presumed perforation on (computer tomography) CT scan AND phlegmon or abscess greater than 2 centimeter (cm).
Exclusion Criteria:
- Antibiotic therapy greater than 24 hours prior to considering for enrollment.
- Attempted drainage before randomization
- Pregnancy
- Antibiotic allergy requiring the use of something other than a beta-lactam or quinolone based therapy.
- Previous major intra-abdominal surgery by laparotomy
- Hospitalization within 2 weeks of randomization
- Presence of septic shock on admission.
- Mechanical ventilation
- Acute renal failure requiring dialysis
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Surgery
Patients who choose operations will have surgery performed to remove the appendix laparoscopically, through 3 or 4 small incisions.
All patients in the operative group will receive standard perioperative antibiotics.
They will also have the abscess(es) drained during the same surgery if there is one present.
In some cases, the operation may be too difficult to perform laparoscopically, so an open appendectomy will be performed, involving a longer incision to remove the appendix.
In some cases, both laparoscopic and open are performed.
The surgeon may also choose to remove a section of the intestine with the appendix or perform additional procedures.
|
Surgery for computer tomography (CT)-proven complicated appendicitis with phlegmon or abscess.
|
Active Comparator: Non-operative management
If a patient chooses non-operative management and if an abscess is present and amenable to percutaneous drainage this will be performed.
If there is no abscess or it is not amenable to drainage antibiotics alone will be provided.
|
If an abscess is present and amenable to percutaneous drainage this will be performed.
If there is no abscess or it is not amenable to drainage antibiotics alone will be provided.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of hospital days
Time Frame: Within 60 days of randomization.
|
This includes all hospital days during the initial stay and any readmission.
|
Within 60 days of randomization.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Need for additional intervention for appendicitis
Time Frame: Within one year of the index admission.
|
Percutaneous drainage, unplanned operative intervention.
|
Within one year of the index admission.
|
Intra-abdominal abscess
Time Frame: More than 7 days after index admission but within 60 days of randomization.
|
More than 7 days after index admission but within 60 days of randomization.
|
|
Failed attempted procedure.
Time Frame: Within 60 days of randomization.
|
Conversion from laparoscopic to open surgery, conversion from non-operative to operative management, percutaneous drainage not possible or unsuccessful.
|
Within 60 days of randomization.
|
Complications
Time Frame: Within 60 days of randomization.
|
Defined by National Surgical Quality Improvement Program criteria.
|
Within 60 days of randomization.
|
Number of interventions for abscess
Time Frame: Within 60 days of randomization.
|
Within 60 days of randomization.
|
|
Need for bowel resection.
Time Frame: Within 60 days of randomization.
|
Within 60 days of randomization.
|
|
Need for bowel resection
Time Frame: Within 60 days of randomization.
|
Within 60 days of randomization.
|
|
Occurrence of delayed appendectomy
Time Frame: Within one year of index admission.
|
Within one year of index admission.
|
|
Recurrence
Time Frame: Within one year of index admission.
|
Within one year of index admission.
|
|
Presence of malignancy in any resected specimen
Time Frame: Within one year of index admission.
|
Within one year of index admission.
|
|
Days of disability
Time Frame: Within 60 days of randomization.
|
Days away from work or school.
|
Within 60 days of randomization.
|
Gastrointestinal (GI) quality of life
Time Frame: 30 days after randomization.
|
This outcome will be measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal Symptoms Scale.
This scale includes 8 subscales of which the investigators will use 6 for a maximum of 41 items, though usually less due to skip logic.
Each item is measured on a 5-point scale.
Items are summed by subscale and converted to a final score by a computer algorithm.
A higher score indicates greater symptom severity and lower quality of life.
|
30 days after randomization.
|
GI quality of life
Time Frame: 60 days after randomization.
|
This outcome will be measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal Symptoms Scale.
This scale includes 8 subscales of which the investigators will use 6 for a maximum of 41 items, though usually less due to skip logic.
Each item is measured on a 5-point scale.
Items are summed by subscale and converted to a final score by a computer algorithm.
A higher score indicates greater symptom severity and lower quality of life.
|
60 days after randomization.
|
GI quality of life
Time Frame: One year after randomization.
|
This outcome will be measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal Symptoms Scale.
This scale includes 8 subscales of which the investigators will use 6 for a maximum of 41 items, though usually less due to skip logic.
Each item is measured on a 5-point scale.
Items are summed by subscale and converted to a final score by a computer algorithm.
A higher score indicates greater symptom severity and lower quality of life.
|
One year after randomization.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 11, 2020
Primary Completion (Estimated)
December 31, 2025
Study Completion (Estimated)
December 31, 2026
Study Registration Dates
First Submitted
November 16, 2019
First Submitted That Met QC Criteria
November 16, 2019
First Posted (Actual)
November 19, 2019
Study Record Updates
Last Update Posted (Actual)
October 24, 2023
Last Update Submitted That Met QC Criteria
October 23, 2023
Last Verified
October 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2000026799
- No NIH funding (Other Identifier: 01.22.24)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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