Pioneering Finnish Research Chosen in Top Ten of the Decade – Changes Treatment of Acute Appendicitis Worldwide


Journal of American Medical Association (JAMA) has chosen a Finnish appendicitis study as one of the top ten articles that are most important to clinical medicine and public health published in the 2010s. The research shows that for most patients, antibiotics could replace surgical treatment when it comes to uncomplicated acute appendicitis. The research article is the only surgical research on the top ten list. JAMA, published by the American Medical Association, has the world’s widest circulation when it comes to weekly published peer-reviewed high-quality medical publications.

Acute appendicitis or its clinical suspicion is the most common reason for emergency surgeries worldwide. However, appendicitis does not always require immediate surgical treatment. It is now known that there are two types of appendicitis: complicated and uncomplicated. A complicated appendicitis will lead to perforation of the appendix and always requires a surgical intervention, whereas an uncomplicated appendicitis is a milder form and may often be cured without surgery.

The Finnish Appendicitis Acuta (APPAC), a randomized clinical multicentre trial led from Turku, reported in their 2015 JAMA article that during a one-year follow-up period most patients with uncomplicated appendicitis were successfully treated with antibiotics. Although the operation to remove an inflamed appendix (i.e. appendectomy) is usually well tolerated, it is still a surgery which always carries the risk of problems during or after the operation.

– Our hypothesis was that most of the patients with uncomplicated appendicitis may be treated with antibiotics rather than surgery. This way, unnecessary operations and the morbidity associated with surgery could be avoided. At the same time, substantial savings could be made in health care, says the principal investigator of the study, Professor Paulina Salminen from the University of Turku who is also the Head Physician of the Unit of Emergency Surgery of the Turku University Hospital.

Future Studies Confirm Efficacy of Antibiotic Treatment

In 2018, JAMA published the long-term follow-up results of the study, on the basis of which it can also be concluded that for most patients the antibiotic treatment was effective and remained safe. In addition, the longer time had passed since the occurrence of appendicitis treated with antibiotics instead of surgical intervention, the rarer was its recurrence.

The results are significant for both patient and health care resources worldwide.

– Based on our results, antibiotic treatment is a feasible option when treating uncomplicated appendicitis and its practice should definitely be studied further. Our research group is currently conducting three new national studies in order to optimise the treatment of uncomplicated appendicitis, continues Salminen.

The controversial nature of the topic created its own challenges for the research work.

– For more than a century, appendectomy had been considered as a necessary treatment for appendicitis. Therefore, research on an alternative treatment provoked many thoughts especially at the beginning of the study. The recognition of the significance of our study provides both great pleasure and motivation for further studies, rejoices Salminen.

Both the APPAC trial and its follow-up are led from Turku University Hospital. The original APPAC trial involved three university hospitals (Turku University Hospital, Oulu University Hospital and Tampere University Hospital) and three central hospitals (Jyväskylä, Mikkeli and Seinäjoki). Turku University Hospital has supported the trial from a government research grant to hospital districts, and the University of Turku from its project funding.

Created 22.01.2020 | Updated 22.01.2020