Influence of Publications on the Management of Appendicitis

Introduction: This article examines the influence of scientific knowledge dissemination on medical practices, specifically the shift in appendicitis management from surgical to non-operative approaches. By analyzing CPT codes and publication data from PubMed, we establish a positive relationship between surgery ratio and average citations per publication, indicating higher adoption of non-operative management with increased citations. This study contributes to understanding how knowledge dissemination impacts patient care and drives changes in medical practices. Understanding the influence of scientific knowledge dissemination on medical practices can pave the way for evidence-based advancements in healthcare, potentially leading to improved patient care and outcomes. Recently, there has been a significant shift in the management of appendicitis from surgical treatment to non-operative approaches using antibiotics. Our hypothesis posits that this shift is driven by scientific discoveries documented in published literature. This paper seeks to uncover the influence of scientific literature on clinical decisions and its impact on patient care, contributing to evidence-based healthcare advancements.

Methods: Patient data was extracted from Cerner Real-World Data, a comprehensive database of over 100 million patients. We analyzed trends in Current Procedural Terminology (CPT) code frequency from 2000-2022, focusing on patients aged 18-45 with an ICD9 or ICD10 code for appendicitis. We calculated the ratio of patients undergoing surgery within 7 days of diagnosis to those managed with antibiotics. Publication data related to appendicitis and antibiotics were obtained from PubMed. A custom Python script interfaced with PubMed's API was developed to retrieve the number of publications related to appendicitis and antibiotics from 2000-2022. Additionally, the script obtained citation counts for each publication to calculate the average citations per publication.

Results: From 2000-2022, there were 152,827 unique encounters for appendicitis in our Cerner Real-World Data analysis and 2,416 publications from our analysis of PubMed. A correlation analysis found a significant positive correlation (Pearson’s r=0.387, p<0.001) between surgery ratio and average citations. This suggests that as average citations per published paper increased, the surgery ratio for appendicitis tended to decrease, indicating a higher adoption of non-operative management. An OLS regression analysis showed that the publication citation ratio explained around 15% (R =0.150) of the variation in the surgery ratio. Granger causality test was performed at different lag orders. At lag order 2, the test statistic (F test) was 3.04 with a significant p-value of <0.05.

Conclusions: Our study establishes a relationship between the paradigm shift in appendicitis management and scientific publications in the form of research papers. However, including more parameters in future investigations on scientific publications will provide a more comprehensive understanding into how these parameters influence medical practices and drive transformative changes in patient care.