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Altirkistani BA, Batais WT, Alsolamy RM, Sulaimani BY, Bakhidar GO. The Influence of the COVID-19 Pandemic on the Prevalence, Characteristics, Management, and Outcomes of Acute Appendicitis at the Academic Tertiary Center, Jeddah. Cureus 2022; 14:e31968. [DOI: 10.7759/cureus.31968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
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Lee MS, Thomas A, Pearson JF, Purcell R, Frizelle F, Glyn T. Risk of colorectal cancer in patients with appendicitis over the age of 40 years. Colorectal Dis 2022; 25:624-630. [PMID: 36413088 DOI: 10.1111/codi.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/07/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022]
Abstract
AIM Acute appendicitis in late adulthood is hypothesized to be associated with an increased risk of colorectal cancer (CRC). This study aimed to establish whether patients over the age of 40 years presenting with appendicitis had an increased risk of being diagnosed with CRC over the subsequent 3 years. METHOD This is a retrospective review of patients aged 40 years and over presenting to Canterbury District Health Board with appendicitis from January 2010 to December 2015. Clinical details were obtained for these patients and cross-referenced with the New Zealand Cancer Registry for the 3 years following diagnosis. The incidence ratio rate (IRR) and standardized incidence ratio (SIR) were calculated by establishing the incidence of CRC in this cohort and comparing it with the Canterbury population data. RESULTS A total of 1099 patients met the inclusion criteria. The majority (75%) underwent CT as part of their initial work-up. The rate of colonoscopy increased with age from around 10% between 40 and 49 years to 27% for those 70 years and over. Eleven cases of CRC were identified, resulting in an IRR 2.35 (95% CI 1.17-4.21). The SIR for this population was 3.28 (95% CI 1.82-5.92). CONCLUSION The rate of CRC is significantly increased compared with the background population in this cohort. The results of this study support luminal investigation of adults aged 40 years and over who present with acute appendicitis as CT alone was insufficient to detect the pathology.
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Affiliation(s)
- Mei Sze Lee
- Department of Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - Alben Thomas
- Department of Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - John F Pearson
- Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand.,Biostatistics and Computational Biology, University of Otago Christchurch, Christchurch, New Zealand
| | - Rachel Purcell
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Francis Frizelle
- Department of Surgery, Canterbury District Health Board, Christchurch, New Zealand.,Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Tamara Glyn
- Department of Surgery, Canterbury District Health Board, Christchurch, New Zealand.,Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
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Levin DR, Siu M, Kramer K, Kelly E, Alouidor R, Fernandez G, Kamine T. Time Cost of Provider Skill: A Pilot Study of Medical Officer Occupied Time By Knowledge, Skill, and Ability Level. Aerosp Med Hum Perform 2022; 93:816-821. [DOI: 10.3357/amhp.6093.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: On space missions one must consider the operating cost of the medical system on crew time. Medical Officer Occupied Time (MOOT) may vary significantly depending on provider skill. This pilot study assessed the MOOT Skill Effect (MOOTSkE).METHODS: An expert
surgeon (ES), fifth year surgical resident (PGY5), second year surgical resident (PGY2), and an expert Emergency Physician (EP) with only 4 mo direct surgical training each performed two simulated appendectomies. The completion times for endotracheal intubation, appendectomy, and two subprocedures
(multilayer tissue repair and single layer tissue repair) were recorded.RESULTS: The ES performed the appendectomy in 410 s, the PGY-5 in 498 s, the PGY-2 in 645 s, and the EP in 973 s on average. The PGY-2 and EP time difference was significant compared to the expert. The PGY-5
was not. The EP’s time was significantly longer for the appendectomy and the multilayer repair than either surgical resident. For the single layer repair, only the EP-ES difference was significant. A single intubation attempt by the PGY-2 took 73 s while the EP averaged 27 s. The average
recorded MOOTSkE between novice and expert was 2.5 (SD 0.34).DISCUSSION: This pilot study demonstrates MOOTSkE can be captured using simulated procedures. It showed the magnitude of the MOOTSkE is likely substantial, suggesting that a more highly trained provider may save substantial
crew time. Limitations included small sample size, limited number of procedures, a simulation that may not reflect real world conditions, and suboptimal camera angles.Levin DR, Siu M, Kramer K, Kelly E, Alouidor R, Fernandez G, Kamine T. Time cost of provider skill: a pilot study
of medical officer occupied time by knowledge, skill, and ability level. Aerosp Med Hum Perform. 2022; 93(11):816–821.
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104
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Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, Camacho MA, Cash BD, Dane B, Felker RA, Grossman EJ, Korngold EK, Liu PS, Marin D, McCrary M, Pietryga JA, Weinstein S, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol 2022; 19:S445-S461. [PMID: 36436969 DOI: 10.1016/j.jacr.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of the experts. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Avinash R Kambadakone
- Division Chief, Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts; Medical Director, Martha's Vineyard Hospital Imaging.
| | - Cynthia S Santillan
- Vice Chair of Clinical Operations, University of California, San Diego, San Diego, California
| | - David H Kim
- Panel Chair; Vice Chair of Education, Department of Radiology, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California. ACR LI-RADS; Division Chief, SAR Portfolio Director; RSNA Radiology Senior DE
| | - James H Birkholz
- Divisional Director, Quality and Safety (Abdominal Imaging), Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Radiology Representative to the Interdisciplinary Dysmotility (GIMIG) Conference
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida; Committee on Emergency Radiology-GSER
| | - Brooks D Cash
- Chief of Gastroenterology, Hepatology, and Nutrition Division, University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Bari Dane
- Director of Body CT, Abdominal Imaging; Director of Quality and Safety Outpatient Imaging, NYU Grossman School of Medicine, New York, New York
| | - Robin A Felker
- Associate Clerkship Director for Internal Medicine, Georgetown University; Primary care physician, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Eric J Grossman
- Medical Director, Multi-Specialty Clinic, Santa Barbara Cottage Hospital, Santa Barbara, California; American College of Surgeons
| | - Elena K Korngold
- Section Chief, Body Imaging, Chair, Department of Radiology Promotion and Tenure Committee, Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians North Carolina Chapter
| | | | | | - Katherine Zukotynski
- Co-Associate Chair for Research, Department of Radiology, McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair; Section Chief Abdominal Imaging, Director of MRI and CT, Virginia Commonwealth University Medical Center, Richmond, Virginia
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105
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Diagnostic accuracy of computed tomography in adults with suspected acute appendicitis at the emergency department in a private tertiary hospital in Tanzania. PLoS One 2022; 17:e0276720. [PMID: 36301963 PMCID: PMC9612457 DOI: 10.1371/journal.pone.0276720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected acute appendicitis coupled with comparatively higher negative appendectomy rates in this setting highlight a possible concern regarding the diagnostic accuracy. This study evaluated the diagnostic accuracy of a computed tomography scan for suspected acute appendicitis at the emergency department in Tanzania. METHODS A retrospective diagnostic accuracy study was conducted from July to October 2020. All patients above 14 years of age who presented at the emergency department with right iliac fossa abdominal pain of fewer than ten days and underwent computed tomography for suspected acute appendicitis were evaluated, and the Alvarado score was computed. Histological diagnosis and clinical follow-up of 14 days were considered the reference standard. Ethical clearance was sought from the Aga Khan University Ethical review committee. RESULTS 176 patients were included in this study. The sensitivity, specificity, and diagnostic accuracy were 100% (95% CI 91.8-100), 96.9% (95% CI 92.2-99.1), and 96.9% (95% CI 93.1-98.3), respectively. The mean Alvarado score in those without acute appendicitis was 4 (95% CI 3.7-4.3) compared to a mean score of 6.6 (95% CI 6.0-7.2) amongst those with acute appendicitis. The area under the receiver operator characteristics curve of computed tomography was 98.4%, and that of the Alvarado score was 84.1%. CONCLUSIONS The diagnostic performance of computed tomography in this study is similar to that established elsewhere. However, the Alvarado score is not routinely used for the initial screening of suspected acute appendicitis patients. A threshold of Alvarado score of 4 as a guide to conduct computed tomography for suspected acute appendicitis would have decreased computed tomography use by 50%, and missed 4 cases. Implementation studies that address Alvarado score use should be conducted.
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106
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Tamme K, Reintam Blaser A, Laisaar KT, Mändul M, Kals J, Forbes A, Kiss O, Acosta S, Bjørck M, Starkopf J. Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis. BMJ Open 2022; 12:e062846. [PMID: 36283747 PMCID: PMC9608543 DOI: 10.1136/bmjopen-2022-062846] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022. ELIGIBILITY CRITERIA Studies reporting data on the incidence and outcomes of AMI in adult populations. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms. RESULTS From 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis.Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (p<0.05). The mid/long-term mortality of AMI was 68.2% (95% CI 60.7 to 74.9). Mortality due to mesenteric venous thrombosis was 24.6% (95% CI 17.0 to 32.9) and of non-occlusive mesenteric ischaemia 58.4% (95% CI 48.6 to 67.7). The short-term mortality of revascularised occlusive arterial AMI was 33.9% (95% CI 30.7 to 37.4). CONCLUSIONS In adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised. PROSPERO REGISTRATION NUMBER CRD42021247148.
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Affiliation(s)
- Kadri Tamme
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Luzerner Kantonsspital, Luzern, Luzern, Switzerland
| | - Kaja-Triin Laisaar
- Department of Epidemiology and Biostatistics, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Merli Mändul
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Statistics, Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Alastair Forbes
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, Tartu, Estonia
| | - Olga Kiss
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Bjørck
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
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107
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Harada T, Harada Y, Hiroshige J, Shimizu T. Factors associated with delayed diagnosis of appendicitis in adults: A single-center, retrospective, observational study. PLoS One 2022; 17:e0276454. [PMID: 36264971 PMCID: PMC9584535 DOI: 10.1371/journal.pone.0276454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Appendicitis is one of the most common causes of acute abdominal pain; yet the risk of delayed diagnosis remains despite recent advances in abdominal imaging. Understanding the factors associated with delayed diagnosis can lower the risk of diagnostic errors for acute appendicitis. These factors, including physicians’ specialty as a generalist or non-generalist, were evaluated through a retrospective, observational study of adult acute appendicitis cases at a single center, between April 1, 2014, and March 31, 2021. The main outcome was timely diagnosis, defined as "diagnosis at the first visit if the facility had computed tomography (CT) capability" or "referral to an appropriate medical institution promptly after the first visit for a facility without CT capability," with all other cases defined as delayed diagnosis. The frequency of delayed diagnosis was calculated and associated factors evaluated through multivariate and exploratory analyses. The overall rate of delayed diagnosis was 26.2% (200/763 cases). Multivariate analysis showed that tenderness in the right lower abdominal region, absence of diarrhea, a consultation of ≤6 h after symptom onset, and consultation with a generalist were associated with a decreased risk of delayed diagnosis of acute appendicitis. Exploratory analysis found that generalists performed more physical findings related to acute appendicitis, suggesting that this diagnostic approach may be associated with timely diagnosis. Future studies should adjust for other potential confounding factors, including patient complexity, consultation environment, number of physicians, diagnostic modality, and physician specialties.
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Affiliation(s)
- Taku Harada
- Division of General Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
- * E-mail:
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Juichi Hiroshige
- Division of General Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
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108
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Jung KU, Yoon KW, Do IG, Lee D. Aspergillus appendicitis complicating chemotherapy of leukemia: A case report and review of the literature. Int J Surg Case Rep 2022; 100:107738. [PMID: 36274295 PMCID: PMC9589183 DOI: 10.1016/j.ijscr.2022.107738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/01/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction The diagnosis of primary Aspergillus appendicitis can be missed or delayed because of its rarity. We report our experience of a case of Aspergillus appendicitis complicating chemotherapy of leukemia. Presentation of case A 48-year-old man who was diagnosed with acute myeloid leukemia developed high fever and epigastric pain two weeks after administration of his fourth consolidation chemotherapy. Right lower quadrant tenderness and rebound tenderness were noticed on physical examination, and the abdomen and pelvis computed tomography suggested acute perforated appendicitis with localized peritonitis. Emergency laparoscopy showed an inflamed appendix, which was resected. Pathology reports revealed invasive aspergillosis in the appendix. The patient recovered after high-dose antifungal therapy, although he required prolonged hospitalization. Discussion Acute appendicitis is very rarely caused by fungi infection with an overall incidence of up to 1.15 %. Differential diagnosis of fungal appendicitis without pathology report is challenging due to low incidence. Conclusion Isolated Aspergillus appendicitis is a rare disease that can progress without appropriate antifungal therapy even after surgical resection of the appendix. Surgeons should pay attention to pathology reports after appendectomy to avoid missing unusual cases, especially in immunocompromised patients. Fungal infections principally occur in the immunocompromised. Misdiagnosis and incorrect treatment are frequent in this rare disease entity. Early diagnosis and prompt surgery with antifungal treatment is best
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Affiliation(s)
- Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung Won Yoon
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - In-Gu Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
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109
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Gupta V, Gupta P, Gill CS, Gupta M. Appendicitis Inflammatory Response Score in Acute Appendicitis: A Study at a Tertiary Care Center in North India. Int J Appl Basic Med Res 2022; 12:234-238. [PMID: 36726654 PMCID: PMC9886148 DOI: 10.4103/ijabmr.ijabmr_287_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Appendicitis is a common cause of acute abdominal pain. The diagnosis is eminently clinical and the cause is surgically correctable. However, a decision of surgery based on the clinical presentation only has a 15%-30% chance of the removal of a normal appendix. Thus, the diagnosis involves a corroboration of clinical, laboratory, and radiological findings. Appendicitis scoring systems can be considered to expedite the diagnostic and decision-making process. Aim The present study was conducted to study the efficacy of Appendicitis Inflammatory Response (AIR) score in the diagnosis of acute appendicitis and its correlation with the histopathological findings. Materials and Methods A cross-sectional study was conducted at a tertiary care center in North India comprising patients who presented to the surgery department with a provisional diagnosis of acute appendicitis and required appendectomy. Results Appendicitis was histopathologically proven in 54 patients. Patients with an AIR score ≥5 were 2.18 times more likely to have appendicitis. The probability of having appendicitis with AIR score ≥5 was 92.16% (positive predictive value). The diagnostic accuracy of AIR score was 82.81%. Conclusion AIR score has a high sensitivity and positive predictive value in the diagnosis of acute appendicitis. It is a quick and convenient system for clinical evaluation of patients in primary care or peripheral hospitals where advanced facilities such as USG scan or CT scan are not available all the time. The application of this scoring system definitely improves diagnostic accuracy and reduces negative appendectomy rate.
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Affiliation(s)
- Varun Gupta
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Palak Gupta
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Chiranjiv Singh Gill
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manvi Gupta
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Li Y, Luo X, Wu Y, Yan S, Liang Y, Jin X, Sun X, Mei L, Tang C, Liu X, He Y, Yi W, Wei Q, Pan R, Cheng J, Su H. Is higher ambient temperature associated with acute appendicitis hospitalizations? A case-crossover study in Tongling, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:2083-2090. [PMID: 35913519 DOI: 10.1007/s00484-022-02342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/12/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Existing studies suggested that ambient temperature may affect the attack of acute appendicitis. However, the identification of the quantitative effect and vulnerable populations are still unknown. The purposes of this study were to quantify the impact of daily mean temperature on the hospitalization of acute appendicitis and clarify vulnerable groups, further guide targeted prevention of acute appendicitis in Tongling. Daily data of cases and meteorological factors were collected in Tongling, China, during 2015-2019. Time stratified case-crossover design and conditional logistic regression model were used to evaluate the odds ratio (OR) of ambient temperature on hospitalizations for acute appendicitis. Stratified analyses were performed by sex, age, and marital status. The odds ratio (OR) of hospitalizations for acute appendicitis increased by 1.6% for per 1 ℃ rise in mean temperature at lag3[OR = 1.016, 95% confidence interval (CI): 1.004-1.028]. In addition, our results suggest it is in the women that increased ambient temperature is more likely to contribute to acute appendicitis hospitalizations; we also found that the married are more susceptible to acute appendicitis hospitalizations due to increased ambient temperature than the unmarried; people in the 21-40 years old are more sensitive to ambient temperature than other age groups. The significant results of the differences between the subgroups indicate that the differences between the groups are all statistically significant. The elevated ambient temperatures increased the risk of hospitalizations for acute appendicitis. The females, married people, and patients aged 21-40 years old were more susceptible to ambient temperature. These findings suggest that more attention should be paid to the impact of high ambient temperature on acute appendicitis in the future.
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Affiliation(s)
- Yuxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xuelian Luo
- Department of Medicine, Tongling Vocational and Technical College, Tongling, 244000, China
| | - Yudong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Shuangshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Yunfeng Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xiaoyu Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xiaoni Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Lu Mei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Chao Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xiangguo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Yangyang He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China.
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Diagnostic accuracy of computed tomography and ultrasound for the diagnosis of acute appendicitis: A systematic review and meta-analysis. Radiography (Lond) 2022; 28:1127-1141. [PMID: 36130469 DOI: 10.1016/j.radi.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The diagnosis of acute appendicitis remains challenging. This review determined the current diagnostic accuracy of CT and ultrasound for suspected acute appendicitis in adults. METHODS This systematic review adhered to the PRISMA for diagnostic test accuracy guidelines. A systematic search was undertaken in appropriate databases. Screening of potential titles and abstracts, full-text retrieval, methodological quality assessment using QUADAS, and data extraction was performed. Meta-analyses were performed for relevant subgroups, and sensitivity analysis was completed to account for outliers. GRADE was utilized to assess the certainty of findings. RESULTS 31 studies evaluating CT, 10 evaluating US, and six evaluating both were included. Pooled sensitivity and specificity for CT was 0.972 [0.958, 0.981] and 0.956 [0.941, 0.967] respectively, and 0.821 [0.738, 0.882] and 0.859 [0.727, 0.933] for US, respectively. When analyzing subgroups based on the use of contrast enhancement, sensitivity and specificity was highest for CT with intravenous and oral contrast (0.992 [0.965, 0.998], 0.974 [0.936, 0.99]), compared to CT with intravenous contrast (0.955 [0.922, 0.974], 0.942 [0.916, 0.960]). Low-Dose CT produced comparable values (0.934 [0.885,0.963], 0.937 [0.911, 0.955]) relative to these subgroups and standard dose non-contrast CT (0.877 [0.774,0.937], 0.914 [0.827, 0.959]). US studies which excluded equivocal findings demonstrated significantly greater values than the remainder of US studies (p < 0.0001). CONCLUSION The updated diagnostic test accuracies of CT, US and relevant subgroups should be implemented in light of factors such as dose, cost, and timing. IMPLICATIONS FOR PRACTICE For diagnosis of adult acute appendicitis: • CT with intravenous plus oral contrast enhancement yields statistically significantly greater diagnostic accuracy than CT with intravenous contrast alone. • Low-dose CT yields comparable sensitivity and specificity to standard-dose CT. • Ultrasound studies which exclude equivocal results may overinflate sensitivity and specificity.
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Azadbakht M, Azadbakht S, Daniali S, Dehghani M. Comparison of the prevalence of perforated appendicitis during and before COVID19 pandemic. Ann Med Surg (Lond) 2022; 82:104785. [PMID: 36186496 PMCID: PMC9515006 DOI: 10.1016/j.amsu.2022.104785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Coronavirus disease 2019 has significantly impacted the rate of emergency department visits among patients with the non-repository disease. Patients with acute appendicitis are also likely to delay their visit to the health care center, which can lead to complications including perforated appendicitis. The aim of this study was to compare the prevalence of perforated appendicitis during the COVID19 and pre-pandemic periods. Methods This retrospective study was performed on all appendectomies performed during COVID-19, Group A, and one year earlier, Group B. A questionnaire comprising demographic variables (age, gender, occupation, education), clinical variables (white blood cell count, fever), location and type of appendicitis, the status of appendectomy, and duration of hospitalization was completed for all the patients included in the study. Results The demographic variables were not significantly different among the two groups. The perforation appendicitis rate during the COVID19 pandemic increased compared to the previous year, The difference was not statistically significant. The number of negative appendectomy in group A was significantly less compared to group B. The mean time from the onset of pain to the time of referral was significantly lesser in group A. The mean length of hospital stay in group B was longer than in group A. In terms of fever, patients with perforated appendicitis in group B had a higher fever than in group A, which was statistically significant. Conclusion A non-significant increase in the number of perforated appendicitis cases during the pandemic period. Duration of hospitalization and fever was significantly greater in pre-pandemic perforated appendicitis cases. Coronavirus disease has significantly impacted the rate of emergency department visits. Patients with acute appendicitis are also likely to delay their visit to the health care center. Which can lead to complications including perforated appendicitis. A non-significant increase in the number of perforated appendicitis cases during pandemic period.
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Affiliation(s)
- Morteza Azadbakht
- Fellowship of Advanced Laparoscopic and Bariatric Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saleh Azadbakht
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- Corresponding author. Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Samira Daniali
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Dehghani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Anyomih TTK, Jennings T, Mehta A, O'Neill JR, Panagiotopoulou I, Gourgiotis S, Tweedle E, Bennett J, Davies RJ, Simillis C. Systematic review and meta-analysis comparing perioperative outcomes of pediatric emergency appendicectomy performed by trainee vs trained surgeon. Pediatr Surg Int 2022; 38:1187-1196. [PMID: 35857086 DOI: 10.1007/s00383-022-05160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
Appendicectomy is a common pediatric surgical procedure performed by trainees and surgeons with varying reported outcomes. It is a benchmark procedure for trainee progression and training benefits should be weighed against patient safety and perioperative outcomes. This systematic review and meta-analysis investigated any differential perioperative outcomes dependent on the grade of the operating surgeon. A systematic literature review and meta-analysis were performed comparing outcomes of pediatric appendicectomy performed by trainees versus trained surgeons. Of 2,086 articles screened, 5 retrospective non-randomized comparative studies reporting on 10,019 participants were analyzed. There was no difference in overall complications (OR 0.92; 95% CI 0.76, 1.12; P = 0.42), major complications [Clavien-Dindo (CD) III/IV] (OR 1.18; 95% CI 0.71, 1.97; P = 0.52), minor complications (CD I/II) (OR 1.13; 95% CI 0.57, 2.27; P = 0.72), post-op ileus (OR 0.74; 95% CI 0.10, 5.26; P = 0.76), wound infections (OR 0.87; 95% CI 0.62, 1.21; P = 0.41), abscess formation (OR 0.58; 95% CI 0.28, 1.22; P = 0.15), operation times [Mean Difference (MD) 2.31 min; 95% CI - 4.94, 9.56; P = 0.53] and reoperation rate (OR 1.22; 95% CI 0.23, 6.42; P = 0.81). Trainees had fewer conversions to open appendicectomy (OR 0.14; 95% CI 0.02, 0.88; P = 0.04). Appendicectomy performed on pediatric patients by trainees did not compromise patient safety. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Theophilus T K Anyomih
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Thomas Jennings
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alok Mehta
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Robert O'Neill
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ioanna Panagiotopoulou
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Stavros Gourgiotis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Elizabeth Tweedle
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - John Bennett
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Constantinos Simillis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Azhari H, King JA, Coward S, Windsor JW, Ma C, Shah SC, Ng SC, Mak JWY, Kotze PG, Ben-Horin S, Loftus EV, Lees CW, Gearry R, Burisch J, Lakatos PL, Calvet X, Bosques Padilla FJ, Underwood FE, Kaplan GG. The Global Incidence of Peptic Ulcer Disease Is Decreasing Since the Turn of the 21st Century: A Study of the Organisation for Economic Co-Operation and Development (OECD). Am J Gastroenterol 2022; 117:1419-1427. [PMID: 35973143 DOI: 10.14309/ajg.0000000000001843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/27/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Peptic ulcer disease (PUD) is a common cause of hospitalization worldwide. We assessed temporal trends in hospitalization for PUD in 36 Organisation for Economic Co-operation and Development (OECD) countries since the turn of the 21st century. METHODS The OECD database contains data on PUD-related hospital discharges and mortality for 36 countries between 2000 and 2019. Hospitalization rates for PUD were expressed as annual rates per 100,000 persons. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs) for each country, which were pooled using meta-analyses. The incidence of PUD was forecasted to 2021 using autoregressive integrated moving average and Poisson regression models. RESULTS The overall median hospitalization rate was 42.4 with an interquartile range of 29.7-60.6 per 100,000 person-years. On average, hospitalization rates (AAPC = -3.9%; 95% CI: -4.4, -3.3) and morality rates (AAPC = -4.7%; 95% CI: -5.6, -3.8) for PUD have decreased from 2000 to 2019 globally. The forecasted incidence of PUD hospitalizations in 2021 ranged from 3.5 per 100,000 in Mexico to 92.1 per 100,000 in Lithuania. Across 36 countries in the OECD, 329,000 people are estimated to be hospitalized for PUD in 2021. DISCUSSION PUD remains an important cause of hospitalization worldwide. Reassuringly, hospitalizations and mortality for PUD have consistently been falling in OECD countries in North America, Latin America, Europe, Asia, and Oceania. Identifying underlying factors driving these trends is essential to sustaining this downward momentum.
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Affiliation(s)
- Hassan Azhari
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - James A King
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta SPOR Support Unit Data Platform, Alberta Health Services, Calgary, Alberta, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Shailja C Shah
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
- GI Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce W Y Mak
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Paulo G Kotze
- Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Charlie W Lees
- The University of Edinburgh, Western General Hospital, Edinburgh, Scotland
| | - Richard Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Johan Burisch
- Gastrounit, medical division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Peter L Lakatos
- Division of Gastroenteorlogy, McGill University, Montreal, Canada
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Xavier Calvet
- Gastroenterology Department, Hospital Universitari Parc Taulí. Sabadell, Catalonia
- Centro de investigación e red de Enfermedades Hepaticas y Digestivas (CiberEHD)
| | - Francisco Javier Bosques Padilla
- Department of Gastroenterology, University Hospital, Autonomous University of Nuevo Leon, Hospital San José Tecnológico de Monterrey
| | - Fox E Underwood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Sula S, Han T, Marttila H, Haijanen J, Löyttyniemi E, Sippola S, Grönroos J, Hakanen AJ, Salminen P. Blood culture positivity in patients with acute appendicitis: A propensity score-matched prospective cohort study. Scand J Surg 2022; 111:31-38. [PMID: 36000748 DOI: 10.1177/14574969221110754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of bacteremia in acute appendicitis is unknown. We aimed to assess prevalence and predictive factors of bacteremia in adult patients with appendicitis. METHODS In this prospective propensity score-matched cohort study, patients were recruited as part of one single-center prospective observational study assessing appendicitis microbiology in concurrence with two randomized controlled trials on non-operative treatment of uncomplicated acute appendicitis. All patients evaluated for enrollment in these three trials between April 2017 and December 2018 with both a confirmed diagnosis of appendicitis and available blood culture on admission were included in this study. Potential predictive factors of bacteremia (age, sex, body mass index (BMI), body temperature, C-reactive protein (CRP), leukocyte count, comorbidities, symptom duration, and appendicitis severity) were assessed. Prevalence of bacteremia was determined by all available blood cultures followed by propensity score matching using sex, age, BMI, CRP, leukocyte count, and body temperature of the patients without available blood culture. RESULTS Out of the 815 patients with appendicitis, 271 patients had available blood culture and the prevalence of bacteremia was 12% (n = 33). Based on propensity score estimation, the prevalence of bacteremia in the whole prospective appendicitis cohort was 11.1%. Bacteremia was significantly more frequent in complicated acute appendicitis (15%; 29/189) compared with uncomplicated acute appendicitis (5%; 4/82) (p = 0.015). Male sex (p = 0.024) and higher body temperature (p = 0.0044) were associated with bacteremia. CONCLUSIONS Estimated prevalence of bacteremia in patients with acute appendicitis was 11.1%. Complicated appendicitis, male sex, and higher body temperature were associated with bacteremia in acute appendicitis.
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Affiliation(s)
- Sami Sula
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, FinlandDepartment of Surgery, University of Turku, Turku, FinlandSatasairaala Central Hospital, Pori, Finland
| | - Tatu Han
- Department of Surgery, University of Turku, Turku, FinlandFaculty of Medicine, University of Turku, Turku, Finland
| | - Harri Marttila
- Department of Hospital Hygiene and Infection Control, Turku University Hospital, Turku, Finland
| | - Jussi Haijanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, FinlandDepartment of Surgery, University of Turku, Turku, Finland
| | | | - Suvi Sippola
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, FinlandDepartment of Surgery, University of Turku, Turku, Finland
| | - Juha Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, FinlandDepartment of Surgery, University of Turku, Turku, Finland
| | - Antti J Hakanen
- Laboratory Division, Department of Clinical Microbiology, Turku University Hospital, Turku, FinlandResearch Center for Infections and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Paulina Salminen
- Professor of Surgery Division of Digestive Surgery and Urology Turku University Hospital P.O. Box 52 20520 Turku Finland
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Same-Day Discharge after Laparoscopic Appendectomy for Simple Appendicitis in Pediatric Patients—Is It Possible? CHILDREN 2022; 9:children9081220. [PMID: 36010112 PMCID: PMC9406982 DOI: 10.3390/children9081220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 12/02/2022]
Abstract
(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents (n = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0–4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents (n = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.
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Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study. J Clin Med 2022; 11:jcm11154495. [PMID: 35956110 PMCID: PMC9369616 DOI: 10.3390/jcm11154495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.
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Chen Y, Guo S, Liu Y, Yuan J, Fan Z. Single-port laparoscopic appendectomy using a needle-type grasping forceps compared with conventional three-port laparoscopic appendectomy for patients with acute uncomplicated appendicitis: a single-center retrospective study. J Int Med Res 2022; 50:3000605221119647. [PMID: 35993249 PMCID: PMC9403465 DOI: 10.1177/03000605221119647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the clinical outcomes between single-port laparoscopic
appendectomy using a needle-type grasping forceps (SLAN) and conventional
three-port laparoscopic appendectomy (CLA) for patients with uncomplicated
appendicitis. Methods We retrospectively collected clinical data of patients with uncomplicated
appendicitis who underwent SLAN or CLA from May 2019 to May 2021 in our
center. The patients’ baseline characteristics, perioperative outcomes, and
follow-up data were compared between the two groups. Additionally, baseline
characteristics were compared with postoperative outcomes in the SLAN
group. Results Ninety-six patients were enrolled (SLAN group, n = 32; CLA group, n = 64).
The SLAN group had a shorter hospital stay, lower 24-hour postoperative
visual analogue scale scores, shorter postoperative fasting time, lower
frequency of antibiotic administration, and longer operative time than the
CLA group. In the SLAN group, younger patients had a longer appendix and
male patients had a thicker appendix; additionally, patients with an
appendiceal diameter of 0.6 to 1.0 cm had a longer postoperative hospital
stay and higher frequency of antibiotic administration. Conclusions Compared with CLA, SLAN may be less invasive, provide faster postoperative
recovery, and result in better cosmesis for patients with uncomplicated
appendicitis. Further research should be performed to evaluate the long-term
outcomes.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Yanjie Liu
- Department of Oncology, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Jieqing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Zongqi Fan
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning, China
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Al Babtain I, Alraee SA, Shalhoub MM, Hijazi LO, albalawi AA, alamer M. The Impact of Acute Care Surgery Model on the Management of Acute Appendicitis and Cholecystitis: A Single-Center Study. Cureus 2022; 14:e26724. [PMID: 35967148 PMCID: PMC9363238 DOI: 10.7759/cureus.26724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background Acute care surgery (ACS) is a novel model for the provision of emergency general surgery (GS) care. Investigating the impact of the ACS team on the management of acute emergencies can help in establishing proper management measures and improving patient care in an emergency setting. The study aims to compare the performance indicators and patient outcomes such as hospital length of stay (LOS), time to diagnosis, and operation before and after the implementation of the acute care system. Methods The study reviewed two retrospective cohorts: the pre-ACS system (n = 202) from January 2012 to December 2013 and the post-ACS system (n = 188) from January 2014 to December 2015, which were done in a tertiary care center. All adult patients diagnosed with acute appendicitis and cholecystitis requiring emergency surgery were included. Results There was an improvement in the time interval between GS referral to the diagnosis of acute appendicitis and cholecystitis (p = 0.07) and from diagnosis to the start of the operation (p = 0.38). Patients in the post-ACS model had a shorter hospital stay than the pre-ACS model patients with [M = 3.69 SD(3.18) days versus M = 3.57 SD (3.60) days, p = 0.25]. Time from the emergency department arrival to GS referral did not show an improvement [M = 4.36 SD(3.34)] hours in the pre-ACS model versus [M = 4.53 SD(3.98)] hours in the ACS model, p = 0.86). Conclusion The ACS model led to earlier diagnosis of acute appendectomy and cholecystectomy cases and reduced the LOS. The introduction of the ACS model in Saudi Arabia showed improvement in patient care during acute emergencies. Further studies including multiple centers with larger sample sizes and longer review periods are needed to evaluate the efficiency and cost-effectiveness of the ACS model.
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Ernudd I, Älgå A, Sandblom G, Dahlberg M, Mantel Ä. Treatment strategies and perforation rate of acute appendicitis during the early phase of the Covid-19 Pandemic: A Swedish cohort study. J Surg Res 2022; 280:450-458. [PMID: 36054956 PMCID: PMC9283669 DOI: 10.1016/j.jss.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
Introduction It is unknown whether the COVID-19 pandemic has had an impact on emergency surgical care in Sweden. This study aimed to compare frequency, treatment strategies, severity, and complication rate of appendicitis during the initial phase of the COVID-19 pandemic with those of previous years. Methods In this single-center study, we identified all patients admitted with appendicitis between March 16 and June 16, 2020, at the Stockholm South General Hospital, and compared these with patients hospitalized with appendicitis during the same calendar period the three previous years. We used multivariate logistic regression to calculate Odds Ratios (OR) with 95% confidence intervals as measurement of the association between appendicitis treatment and perforation rate during the COVID-19 period compared to the nonCOVID-19 periods. Results In all, 892 patients hospitalized with appendicitis were identified, 241 (27%) in 2020 (Covid period group) and the remaining 651 (73%) during the same calendar periods 2017-2019 (nonCovid period group). Appendicitis during the COVID-19 period was associated with double the risk for undergoing conservative treatment (OR 2.15 [95% CI 1.44-3.21]), and a decreased risk for being diagnosed with perforated appendicitis (OR 0.68 [95% CI 0.48-0.98]). Conclusions Patients admitted with appendicitis during the early phase of the COVID-19 pandemic in Stockholm, Sweden, were more likely to receive conservative treatment and less likely to suffer from perforated appendicitis compared to patients hospitalized before the pandemic. Hypothetically, this difference could have been due to pandemic-associated resource reallocation, or it may simply reflect an increasing trend towards conservative management of appendicitis.
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Affiliation(s)
- Ivan Ernudd
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
| | - Andreas Älgå
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Gabriel Sandblom
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Martin Dahlberg
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Ängla Mantel
- Department of Medicine, Solna, Sweden; Division of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
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Petrauskas V, Poskus E, Luksaite – Lukste R, Kryzauskas M, Petrulionis M, Strupas K, Poskus T. Suspected and Confirmed Acute Appendicitis During the COVID-19 Pandemic: First and Second Quarantines—a Prospective Study. Front Surg 2022; 9:896206. [PMID: 35800113 PMCID: PMC9253423 DOI: 10.3389/fsurg.2022.896206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023] Open
Abstract
PurposeCOVID-19 posed an unprecedented modern global healthcare crisis affecting both elective and urgent surgeries. The aim of this study is to evaluate the difference in the presentation of acute appendicitis (AA) before and during the COVID-19 era, the first and second quarantines.MethodsWe performed a prospective study from December 2018 to May 2021. Two cohorts were analysed, one with patients who presented to the emergency department (ED) with suspected AA and the second with confirmed AA. Both cohorts were divided into four groups: before COVID-19, during the first quarantine, between the first and second quarantine, and during the second quarantine. Data such as demographics, the time to first contact with the healthcare provider and time to operation, laboratory tests, clinical stage of AA, length of stay, and COVID-19 status were collected. A total of 469 patients were enrolled.ResultsA total of 209 patients were male (45%) and 260 were female (55%), with the median age being 33 years (24–45). In the first cohort of suspected AA, there was no difference in sex; however, more older patients presented to the ED during the first quarantine (41 years) compared with other groups (28.5, 36, and 32.5 years), p < 0.000. Before the pandemic, there was a shorter duration of symptoms to first contact with the healthcare provider (13 h) compared with other groups, p = 0.001. In the second cohort of confirmed AA, there was a shorter period of time to operation from first symptoms before the pandemic (22 h) compared with other groups (30, 35, 30.5 h), p < 0.000. There were more complicated gangrenous, perforated appendicitis or periappendicular abscess in Group 2 and 3 (26, 22 and 10%, and 26, 22 and 2%, respectively) compared with Group 1 (20, 4 and 3%) and Group 4 (22, 12, and 2%), p = 0.009. Hospital stay was longer during the first quarantine (3 days) compared with other groups (2 days), p = 0.009. Six patients were COVID-19 positive: one from Group 3 and five from Group 4 (p > 0.05).ConclusionsOur study suggests that during the first quarantine of the COVID-19 pandemic, there was delayed presentation to the ED with suspected AA and there was a greater proportion of complicated appendicitis and longer hospitalization in confirmed cases as well.
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Affiliation(s)
- Vidas Petrauskas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Correspondence: Vidas Petrauskas
| | - Eligijus Poskus
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Raminta Luksaite – Lukste
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Petrulionis
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Arenas DJ, Hernandez PT, Hwang J, Agarwal D, Warshauer AK, Holena DN. A low appendiceal mucinous neoplasm lesion in an inflamed appendix within an inguinal hernia. J Surg Case Rep 2022; 2022:rjab489. [PMID: 35673540 PMCID: PMC9167813 DOI: 10.1093/jscr/rjab489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
Amyand’s hernia, an incarcerated appendix inside an inguinal hernia, accounts for <1% of hernias in children and even less in adults. Similarly, low-grade appendiceal mucinous (LAMN) lesions are only found in <1% of removed appendices. We present the case of a 72-year-old man with a 15-year history of a large right inguinoscrotal hernia that presented with right lower quadrant pain, was found by computed tomography imaging to have an incarcerated appendix with a large fluid collection, and was post-operatively diagnosed with an LAMN lesion. Although our case is rare due to the simultaneity of the Amyand’s hernia and LAMN conditions, each separate condition is prevalent enough for most surgical providers to encounter at least one of these. For our case, we discuss the decisions made in the pre-operative and post-operative management and relevant literature.
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Affiliation(s)
- Daniel J Arenas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul T Hernandez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmine Hwang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Divyansh Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daniel N Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Choi YS, Yi JW, Chung CTY, Shin WY, Choi SK, Heo YS. Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060783. [PMID: 35744046 PMCID: PMC9230818 DOI: 10.3390/medicina58060783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has brought serious changes in healthcare systems worldwide, some of which have affected patients who need emergency surgery. Acute appendicitis is the most common surgical disease requiring emergency surgery. This study was performed to determine how the COVID-19 pandemic has changed the treatment of patients with acute appendicitis in South Korea. Materials and Methods: We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis in our hospital from January 2019 to May 2021. We classified the patients into two groups according to whether they were treated before or after the COVID pandemic and 10 March 2020 was used as the cutoff date, which is when the World Health Organization declared the COVID pandemic. Results: A total of 444 patients were included in the “Pre-COVID-19” group and 393 patients were included in the “COVID-19” group. In the “COVID-19” group, the proportion of patients with severe morbidity was significantly lower. The time that the patients spent in the emergency room before surgery was significantly longer in the ”COVID-19” group (519.11 ± 486.57 min vs. 705.27 ± 512.59 min; p-value < 0.001). There was no difference observed in the severity of appendicitis or in the extent of surgery between the two groups. Conclusions: During the COVID-19 pandemic, a statistically significant time delay (186.16 min) was needed to confirm COVID-19 infection status. However, there was no clinical difference in the severity of appendicitis or in the extent of surgery. To ensure the safety of patients and medical staff, a COVID-19 PCR test should be performed.
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Marconi E, Crescioli G, Bonaiuti R, Pugliese L, Santi R, Nesi G, Cerbai E, Vannacci A, Lombardi N. Acute appendicitis in a patient immunised with COVID-19 vaccine: A case report with morphological analysis. Br J Clin Pharmacol 2022; 89:551-555. [PMID: 35633085 PMCID: PMC9348236 DOI: 10.1111/bcp.15421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 01/18/2023] Open
Abstract
Although the benefit/risk profile for mRNA COVID-19 vaccines is recognised as extremely favourable, appendicitis is currently considered an adverse event (AE) of special interest. We describe the case of a 58-year-old female who presented with signs and symptoms of appendicitis approximately 48 hours after her first injection of the Pfizer-BioNTech vaccine. Abdominal ultrasound revealed fluid collection in the right iliac fossa and cecal wall thickening. Following the surgical visit, CT scan with contrast showed a distended appendix with thickened walls, suggestive of acute appendicitis. The patient tested negative to upper respiratory COVID-19 reverse transcription-polymerase chain reaction. Clinical trials and observational studies suggest a possible association between appendicitis and COVID-19 vaccines. Th-1 driven granulomatous inflammation reported in our case represents an infrequent nonspecific chronic inflammation of the appendix, especially in the setting of delayed or interval appendectomy. In view of the current paediatric vaccination campaign, we recommend monitoring the safety profile and potential gastrointestinal AEs associated with mRNA COVID-19 vaccines to swiftly manage subjects with gastrointestinal symptoms and prevent potential complications.
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Affiliation(s)
- Ettore Marconi
- Health SearchItalian College of General Practitioners and Primary CareFlorenceItaly
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly,Tuscan Regional Centre of PharmacovigilanceFlorenceItaly
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | - Lavinia Pugliese
- Histopathology and Molecular Diagnostics, Careggi Teaching HospitalFlorenceItaly
| | - Raffaella Santi
- Pathology Section, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Gabriella Nesi
- Pathology Section, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly,Tuscan Regional Centre of PharmacovigilanceFlorenceItaly
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly,Tuscan Regional Centre of PharmacovigilanceFlorenceItaly
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125
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Kaur G, Williams N, Vidhun R, Stroever S, Dodge JL. The Gallbladder and Vermiform Appendix as Quality Assurance Indicators in Autopsy Pathology. Am J Clin Pathol 2022; 157:858-862. [PMID: 34871340 DOI: 10.1093/ajcp/aqab199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We investigate the number of autopsy reports that did or did not document the presence or absence of the gallbladder or appendix or document abdominal scars in patients following cholecystectomy or appendectomy. We also report gallbladder and appendix pathology at autopsy. METHODS Autopsy reports from patients 18 years or older autopsied at a community teaching hospital between January 1, 2009, and December 31, 2018 were reviewed. Nonabdominal autopsies were excluded. Histopathologic examination of the gallbladder and appendix was only performed if gross pathology was seen. RESULTS Of the 385 autopsies studied, 48 (12.5%) had cholecystectomies, of which 6 (12.5%) did not document abdominal scars. Sixty-two (16.1%) had appendectomies, of which 12 (19.4%) did not document abdominal scars. The presence or absence of the gallbladder and appendix was not documented in 6 (1.6%) and 16 (4.2%) of reports, respectively. Pathology was seen in 87 (25.8%) gallbladders and 4 (1.2%) appendixes. CONCLUSIONS Absence of the gallbladder or appendix is a relatively common autopsy finding. Auditing autopsy reports for documentation of their presence or absence, along with associated abdominal scars, are potential quality assurance indicators of autopsy reports. Documentation of these elements could be improved by changing the autopsy template or using synoptic reporting.
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Affiliation(s)
- Gagandeep Kaur
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
| | - Nathan Williams
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
| | - Ramapriya Vidhun
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
| | - Stephanie Stroever
- Department of Research and Innovation, Nuvance Health , Danbury, CT , USA
| | - Jessica L Dodge
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
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Rahman R, Walsh A, Chase T, Ghanbari A. A unique case report of three morphologically distinct malignancies in an appendix specimen. Int J Surg Case Rep 2022. [PMCID: PMC9178484 DOI: 10.1016/j.ijscr.2022.107260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Samper AFG, Herrera-Almario GE, Tulloch D, Blanco D, Cardoso LL, Rocha REN, Rajan R, Gracias V, Hanna JS. A granular analysis of service delivery for surgical system strengthening: Application of the Lancet indicators for policy development in Colombia. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100217. [PMID: 36777688 PMCID: PMC9904114 DOI: 10.1016/j.lana.2022.100217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Lancet Commission on Global Surgery (LCoGS) surgical indicators have given the surgical community metrics for objectively characterizing the disparity in access to surgical healthcare. However, aggregate national statistics lack sufficient specificity to inform strengthening plans at the community level. We performed a second-stage analysis of Colombian surgical system service delivery to inform the development of resource- and context-sensitive interventions to inform a revision of the Decennial Public Health Plan for access inequity resolution. METHODS Data from the year 2016 to inform total operative volume (TOV) and 30-day non-risk adjusted peri-operative mortality (POMR) were collected from the Colombian national health information system. TOV and POMR were sub-characterized by demographics, urgency, service line, disease pathology and facility location. FINDINGS In 2016, aggregate national mortality was 0·87%, while mortality attributable to elective and emergency surgery was 0·73% and 1·30%, respectively. The elderly experienced a 5·6-fold higher mortality, with 4·2% undergoing an operation within 30 days of dying. Individuals undergoing hepatobiliary, thoracic, cardiac, and neurosurgical operations experienced the highest mortality rates while obstetrics, general surgery, orthopaedics, and urology performed the largest procedure volume. Finally, analysis of operation and service line specific POMR reveals opportunities for improvement. INTERPRETATION This granular second-stage analysis provides actionable data which is fundamental to the development of resource and context-sensitive interventions to address gaps and inequities in surgical system service delivery. Furthermore, this analysis validates the modeling underlying development of the LCoGS indicators. These data will inform the assessment of implementation priorities and revision of the Colombian Decennial Public Health Plan. FUNDING None.
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Affiliation(s)
| | - Gabriel E. Herrera-Almario
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - David Tulloch
- Center for Remote Sensing and Spatial Analysis, Rutgers School of Environmental and Biological Sciences, New Brunswick, NJ, USA
| | - Daniela Blanco
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | | | | | - Roshni Rajan
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
| | - Vicente Gracias
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
- Rutgers Global Health Institute, New Brunswick, NJ, USA
| | - Joseph S. Hanna
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
- Rutgers Global Health Institute, New Brunswick, NJ, USA
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Bhaskar J, McLean RC, Bhaskar K, Brown LR. Temporal Trends in the Investigation, Management and Outcomes of Acute Appendicitis over 15 Years in the North of England: A Retrospective Cohort Study. World J Surg 2022; 46:2141-2154. [PMID: 35585254 PMCID: PMC9116928 DOI: 10.1007/s00268-022-06586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute appendicitis is a common surgical emergency with an estimated lifetime prevalence of 8.6% for males and 6.7% for females. Despite the frequency of presentation, considerable variation in clinical practice exists. Our study aimed to explore temporal trends in the investigation, treatment and outcomes for patients with appendicitis between 2002 and 2016. METHODS Data collected included all patients aged ≥16 years across the NHS trusts in Northern England between 01/01/2002 and 31/12/2016 diagnosed with appendicitis. Patient demographics, co-morbidity and management strategies were included. Outcomes of interest were length of stay and inpatient mortality. RESULTS Over a 15 years period, 22,137 patients were admitted with acute appendicitis. A consistent male preponderance (n = 11,952, 54%) was observed, and median age increased over time (2002-2006: 36.4 vs. 2012-2016: 39.5, p < 0.001). Comorbidity of patients also increased (p < 0.001) in recent years. Computed tomography (CT) use increased from 0.8 to 21.9% (p < 0.001) over the study period. Following CT scanning, there was a longer time to theatre (1.22 vs. 0.70 days, p < 0.001), and patients were more frequently managed non-operatively (23.8% vs. 5.7%, p < 0.001). The utilisation of laparoscopic approaches significantly increased from 4.1 to 70.4% (p < 0.001). Laparoscopic patients had a shorter median length of stay (2.97 days) when compared with open surgery (4.44 days) or non-operative (6.19 days) patients. The 30-day mortality rate was 0.33% overall and decreased with time (p = 0.004). CONCLUSIONS CT and laparoscopic surgery are increasingly utilised in the management of appendicitis. Along with other advances in clinical practice, they have led to reduced lengths of stay and mortality.
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Affiliation(s)
- Jared Bhaskar
- St George's University of London, Cranmer Terrace, Tooting, London, SW17 0RE, England, UK.
| | - Ross C McLean
- Queen Elizabeth Hospital Site, Queen Elizabeth Avenue, Gateshead, NE9 6SX, England, UK
| | - Keir Bhaskar
- Department of Medicine, Imperial College London, Exhibition Road, South Kensington, London, SW7 2BX, England, UK
| | - Leo R Brown
- Royal Infirmary of Edinburgh, Little France, Edinburgh, EH2 2EQ, Scotland, UK
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Stevens A, Meier J, Bhat A, Bhat S, Balentine C. Age is associated with increased morbidity after laparoscopic appendectomy. Surgery 2022; 172:488-493. [PMID: 35568586 PMCID: PMC10370360 DOI: 10.1016/j.surg.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/05/2022] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is one of the most common emergency general surgery procedures in the United States. Little is known about its postoperative outcomes for older adults because appendicitis typically occurs in younger patients. The purpose of this study was to examine the association between age and postoperative complications after appendectomy. We hypothesized that age would have a significant and nonlinear association with morbidity. METHODS We conducted a retrospective cohort study of individuals whose laparoscopic appendectomies were recorded in the Veterans Affairs (VA) Surgical Quality Improvement Program (from 2000-2018; n = 14,619) and National Surgical Quality Improvement Program (2005-2019; n = 349,909) databases. The primary outcome was 30-day morbidity. We used logistic regression with fractional polynomials to model nonlinear relationships between age and outcomes. RESULTS The median age (interquartile range) of the nonveteran cohort was 36 years (26-51; 8.4% of patients were 65 or older) versus 51 years among veterans (35-63; 21% were 65 or older). For veterans and nonveterans, there was a significant and nonlinear relationship between age and risk of complications. In the nonveteran cohort, the predicted probability (with 95% confidence interval) of postoperative complications was 9.8% (9.7-10.1) at age 65, 11.9% (11.7-12.3) at age 75, and 14.5% (14.1-14.9) at age 85. Among veterans, the risk was 7.5% (6.9-8.1) at age 65, 8.3% (7.6-9.1) at age 75, and 9.1% (8.1-10.1) at age 85. CONCLUSION For both veterans and nonveterans, older age was associated with a significantly increased risk of postoperative complications. Notably, morbidity within the VA was lower for older adults than in non-VA hospitals.
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Affiliation(s)
- Audrey Stevens
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX.
| | - Jennie Meier
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX. https://twitter.com/Jenniemeier
| | - Archana Bhat
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX. https://twitter.com/bhats7637
| | - Sneha Bhat
- University of Texas Southwestern Department of Surgery, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX
| | - Courtney Balentine
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX
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ALTINTAŞ URAL D, KARAKAYA AE, GÜLER AG, YALÇIN HS, TUŞAT M. Comparative Analysis of the Acute Appendicitis Management in Children Before and During the COVID-19 Pandemic. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1089646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Introduction: Acute appendicitis (AA) is one of the most common emergency surgical diseases in pediatric population. Herein, we aimed to compare the incidence and severity of AA before and during the COVID-19 outbreak.
Methods: This multicenter study was conducted in three medical faculty hospitals between the periods of 15 March-30 June 2019 (Group A), and the pandemic period of 15 March-30 June 2020(Group B). We evaluated the clinicopathological characteristics of the patients in each group due to age, gender, serum leukocyte, C-reactive protein, radiological imaging use of postop peritoneal drain and presence of serious complications.
Results: A total of 141 patients were identified, 64 in Group A and 77 in Group B. We found higher complication rates in Group B. Fewer patients applied in Group B, but a higher rate of AA was diagnosed. During the COVID-19 period, more patients were admitted with the later stages of the AA and with significant complications. Radiological imaging of patients with appendicitis in Group B showed more severe disease than cases in Group A.
Conclusion: Higher rate of perforated and complicated appendicitis in the pandemic period was due to misdiagnosis/delayed diagnosis in primary care centers as a result of fear from contagious coronavirus. While the period of the COVID - 19 pandemic presents difficulties in treating infected patients, we would like to emphasize the importance of a comprehensive assessment and physical examination in children with suspected surgical conditions.
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Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases. Diagnostics (Basel) 2022; 12:diagnostics12041011. [PMID: 35454059 PMCID: PMC9032964 DOI: 10.3390/diagnostics12041011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Despite great advances in medicine, numerous available laboratory markers, and radiological imaging, the diagnosis of acute appendicitis (AA) in some cases still remains controversial and challenging for clinicians. Because of that, clinicians are still looking for an ideal marker that would be specific to AA. The red blood cell distribution width (RDW) has been recently investigated in several studies as a potential biomarker for AA. The aim of this systematic review and meta-analysis was to systematically summarize and compare all relevant data on RDW as a diagnostic biomarker for AA. Methods: This systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Scopus, Web of Science, and Excerpta Medica database—EMBASE) were systematically searched for relevant comparative studies by two independent researches using keywords ((red cell distribution width) OR rdw) AND (appendicitis). An independent assessment of the methodological quality was performed by two authors using the Downs and Black scale. RevMan 5.4 software was used to perform the meta-analysis. Results: Fifteen studies were included in the final meta-analysis; the majority of the studies was retrospective. Nine studies compared the RDW values between AA and non-AA; four studies compared the same between AA and healthy controls, while two studies compared the RDW values among all three groups. The estimated heterogeneity among the studies for all outcome was statistically significant (I2 = 92−99%, p < 0.00001). The pooling the data demonstrated no statistically significant difference in the RDW values (weighted mean difference (WMD) = 0.03, 95% CI = (−0.46, 0.52), p = 0.91) between AA and healthy controls as well as between AA and non-AA cases (WMD = 0.23, 95%CI = (−0.19, 0.65), p = 0.28). A separate subanalysis was performed to evaluate the utility of this biomarker for the pediatric age group. Pooling the data demonstrated no significant difference among the AA and non-AA groups in terms of the RDW values (WMD = 0.99, 95% CI = (−0.35, 2.33), p = 0.15). Conclusion: The RDW value difference demonstrated no statistically significant difference in AA versus healthy individuals and AA versus non-AA individuals. At the moment, there is no evidence of RDW utility in diagnostic testing of AA. Further research with prospective, multicenter studies and studies targeting special patient groups with a large sample size are needed in this field.
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Risk factors for periappendiceal adhesions in acute appendicitis: a retrospective comparative study. BMC Surg 2022; 22:134. [PMID: 35392891 PMCID: PMC8991578 DOI: 10.1186/s12893-022-01579-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Acute appendicitis usually requires immediate surgical treatment, but appendectomies were difficult for some patients with severe periappendiceal adhesions. We investigated risk factors of intraoperative adhesions to help surgeons make better treatment plans for appendicitis. Methods We retrospectively analyzed 186 cases diagnosed with acute appendicitis and underwent surgery in Shandong Provincial Hospital affiliated to Shandong First Medical University between January 2018 and December 2019. According to the degree of intraoperative adhesions, they were divided into mild, moderate and severe groups. Then, we analyzed a number of preoperative factors contributed to adhesions, suppuration and perforation during appendectomy in 186 patients. Results Contrast to the moderate group (MoG) and the mild group (MiG), the severe degree of adhesions group (SG) had a higher intraoperative perforation and suppuration rate, a greater likelihood of conversion to open and more postoperative complications. Multivariable logistic regression analysis showed that recurrent appendicitis and high neutrophil percentage were independently associated with periappendiceal adhesions. The preoperative ultrasonography (US) revealed periappendiceal fluid and high neutrophil percentage were independently associated with appendix suppuration. A high preoperative neutrophil percentage was independently associated with appendix perforation. Conclusions Recurrent appendicitis and preoperative high neutrophil percentage were risk factors of periappendiceal adhesions; preoperative US revealed periappendiceal fluid and high neutrophil percentage were risk factors of appendix suppuration; and a high preoperative neutrophil percentage was a risk factor of appendix perforation.
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Appendiceal knotting causing small bowel obstruction: A rare case report. Int J Surg Case Rep 2022; 93:106970. [PMID: 35367944 PMCID: PMC8980631 DOI: 10.1016/j.ijscr.2022.106970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Appendicitis causing intestinal obstruction by forming a knot around a small bowel is uncommon. Preoperative diagnosis is challenging as the typical presentations of appendicitis are not usually seen. The diagnosis of appendicular knotting is usually an intraoperative surprise. Case presentation A 34-year-old male patient (BMI-20.86 kg/m2) presented to the surgical emergency unit with colicky central abdominal pain of 2-days duration, which later involved the whole abdomen. In association with this, he had a history of frequent vomiting of ingested matter which later became bilious. The abdominal examination revealed diffuse abdominal tenderness with guarding and rigidity. On midline exploratory laparotomy, the inflamed appendix which was adherent to the distal part of the ileum was observed. The appendix and the encircled segment of the distal ileum were both gangrenous, and the patient underwent resection of the bowel segment in addition to appendectomy. Clinical discussion Whenever an appendix wraps around an intestine or its tip adheres with small bowel, cecum, or posterior peritoneum forming a ring-like structure, and a segment of a bowel herniates through an opening can cause a closed-loop obstruction with or without strangulation. The management for ileo-appendicular knotting associated with gangrenous bowel could be appendectomy and resection of the bowel segment. Postoperatively, the patient had developed diarrhea caused by ileocecal resection, which later subsided by medication. Conclusion Ileo-appendicular knotting is a rare cause of small intestinal obstruction, and it's challenging to diagnose during the preoperative period. As surgeons dealing with acute abdomen in routine clinical practice, knowledge of this unusual case is helpful for clinical suspicion and evidence-based management.
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Smith HF. A review of the function and evolution of the cecal appendix. Anat Rec (Hoboken) 2022; 306:972-982. [PMID: 35363436 DOI: 10.1002/ar.24917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
Since its initial discovery in the 1500s, the cecal appendix has been an anatomical structure of great intrigue, notorious for its inconvenient tendency to become inflamed and often require surgical intervention. Appendicitis is one of the most common indications for emergency abdominal surgery, costing healthcare systems billions of dollars globally and causing tens of thousands of deaths annually. Yet, recent studies have indicated that the appendix may serve important protective functions in fortifying the body's immune response against invading pathogens and re-inoculating the gut with commensal bacteria after periods of gastrointestinal illness. While the cecal appendix was once believed to be a synapomorphy of hominoids (humans and other great apes), recent studies suggested that it is a recurrent trait found in several other species of primates, rodents, lagomorphs, marsupials, and monotremes. Mapping appendiceal and other gastrointestinal traits across a mammalian consensus phylogeny revealed that the cecal appendix has evolved independently numerous times throughout mammalian evolution, significantly more than would be expected due to chance alone, suggesting that the appendix is adaptively advantageous. However, attempts to identify an overarching ecological, behavioral, dietary, or environmental factor driving some species to evolve an appendix have been largely unsuccessful, indicating that the cecal appendix has a complex and diverse evolutionary history. This review discusses the current understanding of the pathophysiology, evolution, and possible functions of the appendix, both within humans and broadly across the class Mammalia.
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Affiliation(s)
- Heather F Smith
- Department of Anatomy, Midwestern University, Glendale, Arizona, USA
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
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135
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Petroianu A. Relevant aspects of acute appendicitis. Rev Assoc Med Bras (1992) 2022; 68:121-124. [PMID: 35239865 DOI: 10.1590/1806-9282.20211315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andy Petroianu
- Universidade Federal de Minas Gerais, Department of Surgery - Belo Horizonte (MG), Brazil
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Bayissa BB, Miressa F, Abulkadir A, Fekadu G. Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Yuan J, Chen Q, Hong W, Yu L, Li X. Comparison of Clinical Features and Outcomes of Appendectomy in Elderly vs. Non-Elderly: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:818347. [PMID: 35265661 PMCID: PMC8899017 DOI: 10.3389/fsurg.2022.818347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background The objective of this study is to compare clinical and surgical outcomes of appendectomy among elderly and non-elderly subjects. Methods A systematic search was conducted on PubMed, Scopus, and Google academic databases. Studies, observational in design, that compared peri-and postoperative outcomes of appendectomy, in patients with acute appendicitis, between elderly and non-elderly/younger subjects were considered for inclusion. Statistical analysis was performed using STATA software. Results A total of 15 studies were included. Compared to non-elderly patients, those that were elderly had an increased risk of complicated appendicitis [relative risk (RR), 2.38; 95% CI: 2.13, 2.66], peritonitis [RR, 1.88; 95% CI: 1.36, 2.59], and conversion from laparoscopic to open appendectomy [RR, 3.02; 95% CI: 2.31, 3.95]. The risk of overall postoperative complications [RR, 2.59; 95% CI: 2.19, 3.06], intra-abdominal abscess [RR, 1.84; 95% CI: 1.15, 2.96], wound infection [RR, 3.80; 95% CI: 2.57, 5.61], and use of postoperative drainage [RR, 1.14; 95% CI: 1.09, 1.19] was higher among the elderly. The risk of readmission (30 days) [RR, 1.61; 95% CI: 1.16, 2.24] and mortality (30 days) [RR, 12.48; 95% CI: 3.65, 42.7] was also higher among elderly. Conclusions Findings suggest an increased risk of peri-and postoperative complications among elderly subjects undergoing appendectomy, compared to non-elderly subjects. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021286157.
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Affiliation(s)
- Jie Yuan
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
| | - Qingfeng Chen
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo Hospital of the Zhejiang University, Ningbo, China
| | - Weicong Hong
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
| | - Lifeng Yu
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
| | - Xuen Li
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
- *Correspondence: Xuen Li
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de Costa A. The appendix‐mucosal immunity and tolerance in the gut: consequences for the syndromes of appendicitis and its epidemiology. ANZ J Surg 2022; 92:653-660. [PMID: 35152541 PMCID: PMC9304207 DOI: 10.1111/ans.17522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
The cause of appendicitis is unknown. A review is presented across diverse sources relating to the biology of the appendix and its perturbations. A mechanistic model of the function of the appendix is presented, and its application to the syndromes and consequences of appendicitis is described.
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Affiliation(s)
- Alan de Costa
- College of Medicine and Dentistry James Cook University, Cairns Clinical School, Cairns Hospital Cairns Queensland Australia
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139
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Fuad M, Modher A. Primary Closure or Delayed Primary Closure? Assessment of Optimum Management of Surgical Wounds for Perforated Appendicitis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Open appendectomy is the treatment of choice for perforated appendicitis. Perforated appendicitis is associated with a 15–20% risk of developing post-operative wound infection, which the later associated with increased morbidity as increasing post-operative pain, longer hospital stay, suppurative wounds, patient dissatisfaction and increase cost of treatment. Some literatures revealed inconsistent results related to the incidence of surgical site infection (SSI) between delayed primary closures (DPC) and primary closure (PC) in open appendectomy for perforated appendicitis.
AIM: The objective of the study is to define the best practice of wound management in patients operated on for perforated appendicitis.
PATIENTS AND METHODS: One hundred and twenty patients having perforated appendicitis underwent open appendectomy enrolled in the study. The patients were randomly grouped according to the method of managing the surgical incisions into two groups; patients with their incisions closed primarily (PC) and those with their incisions left open to be frequently dressed for 5 days with Betadine-soaked gauze packing till it become clean then closed (DPC). An infected wound was assigned as such if purulent discharge yielded from the incision site. Results to be addressed were the incidence of SSI and the hospitalization length.
RESULTS: Out of the total 120 patients, 19.17 % developed SSI following closure of the incision. Patients managed by PC revealed higher rate of SSI than DPC group (32.8% vs. 5.1%, p < 0.001) and longer hospitalization (8.3 vs. 6.4 days, with a p < 5%).
CONCLUSION: DPC is preferred policy over PC when managing an open appendicectomy wounds for perforated appendicitis, as the former is associated with low incidence of wound infection and shorter hospitalization.
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140
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Sukiman H, Mohamad AM, Raduan MFN, Yasim MNAM, Lazim MIM. Effect of the Movement Control Order on the Incidence of Complicated Appendicitis During the COVID-19 Pandemic: A Cross-Sectional Study. Malays J Med Sci 2022; 28:130-136. [PMID: 35115895 PMCID: PMC8793977 DOI: 10.21315/mjms2021.28.5.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Appendicitis is common and delayed presentation results in complicated appendicitis with increased morbidity. This study investigates the effect of the Movement Control Order (MCO) during the COVID-19 pandemic on the presentation and severity of appendicitis. Methods A cross-sectional study including 193 patients diagnosed with appendicitis was conducted at four hospitals in Pahang, Malaysia. Those who presented between 1 February 2020 and 17 March 2020 were included in the pre-MCO group and those between 18 March 2020 and 30 April 2020 in the MCO group. The definitions of simple and complicated appendicitis were based on the Sunshine Appendicitis Grading Score. The primary outcome was the incidence of complicated appendicitis, and the secondary outcomes were length of stay, a composite of surgical morbidities and a composite of organ failure. Results A total of 105 patients in the pre-MCO group and 88 in the MCO group were analysed. The incidence of complicated appendicitis was 33% and it was higher in the MCO than in the pre-MCO group (44% versus 23%, P = 0.002). The MCO period was independently associated with complicated appendicitis in the logistic regression (P = 0.001). It was also associated with prolonged length of stay (3.5 days versus 2.4 days, P < 0.001) and higher overall surgical morbidity (19% versus 5%, P = 0.002). Conclusion The MCO imposed during the COVID-19 pandemic was associated with a higher incidence of complicated appendicitis and surgical morbidity.
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Affiliation(s)
- Hamzah Sukiman
- Department of Surgery, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Abdul Malek Mohamad
- Department of Surgery, International Islamic University Malaysia Medical Centre, Kuantan, Pahang, Malaysia
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Lisi G, Campanelli M, Mastrangeli MR, Spoletini D, Menditto R, Grande S, Boccuzzi M, Grande M. The treatment of acute appendicitis in two age-based groups during COVID-19 pandemic: a retrospective experience in a COVID-19 referral hospital. Int J Colorectal Dis 2022; 37:323-328. [PMID: 34738164 PMCID: PMC8567973 DOI: 10.1007/s00384-021-04060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE During the past months, the Italian Government has reduced the restrictions and access to hospitals as well as outpatient. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the COVID-19 pandemic, it is useful to assess how the current situation is influencing the management of elderly patients with acute appendicitis. METHODS Between February 2020 and December 2020, all patients 18 years or older undergone appendectomy were included. Patients were divided in two age-based groups (young groups, YG; elderly group, EG). Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis. RESULTS One hundred eight patients underwent appendectomy, 81 patients into the YG, and 27 in the EG. Laparoscopy was performed in 87.7% of the YG and in 51.8% of the elderly (p < 0.000), while conversion to laparotomy was necessary in 3.7% in the YG vs 22.3% of the other group (p < 0.009). Open procedures were more frequent in the EG, 25.9% vs 8.6% (p value < 0.05). No mortality rate was reported in both groups; moreover, the mean hospital stay was greater in the EG than the YG (p < 0.000). CONCLUSION Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy despite no significant relationship between these findings and the histologic examination was reported.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - Michela Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | | | - Domenico Spoletini
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Rosa Menditto
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Simona Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - Massimiliano Boccuzzi
- Department of Surgery, San Sebastiano Hospital, via Tuscolana 1, 00046, Frascati, Rome, Italy
| | - Michele Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
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142
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Motazedian G, Aryanpoor P, Rahmanian E, Abiri S, Kalani N, Hatami N, Bagherian F, Etezadpour M, Farzaneh R, Maleki F, Foroughian M, Ghaedi M. Incidence of Pediatric Perforated Appendicitis during the COVID-19 Pandemic; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e3. [PMID: 35072092 PMCID: PMC8771157 DOI: 10.22037/aaem.v10i1.1421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooled event rate of pediatric perforated appendicitis before and during the COVID-19 pandemic. METHODS This was a systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, and PubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect and depict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3. RESULTS Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforated appendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%. In the COVID era, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a significant difference in the subgroup analysis within the pre-COVID and COVID era (P<0.001), showing a higher perforation rate in the COVID era. CONCLUSION Our study showed that during the COVID-19 pandemic, the rate of perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.
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Affiliation(s)
- Gholamreza Motazedian
- Plastic & Reconstructive Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Poorya Aryanpoor
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Ehsan Rahmanian
- Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Samaneh Abiri
- Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Navid Kalani
- Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Naser Hatami
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Farhad Bagherian
- Department of Emergency Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Etezadpour
- Surgery department, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
| | - Roohie Farzaneh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Maleki
- Department of Emergency Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Ghaedi
- Plastic Surgery department, Jahrom University of Medical Sciences, Jahrom, Iran
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Vanderbecq Q, Ardon R, De Reviers A, Ruppli C, Dallongeville A, Boulay-Coletta I, D’Assignies G, Zins M. Adhesion-related small bowel obstruction: deep learning for automatic transition-zone detection by CT. Insights Imaging 2022; 13:13. [PMID: 35072813 PMCID: PMC8787000 DOI: 10.1186/s13244-021-01150-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background To train a machine-learning model to locate the transition zone (TZ) of adhesion-related small bowel obstruction (SBO) on CT scans. Materials and methods We used 562 CTs performed in 2005–2018 in 404 patients with adhesion-related SBO. Annotation of the TZs was performed by experienced radiologists and trained residents using bounding boxes. Preprocessing involved using a pretrained model to extract the abdominopelvic region. We modeled TZ localization as a binary classification problem by splitting the abdominopelvic region into 125 patches. We then trained a neural network model to classify each patch as containing or not containing a TZ. We coupled this with a trained probabilistic estimation of presence of a TZ in each patch. The models were first evaluated by computing the area under the receiver operating characteristics curve (AUROC). Then, to assess the clinical benefit, we measured the proportion of total abdominopelvic volume classified as containing a TZ for several different false-negative rates. Results The probability of containing a TZ was highest for the hypogastric region (56.9%). The coupled classification network and probability mapping produced an AUROC of 0.93. For a 15% proportion of volume classified as containing TZs, the probability of highlighted patches containing a TZ was 92%.
Conclusion Modeling TZ localization by coupling convolutional neural network classification and probabilistic localization estimation shows the way to a possible automatic TZ detection, a complex radiological task with a major clinical impact. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01150-y.
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Su D, Li Q, Zhang T, Veliz P, Chen Y, He K, Mahajan P, Zhang X. Prediction of acute appendicitis among patients with undifferentiated abdominal pain at emergency department. BMC Med Res Methodol 2022; 22:18. [PMID: 35026994 PMCID: PMC8759254 DOI: 10.1186/s12874-021-01490-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emergency visits using both structured data and free-text data from a national survey. Methods We performed a secondary data analysis on the 2005-2017 United States National Hospital Ambulatory Medical Care Survey (NHAMCS) data to estimate the association between emergency department (ED) patients with the diagnosis of AA, and the demographic and clinical factors present at ED visits during a patient’s ED stay. We used binary logistic regression (LR) and random forest (RF) models incorporating natural language processing (NLP) to predict AA diagnosis among patients with undifferentiated symptoms. Results Among the 40,441 ED patients with assigned International Classification of Diseases (ICD) codes of AA and appendicitis-related symptoms between 2005 and 2017, 655 adults (2.3%) and 256 children (2.2%) had AA. For the LR model identifying AA diagnosis among adult ED patients, the c-statistic was 0.72 (95% CI: 0.69–0.75) for structured variables only, 0.72 (95% CI: 0.69–0.75) for unstructured variables only, and 0.78 (95% CI: 0.76–0.80) when including both structured and unstructured variables. For the LR model identifying AA diagnosis among pediatric ED patients, the c-statistic was 0.84 (95% CI: 0.79–0.89) for including structured variables only, 0.78 (95% CI: 0.72–0.84) for unstructured variables, and 0.87 (95% CI: 0.83–0.91) when including both structured and unstructured variables. The RF method showed similar c-statistic to the corresponding LR model. Conclusions We developed predictive models that can predict the AA diagnosis for adult and pediatric ED patients, and the predictive accuracy was improved with the inclusion of NLP elements and approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01490-9.
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Affiliation(s)
- Dai Su
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Qinmengge Li
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, USA.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health School, Sichuan University, Chengdu, China
| | - Philip Veliz
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, USA
| | - Yingchun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Kevin He
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Prashant Mahajan
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, USA
| | - Xingyu Zhang
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
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Rashid A, Gupta A, Adiamah A, West J, Grainge M, Humes DJ. Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:531-541. [PMID: 34988603 PMCID: PMC8731215 DOI: 10.1007/s00268-021-06373-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
Introduction With the global prevalence of liver cirrhosis rising, this systematic review aimed to define the perioperative risk of mortality in these patients following appendicectomy. Methods Systematic searches of Medline, EMBASE, Cochrane Library databases, ICTRP, and Clinical trials.gov were undertaken to identify studies including patients with cirrhosis undergoing appendicectomy, published since database inception to March 2021. Studies had to report mortality. Two review authors independently identified eligible studies and extracted data. Pooled analysis of in-patient and 30-day mortality was performed. Results Of the 948 studies identified, four were included and this comprised three nationwide database studies (USA and Denmark) and one multi-centre observational study (Japan). A total of 923 patients had cirrhosis and 167,211 patients did not. In-patient mortality ranged from 0 to 1.7% in patients with cirrhosis and 0.17 to 0.3% in patients without. 30-day mortality was 9% in patients with cirrhosis compared to 0.3% in those without. One study stratified cirrhotic patients into compensated and decompensated groups. In patients with compensated cirrhosis, mortality following laparoscopic appendicectomy (0.5%) was significantly lower than open appendicectomy (3.2%). The meta-analysis highlighted a tenfold increase in perioperative mortality in cirrhotic patients (OR 9.92 (95% CI 4.67 to 21.06, I2 = 28%). All studies reported an increased length of stay in patients with cirrhosis. Conclusion This review suggests that appendicectomy in the cirrhotic population is associated with increased mortality. LA may be safer in this population. Lack of information on cirrhosis severity and failure to control for age and co-morbidities make the results difficult to interpret. Further large population-based studies are required.
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Affiliation(s)
- Adil Rashid
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Alisha Gupta
- School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Alfred Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Matthew Grainge
- Division of Epidemiology and Public Health, School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK
| | - David J Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.,Division of Epidemiology and Public Health, School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK
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146
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Iannuzzi JP, King JA, Leong JH, Quan J, Windsor JW, Tanyingoh D, Coward S, Forbes N, Heitman SJ, Shaheen AA, Swain M, Buie M, Underwood FE, Kaplan GG. Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis. Gastroenterology 2022; 162:122-134. [PMID: 34571026 DOI: 10.1053/j.gastro.2021.09.043] [Citation(s) in RCA: 206] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Acute pancreatitis is a common disease with significant associated morbidity and mortality. We performed a systematic review and meta-analysis of population-based studies to explore the changing temporal trends of acute pancreatitis incidence globally. METHODS We performed a systematic literature search to identify population-based studies reporting the annual incidence of acute pancreatitis. Abstracts were assessed independently to identify applicable articles for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs). The AAPCs were pooled in a meta-analysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map. RESULTS Forty-four studies reported the temporal incidence of acute pancreatitis (online interactive map: https://kaplan-acute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC, 3.07%; 95% CI, 2.30% to 3.84%; n = 34). Increasing incidence was observed in North America (AAPC, 3.67%; 95% CI, 2.76% to 4.57%; n = 4) and Europe (AAPC, 2.77%; 95% CI, 1.91% to 3.63%; n = 23). The incidence of acute pancreatitis was stable in Asia (AAPC, -0.28%; 95% CI, -5.03% to 4.47%; n = 4). CONCLUSIONS This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last 56 years and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa, and Latin America.
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Affiliation(s)
- Jordan P Iannuzzi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - James A King
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Hope Leong
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Divine Tanyingoh
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Coward
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nauzer Forbes
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven J Heitman
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abdel-Aziz Shaheen
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark Swain
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Buie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fox E Underwood
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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147
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Zheng Z, Bi JT, Liu YQ, Cai X. The impact of COVID-19 pandemic on the treatment of acute appendicitis in China. Int J Colorectal Dis 2022; 37:215-219. [PMID: 34647160 PMCID: PMC8514203 DOI: 10.1007/s00384-021-04031-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This research aims to analyze the impact of the novel coronavirus pandemic on the hospital visits of patients with acute appendicitis. METHODS The retrospective analysis was designed to look at the treatment of acute appendicitis in the Department of General Surgery in Beijing Jishuitan Hospital before and during the COVID-19 pandemic (2019-2020). Data was analyzed by the numbers of patients, sex, age, onset time, fever or not, laboratory examination, imaging test, and treatment. And we analyzed the differences between the "pre-COVID group" and "during-COVID group". RESULTS Compared with the year 2019, the number of acute appendicitis patients has diminished substantially during the COVID-19 pandemic (2020), but the number elevated with the control of the pandemic. Even if we did not find the differences of the treatment before and during the pandemic (P = 0.932), the onset time to emergency was significantly longer (P < 0.001), and more patients had showed fever (P < 0.001) during the COVID-19 pandemic. And the total number of white blood cells and C reactive protein level were significantly higher in 2020 than those in 2019 (P = 0.006, 0.003). And the same result was found in patients with appendiceal fecalith (P = 0.047). CONCLUSION During the pandemic of the new coronavirus pneumonia, the number of patients with acute appendix treatment dropped significantly, mainly because it took longer than before, and the condition was more severe. It can be seen that the new coronary pneumonia has a great impact on the patients' medical treatment behavior, and the active prevention and treatment of the new coronavirus pneumonia is currently an important and urgent issue.
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Affiliation(s)
- ZhiXue Zheng
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035 China
| | - Jing Tao Bi
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035 China
| | - Ya Qi Liu
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035 China
| | - Xuan Cai
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035 China
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148
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Herrera J, Arrechea R, Mihura M, Bregante M, Medina J, Pirchi D. Impact of the COVID-19 pandemic and restrictive measures on acute appendicitis: Do not let your guard down. J Minim Access Surg 2022; 18:539-544. [PMID: 35046185 PMCID: PMC9632706 DOI: 10.4103/jmas.jmas_267_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The COVID-19 pandemic has altered the usual dynamics of consultation and presentation for acute appendicitis (AA). The aim of this study was to evaluate the impact of the pandemic and restrictive measures on the cases of AA. Subjects and Methods: A retrospective study of patients diagnosed with AA between December 2019 and July 2020 was conducted. Patients were classified into two groups; one that underwent treatment in the 16 weeks before the implementation of lockdown in Argentina (Group 1) and another that underwent treatment in the 16 weeks after (Group 2). Demographic, clinical and surgical variables were evaluated. Results: Overall, 91 patients underwent surgery, 61 and 30 patients in each group, showing a 51% drop in the incidence. The second group delayed seeking medical care longer (mean 46 h vs. 27 h, P < 0.05), had a higher rate of perforated appendicitis (30% vs. 11%, P < 0.05) and a higher rate of complicated appendicitis (56.6% vs. 18%, P < 0.01). These results were associated with a longer operative time (43.7 ± 15.5 min vs. 36.1 ± 11.1 min, P < 0.05) and a longer mean length of hospital stay (1.9 days vs. 1.4 days, P < 0.01); however, no increase in the quantity and severity of post-operative complications was observed. Conclusion: COVID-19 pandemic and restrictive social measures led to fewer consultations for abdominal pain, resulting in a lower number of AA diagnosed. In addition, a longer delay in seeking medical care was observed, leading to more advanced disease, longer operative time and length of hospital stay.
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149
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Rajput D, Chezhian S, Joshua L, Huda F. The friend turned foe: A rare presentation of bilateral empyema secondary to the perforated appendix. Int J Appl Basic Med Res 2022; 12:140-143. [PMID: 35754667 PMCID: PMC9215184 DOI: 10.4103/ijabmr.ijabmr_533_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
Acute appendicitis is one of the most common surgical emergencies encountered. Although studies have reported a rise in the number of cases over the past decade in Western countries, appendicitis is comparatively lower in Asian countries, mainly due to the prevailing dietary habits. Acute appendicitis can further complicate as either appendicular abscess or an appendicular lump or culminate into peritonitis following gangrene/rupture. Almost one-third of the patients with appendicitis present to the hospital with a ruptured appendix. Management of complicated appendicitis is complex, and the diagnosis itself becomes tricky when it presents unusually. Here, we describe the management of one such rare manifestation in a middle-aged female who had concomitant gangrenous appendicitis and bilateral pyothorax. This case report emphasizes that abdominal pathology can lead to bilateral intrathoracic collection without any preexisting thoracic pathology.
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150
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Zheng Y, Qi S. Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:944405. [PMID: 35859944 PMCID: PMC9289135 DOI: 10.3389/fped.2022.944405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To compare the readmission rate, rate of urgent/unplanned visits to emergency, complication rate along with cost of health care among children and adolescents who were discharged the same day following a laparoscopic appendectomy and those who were not discharged on the same day. METHODS A systematic search was performed in the PubMed, Embase, and Scopus databases. Randomized controlled trials and studies, observational in design, were considered for inclusion. The included studies were conducted in children and adolescents with uncomplicated appendicitis undergoing laparoscopic appendectomy and compared outcomes of interest between patients that were discharged the same day (SDD group) following the operation and patients that were discharged within 2 days post-operatively (non-SSD group). Statistical analysis was performed using STATA software. Effect sizes were reported as pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals. RESULTS A total of 13 studies with 32,021 children and adolescents were included. There was no significant difference in the risks of unplanned visit to the emergency department (OR 1.07, 95% CI: 0.78, 1.47), readmission (OR 0.83, 95% CI: 0.66, 1.05), reoperation/re-intervention (OR 1.73, 95% CI: 0.19, 16.2) and complications (OR 0.84, 95% CI: 0.67, 1.06) in both groups of patients. Patients in the SDD group had slightly lower risk of wound infection/complication (OR 0.74, 95% CI: 0.57, 0.96) compared to patients in the non-SDD group. Those with SDD had to incur comparatively lesser hospital expense (in USD) compared to those with no SDD (WMD -2587.4, 95% CI: -4628.3, -546.6). CONCLUSION In children and adolescents with uncomplicated acute appendicitis undergoing laparoscopic appendectomy, same-day discharge is not associated with increased readmission risk, unplanned visits to emergency, and complications. Further, SDD is associated with lower cost of hospital care. Adoption of SDD in this subset of children and adolescents may be encouraged. SYSTEMATIC REVIEW REGISTRATION [www.crd.york.ac.uk/prospero], identifier [CRD420 22320539].
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Affiliation(s)
- Yifei Zheng
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Shiqin Qi
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
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