151
|
Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312718. [PMID: 34886447 PMCID: PMC8656947 DOI: 10.3390/ijerph182312718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 12/29/2022]
Abstract
The incidence of acute appendicitis decreased in Western countries from 1930 to at least the early 1990s, when epidemiological data started becoming scarcer. This study aimed to assess the trend in annual hospitalizations for acute appendicitis in all people Spain for a 20-year period between 1998 and 2017. This observational study analyzing direct age-standardized hospital admission rates by gender and age group (0–14 years, 15–34 years, 35–44 years, 45–64 years, and ≥65 years). Joinpoint regression models were fitted to evaluate changes in trends. There were 789,533 emergency hospital admissions for acute appendicitis between 1998 and 2017: 58.9% in boys and men and 41.1% in girls and women. Overall, there was a significant increase in admissions for this cause from 1998 to 2009, with an annual percent change (APC) of 0.6%. Following the peak in 2009, admission rates decreased by around 1.0% annually until 2017. The length of hospital stay gradually decreased from 4.5 days in 1998 to 3.4 days in 2017. The trends in hospital admissions for acute appendicitis in Spain changed over the study period, decreasing from 2009, especially in people younger than 35 years.
Collapse
|
152
|
Mitchell J, Yue QY. Appendicitis as a possible safety signal for the COVID-19 vaccines. Vaccine X 2021; 9:100122. [PMID: 34746743 PMCID: PMC8565092 DOI: 10.1016/j.jvacx.2021.100122] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
This study reviewed cases of appendicitis following administration of COVID-19 vaccines reported to VigiBase, the WHO database of individual case safety reports (ICSRs). Three hundred fifty-eight cases were identified, and disproportionate reporting was noted, with 329 calculated expected cases. Upon review, 24 ICSRs were excluded, so 334 unique ICSRs underwent clinical review from 19 countries. Forty-eight percent of ICSRs reported imaging and 69% noted surgical intervention. The cases were clinically coherent, with an apparent increase in reporting in the four days post-vaccination and a possible dose-response relationship. Appendicitis has been suggested as an adverse event of special interest post-vaccination against COVID-19 after a numerical increase in the vaccine arm of a clinical trial. The case series may be affected by differences in global patterns of reporting, and it is not possible to prove nor disprove causality from this case series. Global longitudinal studies are required to clarify any possible relationship.
Collapse
Affiliation(s)
- Joseph Mitchell
- Uppsala Monitoring Centre, Bredgränd 7, Uppsala 753 20, Sweden
| | - Qun-Ying Yue
- Uppsala Monitoring Centre, Bredgränd 7, Uppsala 753 20, Sweden
| |
Collapse
|
153
|
Saggaf M, Novak CB, Baltzer HL, Anastakis DJ. Ontario wait times for delayed surgical treatment of traumatic peripheral nerve injury. Can J Surg 2021; 64:E636-E643. [PMID: 34824152 PMCID: PMC8628844 DOI: 10.1503/cjs.011920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background: To better understand the occurrence and operative treatment of peripheral nerve injury (PNI) and the potential need for additional resources, it is essential to define the frequency and distribution of peripheral nerve procedures being performed. The objective of this study was to evaluate Ontario’s wait times for delayed surgical treatment of traumatic PNI. Methods: We retrieved data on wait times for peripheral nerve surgery from the Ontario Ministry of Health and Long-Term Care Wait Time Information System. We reviewed the wait times for delayed surgical treatment of traumatic PNI among adult patients (age ≥ 18 yr) from April 2009 to March 2018. Data collected included total cases, mean and median wait times, and demographic characteristics. Results: Over the study period, 7313 delayed traumatic PNI operations were reported, with variability in the case volume distribution across Local Health Integration Networks (LHINs). The highest volume of procedures (2788) was performed in the Toronto Central LHIN, and the lowest volume (< 6) in the Waterloo Wellington and North Simcoe Muskoka LHINs. The population incidence of traumatic PNI requiring surgery was 5.1/10 000. The mean and median wait times from surgical decision to surgical repair were 45 and 27 days, respectively. Both the longest and shortest wait times occurred in LHINs with low case volumes. The provincial target wait time was met in 93% of cases, but women waited significantly longer than men (p < 0.001). Conclusion: The provincial distribution of traumatic PNI surgery was variable, and the highest volumes were in the LHINs with large populations. The provincial wait time strategy for traumatic PNI surgery is effective, but women waited longer than men. Precise reporting from all hospitals is necessary to accurately capture and understand the delivery of care after traumatic PNI.
Collapse
Affiliation(s)
- Moaath Saggaf
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| | - Christine B Novak
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| | - Heather L Baltzer
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| | - Dimitri J Anastakis
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| |
Collapse
|
154
|
Eslahi AV, Olfatifar M, Houshmand E, Abdoli A, Bijani B, Hashemipour S, Mahmoudi R, Hajialilo E, Javad Abbaszadeh Afshar M, Mohammadzadeh AR, Badri M. Parasites in surgically removed appendices as a neglected public health concern: a systematic review and meta-analysis. Pathog Glob Health 2021; 116:341-355. [PMID: 34842078 DOI: 10.1080/20477724.2021.2008701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The role of various parasitic infections in the occurrence of appendicitis is illustrated through cases recorded all over the world. The purpose of the current study was to estimate the global prevalence of parasite infestation (other than E. vermicularis) in appendectomy specimens.In the setting of the PRISMA guidelines, multiple databases (Science Direct, Scopus, Web of Science, PubMed, and Google Scholar) were explored in articles published until 28 September 2020. Totally, 62 studies (106 datasets) with 77, 619 participants were included in the analysis.The pooled prevalence of parasites in appendectomy samples was as follows; 0.012% (95% CI; 0.004-0.025) for Ascaris lumbricoides, 0.004% (95% CI; 0.001-0.009) for Trichuris trichiura, 0.025% (95% CI; 0.007-0.052) for Schistosoma mansoni, 0.002% (95% CI; 0.001-0.005) for Taenia spp., 0.061% (95% CI; 0.020-0.122) for Entamoeba histolytica and 0.034% (95% CI; 0.018-0.056) for Giardia lamblia.Our results demonstrated that the risk of appendicitis may increase in the presence of helminth and protozoan infections. As such, the most cases of parasites in appendectomy specimens were reported in developing countries. Regular screening plans for diagnosis, treatment and prevention are needed for prevention of parasitic infection as well as parasitic associated appendicitis, especially in endemic regions of the world.
Collapse
Affiliation(s)
- Aida Vafae Eslahi
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Meysam Olfatifar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Houshmand
- Department of Parasitology, Faculty of Veterinary Medicine, Rasht Branch, Islamic Azad University, Iran
| | - Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Behzad Bijani
- Clinical Research Development Unit, Kosar Hospital, Qazvin University Of Medical Sciences, Qazvin, Iran
| | - Sima Hashemipour
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Razzagh Mahmoudi
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Elham Hajialilo
- Department of Parasitology and Mycology, Qazvin University of Medical Sciences, Qazvin, Iran.,Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Ali Reza Mohammadzadeh
- Clinical Research Development Unit, Qods Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Milad Badri
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|
155
|
Wu J, Li M, Liu Q, Xu X, Lu X, Ma G, Ma C, Zhu X, Wu X, Ren J. Current Practice of Acute Appendicitis Diagnosis and Management in China (PANDA-C): A National Cross-Sectional Survey. Surg Infect (Larchmt) 2021; 22:973-982. [PMID: 34723648 DOI: 10.1089/sur.2021.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The aim of this study was to describe and analyze the current status of the diagnosis and management of acute appendicitis in China. Patients and Methods: An online record system was used to collect data retrospectively from 52 medical centers in mainland China. All patients with acute appendicitis who were first treated at the hospital in 2017 were included and followed up for one year. Propensity score matching (PSM) was used to exclude the potential confounders and analyze the difference in outcomes between the non-operative management (NOM) and surgical groups. Results: A total of 10,187 patients were enrolled, of whom 5,517 (54.2%) were males. A total of 2,056 (20.2%) cases received NOM. The one-year recurrence rate of appendicitis in the NOM group was 19.3%. On PSM analysis, we found that the NOM group had a lower complication rate (2% vs. 4.2%; p = 0.001) and an acceptable success rate (96.8% vs. 100%; p < 0.001) compared with the operative group in patients with non-complicated acute appendicitis. However, in the complicated acute appendicitis population, the in-hospital complication rate in the NOM group was higher (10.8% vs. 5.8%; p = 0.048) and the success rate was lower (95.4% vs. 100%; p < 0.001) than the operative group. The recurrence rate was lower in patients with non-complicated acute appendicitis than in those with complicated acute appendicitis (17.3% vs. 30.8%; p = 0.010). In the operative group, pre-operative antimicrobial prophylaxis-covered anaerobes could reduce the surgical site infection (SSI) rate compared with that in the non-covered anaerobes group in non-complicated patients (0.9% vs. 1.9%; p = 0.020). Conclusions: Appendectomy is currently the most effective treatment for acute appendicitis. However, NOM is an alternative treatment for non-complicated acute appendicitis but not for complicated acute appendicitis because of the lower complication rate, considerable success rate, and recurrence rate.
Collapse
Affiliation(s)
- Jie Wu
- Department of Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.,Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Mengxuan Li
- Department of Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qinjie Liu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Xinjian Xu
- Department of General Surgery, The First Teaching Hospital of Xinjiang Medical University, Wulumuqi, Xinjiang Province, China
| | - Xiuming Lu
- Department of General Surgery, Lu'an People's Hospital, Lu'an, Anhui Province, China
| | - Gang Ma
- Department of Gastrointestinal Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong Province, China
| | - Chi Ma
- Department of Hepatological Surgery, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xiaocheng Zhu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xiuwen Wu
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jianan Ren
- Department of Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.,Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| |
Collapse
|
156
|
Dickinson KJ, Bass BL, Graviss EA, Nguyen DT, Pei KY. Independent Operating by General Surgery Residents: An ACS-NSQIP Analysis. JOURNAL OF SURGICAL EDUCATION 2021; 78:2001-2010. [PMID: 33879397 DOI: 10.1016/j.jsurg.2021.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/15/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Surgical resident autonomy during training is paramount to independent practice. We sought to determine prevalence of general surgery resident autonomy for surgeries commonly performed on emergency general surgery services and identify trends with time. DESIGN We queried ACS-NSQIP for patients undergoing one of 7 emergency general surgery operations. We evaluated trends in independent operating (defined as a resident operating alone, without attending having scrubbed) over the study period. Other outcomes of interest: operative time, 30-day-mortality and complications. SETTING The ACS-NSQIP database. PARTICIPANTS Patients undergoing one of 7 emergency general surgery operations. RESULTS Data regarding resident involvement was only available for the years 2005-2010. 90,790 operations were performed, 922 (1%) by residents operating independently. Appendectomy accounted for 61% independent cases. Independent resident operating was associated with a longer operative time (65 versus 58 minutes, p < 0.001), but lower risk of bleeding requiring transfusion (p < 0.001) and progressive renal insufficiency (p = 0.02). Independent operating was not associated with increased risk of complications/mortality. CONCLUSION Independent resident operating is rare, even with increasing attention to its importance, and is not associated with increased complications or mortality. National data on this subject is old and not currently collected. There is need for a national registry on resident involvement to understand the current effect of independent operating on outcomes.
Collapse
Affiliation(s)
- Karen J Dickinson
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Barbara L Bass
- George Washington University School of Medicine and Health Services, Washington DC
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Kevin Y Pei
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, Indiana
| |
Collapse
|
157
|
Hajibandeh S, Hajibandeh S, Marshall MJ, Smart NJ, Winyard PG, Hyde C, Shaw AM, Daniels IR. Biomarkers for diagnosis of acute appendicitis in adults. Hippokratia 2021. [DOI: 10.1002/14651858.cd011592.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shahab Hajibandeh
- General Surgery; Wales Deanery, Health Education and Improvement Wales; Nantgarw UK
| | - Shahin Hajibandeh
- Department of General Surgery; Sandwell and West Birmingham NHS Trust; West Bromwich UK
| | - Morwena J Marshall
- Exeter Health Services Research Unit; Royal Devon & Exeter NHS Foundation Trust; Exeter UK
| | - Neil J Smart
- Colorectal Surgery; Royal Devon & Exeter NHS Foundation Trust; Exeter UK
| | | | - Chris Hyde
- Exeter Test Group; College of Medicine and Health, University of Exeter Medical School, University of Exeter; Exeter UK
| | - Andrew M Shaw
- Biosciences, College of Life and Environmental Sciences; University of Exeter; Exeter UK
| | - Ian R Daniels
- Colorectal Surgery; Royal Devon & Exeter NHS Foundation Trust; Exeter UK
| |
Collapse
|
158
|
Liu Z, Ma X, Ullah S, Song J, Kong L, Li D, Pan C, Liu B. Endoscopic Retrograde Appendicography: An Alternative Diagnostic Method for Acute Appendicitis. Int J Gen Med 2021; 14:7043-7049. [PMID: 34707395 PMCID: PMC8544128 DOI: 10.2147/ijgm.s336040] [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: 08/25/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of endoscopic retrograde appendicography for the diagnosis of acute appendicitis. Patients and Methods We retrospectively analyzed 33 patients (20 men and 13 women, average age 44±18 years) with suspected acute appendicitis between December 2016 and November 2018. Endoscopic direct-vision imaging or fluoroscopic endoscopic retrograde appendicography was performed to separate suspected acute appendicitis from actual acute appendicitis. The success rate, complications, and recurrence rate were recorded. Results Acute appendicitis was ruled out by normal endoscopic retrograde appendicography in 8 (24%) and confirmed in 23 patients (70%). In 2 patients (6%), appendiceal orifice cannulation failed. Colonoscopic findings in acute appendicitis were mucosal hyperemia and edema of appendiceal orifice (83%), outpouring of pus from the appendiceal orifice (74%), and swollen cecal mucosa (61%). Appendicograpic findings were either normal or in acute disease showed diffuse luminal dilation (diameter: 0.8±0.4 mm), partial stenosis (43%), stiffness or inflexibility (87%) and filling defects (22%). There were no complications during or after follow-up for a median of 13 months (IQR: 9–24 months). Conclusion Endoscopic retrograde appendicography appears to be a reliable and safe method to confirm or exclude the diagnosis of acute appendicitis and prevent unnecessary appendectomy.
Collapse
Affiliation(s)
- Zhenzhen Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiao Ma
- Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Saif Ullah
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jitao Song
- Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Lingjian Kong
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Deliang Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Chao Pan
- Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Bingrong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| |
Collapse
|
159
|
Diagnostic performance of US for suspected appendicitis: Does multi-categorical reporting provide better estimates of disease in adults, and what factors are associated with false or indeterminate results? Eur J Radiol 2021; 144:109992. [PMID: 34634535 DOI: 10.1016/j.ejrad.2021.109992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To identify factors associated with false or indeterminate US result for suspected appendicitis, and assess whether multi-categorical reporting of US yields more precise estimates regarding the probability of appendicitis. METHODS 562 US examinations for suspected appendicitis between May 2013-April 2015 were categorized as true (77/562 true positives or true negatives) or false/indeterminate (485/562 false negatives, false positives or indeterminates) based on results from a prior study. Of 541 examinations with images available retrospectively, a category of A-E was assigned as follows: non-visualized appendix with secondary findings (A) absent or (B) present; appendix visualized and considered (C) negative, (D) equivocal, or (E) positive for appendicitis. The following factors were recorded: age; sex; scan time (daytime vs. off-hours); resident/fellow involvement; abdominal subspecialty radiologist; radiologist experience (>5 years or not); and tenderness on interrogation. Associations between factors and US result were assessed (t-tests, Fisher's exact test and multivariate logistic regression). RESULTS The true group had proportionally more males (18/77 (23.4%) vs. 66/485 (13.6%), p = 0.04) and patients with sonographic tenderness (43/77 (55.8%) vs. 132/353 (27.3%), p < 0.0001). There was no significant difference or association with other factors. On multivariate logistic regression, false/indeterminate results were 1.9 times (95% CIs 1.0-3.5) more likely among females and 3.8 times more likely in the absence of tenderness (95% CIs 2.3-6.4). The proportion of patients with appendicitis in categories A-E was 34/410 (8.3%), 24/44 (54.5%), 0/18 (0%), 0/3 (0%) and 61/66 (92.4%), respectively. CONCLUSIONS Females and absence of tenderness were associated with a false/indeterminate US. Categorical reporting provides more granular estimates of the post-test probability of appendicitis.
Collapse
|
160
|
Nascimento JHFDO, Souza Filho BMDE, Tomaz SC, Vieira ATS, Canedo BF, Andrade ABDE, Gusmão-Cunha A. Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services. Rev Col Bras Cir 2021; 48:e20213010. [PMID: 34644742 PMCID: PMC10683419 DOI: 10.1590/0100-6991e-20213010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.
Collapse
Affiliation(s)
| | | | - Selton Cavalcante Tomaz
- - Universidade do Estado da Bahia (UNEB), Departamento de Ciências da Vida - Salvador - BA - Brasil
| | | | | | - André Bouzas DE Andrade
- - Universidade do Estado da Bahia (UNEB), Departamento de Ciências da Vida - Salvador - BA - Brasil
| | - André Gusmão-Cunha
- - Universidade do Estado da Bahia (UNEB), Departamento de Ciências da Vida - Salvador - BA - Brasil
| |
Collapse
|
161
|
Fikri E, Eyanoer PC. The Determination of Appendicitis from Folate Acid and Vascular Endothelial Growth Factor Level in Animal Model: A Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7069] [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: Appendicitis is one of the most common abdominal emergencies that require surgery in children. The morbidity and mortality rate in appendicitis is greatly affected by rupture or leakage of the appendix. In establishing the diagnosis of appendicitis, several modalities are acknowledged, namely, pediatric appendicitis score and ultrasound. Pathologically, severity and complications of appendicitis occur related to good vascularization and tissue healing process through process of angiogenesis influenced by folic acid (FA) and vascular endothelial growth factor (VEGF). This is clinically important as currently non-operative and non-invasive therapies were developing in stratification of mild appendicitis.
AIM: This study aimed to review the determination of appendicitis from FA and VEGF levels in animal model.
METHODS: This study was conducted in accordance with the PRISMA guidelines for reporting systematic reviews. Articles were reviewed for relation of FA and VEGF in determining appendicitis in PubMed and Science Direct. Articles on experimental animal model published from 1990 to 2020 were included, while articles in English were excluded from the study.
RESULTS: The articles we reviewed conduct an assessment of appendicitis by FA and VEGF level in animal model. Three articles were reviewed ranging from 1990 to 2020. One article presented a significant association of decreased level of FA in determining appendicitis while the other two mentioned trends of decreased level of FA and VEGF in appendicitis without statistically significance.
CONCLUSION: Reduction of folate acid levels could be a critical prescient factor for the weight of muddled an appendicitis in animal model, however, there was a pattern demonstrating low estimation of VEGF as an indicator of appendicitis and convoluted appendix with no measurable note worthiness appeared.
Collapse
|
162
|
Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review. Surg Open Sci 2021; 6:29-39. [PMID: 34604728 PMCID: PMC8473533 DOI: 10.1016/j.sopen.2021.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/31/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Appendectomy is a common emergency surgery performed globally. Despite the frequency of laparoscopic appendectomy, consensus does not exist on the best way to perform each procedural step. We identified literature on key intraoperative steps to inform best technical practice during laparoscopic appendectomy. Methods Research questions were framed using the population, indication, comparison, outcome (PICO) format for 6 key operative steps of laparoscopic appendectomy: abdominal entry, placement of laparoscopic ports, division of mesoappendix, division of appendix, removal of appendix, and fascial closure. These questions were used to build literature queries in PubMed, EMBASE, and the Cochrane Library databases. Evidence quality and certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) definitions. Results Recommendations were rendered for 6 PICO questions based on 28 full length articles. Low quality evidence favors direct trocar insertion for abdominal entry and establishment of pneumoperitoneum. Single port appendectomy results in improved cosmesis with unclear clinical implications. There was insufficient data to determine the optimal method of appendiceal stump closure, but use of a specimen extraction bag reduces rates of superficial surgical site infection and intra-abdominal abscess. Port sites made with radially dilating trocars are less likely to necessitate closure and are less likely to result in port site hernia. When port sites are closed, a closure device should be used. Conclusion Key operative steps of laparoscopic appendectomy have sufficient data to encourage standardized practice.
Collapse
|
163
|
Lapsekili E, Deniz A, Celik SU. Factors associated with postoperative complications following appendectomy in elderly patients. Rev Assoc Med Bras (1992) 2021; 67:1485-1490. [PMID: 35018980 DOI: 10.1590/1806-9282.20210672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 11/22/2022] Open
|
164
|
Composite Criteria for Non-Operative Management of Acute Non-Complicated Appendicitis Result in Low Failure Rates. World J Surg 2021; 46:69-75. [PMID: 34570268 DOI: 10.1007/s00268-021-06330-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study is to investigate the outcomes of conservative management of non-complicated acute appendicitis (AA) using our unique institutional protocol, and to compare between these and the outcomes of operative management. METHODS Patients admitted to our institution between March 2016 and October 2019 with non-complicated AA were grouped according to their initial management: non-operative versus surgical. Our unique protocol for non-operative management includes: pain < 3 days; afebrile upon admission; non-gravid; WBC <15,000 (× 109/L); CRP < 5 mg/dl; appendix diameter < 1 cm; no appendicolith on imaging; no prior episode of AA; no history of Inflammatory Bowel Disease; no evidence of peritonitis on physical examination. The primary outcome measured was failure of non-surgical management during the index admission. Secondary outcomes included recurrence rate, readmissions, complications, length of antibiotic treatment and length of stay (LOS). RESULTS A total of 695 patients were included, 436 in the operative group and 259 in the non-surgical treatment group. The mean follow-up time was 1004.9 ± 205.7 days. Patients initially treated conservatively rarely required surgery during their index admission (6.9%). Recurrence rate was 19.1% after a mean follow up of 33.4 months. The overall failure rate of conservative management was documented in 20.8% of the patients. The complication rate was higher in those treated with upfront surgery (1.6% vs. 0.4%, p < 0.001). The overall LOS was not statistically different between the groups. CONCLUSIONS Our composite protocol for non-surgical management of non-complicated AA results in a low failure rate. A well calculated patient treatment allocation in non-complicated AA can advocate for wide-spread use of the conservative approach.
Collapse
|
165
|
Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics (Basel) 2021; 6:geriatrics6030093. [PMID: 34562994 PMCID: PMC8482159 DOI: 10.3390/geriatrics6030093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
With increased life expectancy and the growing total population of elderly patients, there has been rise in the number of cases of acute appendicitis in elderly people. Although acute appendicitis is not the most typical pathological condition in the elderly, it is not uncommon. Most of these patients require surgical treatment, and as with any acute surgical pathology in advanced age, treatment possibilities are affected by comorbidities, overall health status, and an increased risk of complications. In this literature review we discuss differences in acute appendicitis in the elderly population, with a focus on clinical signs, diagnostics, pathogenesis, treatment, and results.
Collapse
|
166
|
Doleman B, Fonnes S, Lund JN, Boyd-Carson H, Javanmard-Emamghissi H, Moug S, Hollyman M, Tierney G, Tou S, Williams JP. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev 2021. [DOI: 10.1002/14651858.cd015038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Brett Doleman
- Department of Surgery and Anaesthesia; Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham; Derby UK
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery; Herlev Hospital; Herlev Denmark
| | - Jon N Lund
- Division of Health Sciences, School of Medicine; University of Nottingham; Derby UK
| | - Hannah Boyd-Carson
- Department of Surgery; Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham; Derby UK
| | | | - Susan Moug
- Department of Surgery; Royal Alexandra Hospital; Paisley UK
| | - Marianne Hollyman
- Department of General Surgery; Taunton and Somerset NHS Foundation Trust; Taunton UK
| | | | - Samson Tou
- Department of Colorectal Surgery; Royal Derby Hospital; Derby UK
| | - John P Williams
- Department of Surgery and Anaesthesia; Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham; Derby UK
| |
Collapse
|
167
|
Jalava K, Sallinen V, Lampela H, Malmi H, Leppäniemi A, Mentula P. Role of delay and antibiotics on PERForation rate while waiting appendicECTomy (PERFECT): a protocol for a randomized non-inferiority trial. BJS Open 2021; 5:6377141. [PMID: 34580704 PMCID: PMC8477049 DOI: 10.1093/bjsopen/zrab089] [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: 01/04/2021] [Accepted: 08/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background Longer duration from symptom onset is associated with increased risk of perforation in appendicitis. In previous studies, in-hospital delay to surgery has had conflicting effects on perforation rates. Although preoperative antibiotics have been shown to reduce postoperative infections, there are no data showing that administration of antibiotics while waiting for surgery has any benefits. The aims of this study are to evaluate the role of both in-hospital delay to surgery and antibiotic treatment while waiting for surgery on the rate of appendiceal perforation. Methods This prospective, open-label, randomized, controlled non-inferiority trial compares the in-hospital delay to surgery of less than 8 hours versus less than 24 hours in adult patients with predicted uncomplicated acute appendicitis. Additionally, participants are randomized either to receive or not to receive antibiotics while waiting for surgery. The primary study endpoint is the rate of perforated appendicitis discovered during appendicectomy. The aim is to randomize 1800 patients, that is estimated to give a power of 90 per cent (χ2) for the non-inferiority margin of 5 percentage points for both layers (urgency and preoperative antibiotic). Secondary endpoints include length of hospital stay, 30-day complications graded using Clavien–Dindo classification, preoperative pain, conversion rate, histopathological diagnosis and Sunshine Appendicitis Grading System classification. Discussion There are no previous randomized controlled studies for either in-hospital delay or preoperative antibiotic treatment. The trial will yield new level 1 evidence. EU Clinical Trials Register, EudraCT Number: 2019–002348-26; registration number: NCT04378868 (http://www.clinicaltrials.gov)
Collapse
Affiliation(s)
- K Jalava
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - V Sallinen
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Lampela
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Malmi
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Leppäniemi
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mentula
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
168
|
Eamer G, Turnbull V, Robinson T, Alfraih Y, Flageole H. Cost effectiveness of the quality assurance and performance improvement project for suspected appendicitis study. J Pediatr Surg 2021; 56:1528-1535. [PMID: 33131780 DOI: 10.1016/j.jpedsurg.2020.09.006] [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: 05/29/2020] [Revised: 07/20/2020] [Accepted: 09/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Appendicitis is the most common pediatric emergent surgical condition, with 77,000 American pediatric admissions costing $680 million US annually. Diagnosing appendicitis can be challenging. The prospective Quality Assurance and performance improvement project for suspected aPPEndicitis (QAPPE) study implemented a standardized appendicitis assessment pathway. This current study aims to assess the cost-effectiveness of the QAPPE pathway. METHODS QAPPE data (February 2018-January 2019) were compared to retrospective data from the year prior (January-December 2017). Patients aged <18, presenting with suspicion of appendicitis were identified using the emergency department patient database. Patients were excluded if they were transferred from an outside center or if appendicitis was not suspected. Study arms were compared using Student's t-test and assessed with standard costing techniques. The Incremental Cost-Effectiveness Ratio (ICER) was determined. Deterministic and probabilistic sensitivity analyses of the model were performed. Effectiveness was assessed by percent of negative appendectomies where alternate diagnosis was made intraoperatively or histologically. Significance was set at p < 0.05. RESULTS QAPPE (n = 247) and traditional care (n = 234) patients were compared. Traditional care had higher admission frequency and lower pediatric appendicitis score. Demographics between all included patients and those admitted were similar overall. Patient costs were $3656.32 (95% CI $2407-$5250) Canadian (CAD) for QAPPE and $3823.56 (95% CI $2604-$5451) CAD for traditional care. QAPPE was the dominant strategy in the base model and probabilistic simulation found it favored in 64.7% of model iterations with a willingness to pay of $70,000 CAD. CONCLUSION Using the QAPPE pathway to assess patients with suspected appendicitis reduced costs and improved effectiveness of patient care. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Gilgamesh Eamer
- Division of Pediatric General Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Victoria Turnbull
- McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Tessa Robinson
- Division of Pediatric General Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Yasser Alfraih
- Division of Pediatric General Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Helene Flageole
- Division of Pediatric General Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada.
| |
Collapse
|
169
|
Withers N, Hepburn L, Palmer J, Evans F, Mosher J, Dasril J, Liyanage C, Eglinton T, Sakowska MM. Multicentre study of appendicitis management comparing a large South Island metropolitan hospital, to its referring regional and rural centres. ANZ J Surg 2021; 91:2054-2059. [PMID: 34405500 DOI: 10.1111/ans.17125] [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: 02/18/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, patients presenting with acute surgical disease in rural areas have poorer outcomes when compared to urban areas; little data are available regarding outcomes for New Zealand (NZ) rural patients. This study aimed to compare the surgical management of appendicitis in a large metropolitan centre with its regional referral centres. METHODS In this retrospective cohort study, patient data were collated from the studied centres between November 2014 and October 2019. In addition to patient demographics, patterns of referral and presentation, the primary outcome was time to the theatre; secondary outcomes were perforation rates, length of stay and complications. Data are presented as medians (interquartile range). RESULTS A total of 3533 patients underwent appendicectomy over the period studied. For those presenting directly to the metropolitan centre, the median wait-time to the theatre was 16 h (9.2-23.2); if patients were transferred, they waited for 20.8 h (13.6-27). Patients presenting to regional centres waited for 7.6 h (4.5-15.4, P < 0.001). Perforation rates for transferred patients were 31% which was greater than for those presenting to the metropolitan (20%) or regional centres (17%, P = 0.014). Complications were also highest in transferred patients (20%) when compared to the metropolitan (17%) or regional centres (10%, P < 0.001). CONCLUSION Patients who were transferred to Christchurch Hospital from rural centres without surgical services had a longer wait-time than those who presented to Christchurch Hospital directly or were treated in regional centres. This was associated with higher rates of perforated appendicitis.
Collapse
Affiliation(s)
- Nicole Withers
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Lucy Hepburn
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Jethro Palmer
- Department of Surgery, Timaru Hospital, Timaru, New Zealand
| | - Fergus Evans
- Department of Surgery, Grey Base Hospital, Greymouth, New Zealand
| | - Jamie Mosher
- Department of Surgery, Grey Base Hospital, Greymouth, New Zealand
| | - Juni Dasril
- Department of Surgery, Wairau Hospital and Health Centre, Blenheim, New Zealand
| | - Chris Liyanage
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Tim Eglinton
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | | |
Collapse
|
170
|
Li Z, Li Z, Zhao L, Cheng Y, Cheng N, Deng Y. Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2021; 8:CD010168. [PMID: 34402522 PMCID: PMC8407456 DOI: 10.1002/14651858.cd010168.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. MAIN RESULTS Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.
Collapse
Affiliation(s)
- Zhuyin Li
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Li
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Longshuan Zhao
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yilei Deng
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
171
|
The Direct Medical Cost of Acute Appendicitis Surgery in a Resource-Limited Setting of Papua New Guinea. World J Surg 2021; 45:3558-3564. [PMID: 34392400 DOI: 10.1007/s00268-021-06290-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute appendicitis is a common surgical emergency, and challenges in access to surgery in a low middle-income country can direct cost implications. METHODS A prospective cost of illness study was conducted at Alotau Provincial Hospital (APH) from October 14, 2019, to June 1, 2020. A bottom-up approach of microcosting was used to estimate the direct medical cost of consecutive patients with acute appendicitis undergoing surgery. RESULTS The mean cost of acute appendicitis surgery for each patient was K39,517.66 (US$11,460.12) for uncomplicated appendicitis, K45,873.99 (US$13,303.46) for complicated appendicitis and K38,838.80 (US$ 11,263.25) for a normal appendix. In total, the direct medical cost for acute appendicitis in this study was K4,562,625.29 (US$ 1,323,161.33) with the majority of expenditure incurred by surgical ward expenses. CONCLUSION This study demonstrates that direct medical costs for uncomplicated appendicitis surgery in a resource-limited hospital are less expensive. As the pathology progresses, the cost also exponentially increases. Policy makers and clinicians must establish appropriate curative surgical services at secondary (NOM of acute appendicitis and laparoscopic surgery) and primary health-care levels to address acute appendicitis surgery as this can reduce costs.
Collapse
|
172
|
Li Q, Tong Y, Liu S, Yang K, Liu C, Zhang J. Association between body mass index and short-term mortality in patients with intra-abdominal infections: a retrospective, single-centre cohort study using the Medical Information Mart for Intensive Care database. BMJ Open 2021; 11:e046623. [PMID: 34389563 PMCID: PMC8365805 DOI: 10.1136/bmjopen-2020-046623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to determine the relationship between the body mass index (BMI) and short-term mortality of patients with intra-abdominal infection (IAI) using the Medical Information Mart for Intensive Care (MIMIC-III) database. DESIGN Retrospective cohort study. SETTING Adult intensive care units (ICUs) at a tertiary hospital in the USA . PARTICIPANTS Adult IAI ICU patients from 2001 to 2012 in the MIMIC-III database. INTERVENTIONS In univariate analysis, we compared the differences in the characteristics of patients in each BMI group. Cox regression models were used to evaluate the relationships between BMI and short-term prognosis. PRIMARY AND SECONDARY OUTCOME MEASURES 90-day survival. RESULTS In total, 1161 patients with IAI were included. There were 399 (34.4%) patients with a normal BMI (<25 kg/m2), 357 (30.8%) overweight patients (25-30 kg/m2) and 405 (34.9%) obese patients (>30 kg/m2) who tended to be younger (p<0.001) and had higher Sequential Organ Failure Assessment scores (p<0.05). The mortality of obese patients at 90 days was lower than that of patients with a normal BMI (20.74% vs 23.25%, p<0.05), but their length of stay in the ICU was higher (4.9 days vs 3.6 days, p<0.001); however, their rate of mechanical ventilation utilisation was higher (61.48% vs 56.86%, p<0.05). In the Cox regression model, we also confirmed that BMI was a protective factor in patients with IAIs, and the adjusted mortality rate of patients with a higher BMI was 0.97 times lower than that of patients with a lower BMI (p<0.001, HR=0.97, 95% CI 0.96 to 0.99). CONCLUSIONS IAI patients with an overweight or obese status might have lower 90-day mortality than patients with a normal BMI.
Collapse
Affiliation(s)
- Qinglin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yingmu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sinan Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kaibo Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|
173
|
To Scan or Not to Scan: Development of a Clinical Decision Support Tool to Determine if Imaging Would Aid in the Diagnosis of Appendicitis. World J Surg 2021; 45:3056-3064. [PMID: 34370058 DOI: 10.1007/s00268-021-06246-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Appendicitis is one of the most common surgically treated diseases in the world. CT scans are often over-utilized and ordered before a surgeon has evaluated the patient. Our aim was to develop a tool using machine learning (ML) algorithms that would help determine if there would be benefit in obtaining a CT scan prior to surgeon consultation. METHODS Retrospective chart review of 100 randomly selected cases who underwent appendectomy and 100 randomly selected controls was completed. Variables included components of the patient's history, laboratory values, CT readings, and pathology. Pathology was used as the gold standard for appendicitis diagnosis. All variables were then used to build the ML algorithms. Random Forest (RF), Support Vector Machine (SVM), and Bayesian Network Classifiers (BNC) models with and without CT scan results were trained and compared to CT scan results alone and the Alvarado score using area under the Receiver Operator Curve (ROC), sensitivity, and specificity measures as well as calibration indices from 500 bootstrapped samples. RESULTS Among the cases that underwent appendectomy, 88% had pathology-confirmed appendicitis. All the ML algorithms had better sensitivity, specificity, and ROC than the Alvarado score. SVM with and without CT had the best indices and could predict if imaging would aid in appendicitis diagnosis. CONCLUSION This study demonstrated that SVM with and without CT results can be used for selective imaging in the diagnosis of appendicitis. This study serves as the initial step and proof-of-concept to externally validate these results with larger and more diverse patient population.
Collapse
|
174
|
Hansen GL, Kleif J, Jakobsen C, Paerregaard A. Changes in Incidence and Management of Acute Appendicitis in Children-A Population-Based Study in the Period 2000-2015. Eur J Pediatr Surg 2021; 31:347-352. [PMID: 32869225 DOI: 10.1055/s-0040-1714655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. MATERIALS AND METHODS Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. RESULTS A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (-29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. CONCLUSION In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.
Collapse
Affiliation(s)
| | - Jakob Kleif
- Department of Surgery, Hillerød Hospital, Hillerød, Denmark
| | | | | |
Collapse
|
175
|
Ugurlu C, Yildirim M, Ozturk A, Ozcan O, Bostan MS, Yilmaz S. Lymphocyte-to-C-reactive Protein Ratio: a New Biomarker to Predict Perforation in Acute Appendicitis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
176
|
El-Gohary Y, Molina M, Chang J, Dodd A, Miller E, Harrell C, Wang F, Zhang H, Davidoff AM, Fernandez-Pineda I, Murphy AJ, Huang EY. The use of computed tomography versus clinical acumen in diagnosing appendicitis in children: A two-institution international study. J Pediatr Surg 2021; 56:1356-1361. [PMID: 33339568 DOI: 10.1016/j.jpedsurg.2020.09.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Appendicitis in children can be diagnosed utilizing clinical and laboratory findings, with the assistance of ultrasound (US) and/or computed tomography (CT). However, repeated exposure to ionizing radiation increases the lifetime risk of cancer. We compared the work-up of suspected appendicitis between a children's hospital in the United States (USA) and one in Spain to identify differences in imaging use and associated outcomes. METHODS A two-institution retrospective review was performed for surgical consultations of suspected appendicitis from 2015-2017. We compared imaging use, the utilization of overnight observation, and diagnostic accuracy rates between the two centers. RESULTS A total of 1,952 children were evaluated. Among the 1,288 in the USA center, 754(58.5%) underwent CT during their evaluation. The most common imaging modality was US only (39.9%), then CT only (39.3%), CT+US (19.3%), and no imaging (i.e. only clinical acumen) (1.6%). In Spain, only 19 (2.9%) of 664 children underwent CT compared to the USA (p < 0.0001). Only clinical acumen was the most common modality employed (48.6%), followed by US only (48.5%), US+CT (2.4%), and CT only (0.5%). In the USA, 16.8% were observed overnight, 2.3% of whom received no imaging. In Spain, 33.4% were observed overnight, 32.4% of whom had no imaging (p < 0.0001). The accuracy rates for diagnosing appendicitis in the USA and Spain centers were 94.7% and 95.1%, respectively. CONCLUSION Use of clinical acumen and/or US have similar clinical outcomes and similar accuracy rates compared to heavy reliance on CT imaging for diagnosing appendicitis, with associated decrease in radiation exposure. The disparate diagnostic approach of the two centers may reflect that physical examination is a dying art in North America. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Yousef El-Gohary
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA.
| | - Maria Molina
- Department of Pediatric Surgery, Hospital Universitario Virgen Del Rocio, Sevilla, Spain
| | - Jeremy Chang
- College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Ashley Dodd
- College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Emily Miller
- College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Camden Harrell
- Department of Biostatistics, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Biostatistics, Department of Biostatistics, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | | | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Eunice Y Huang
- Division of Pediatric Surgery, Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA..
| |
Collapse
|
177
|
Ariza A, Gaitán L, Marroquín L, Márquez A, Diaz-Castrillón CE, Torregrosa Almonacid L. Fuentes de energía en apendicectomía laparoscópica en un programa académico de Cirugía general en Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La apendicectomía por laparoscopia se considera el patrón de oro en el tratamiento de la apendicitis aguda. Sin embargo, su disponibilidad es limitada en nuestro sistema de salud, principalmente por los costos asociados. El objetivo de este estudio fue evaluar la relación entre el uso de los diferentes tipos de energía y los métodos de ligadura de la base apendicular, con las complicaciones postoperatorias, al igual que describir los costos asociados.
Métodos. Estudio observacional analítico de una cohorte retrospectiva de pacientes mayores de 15 años a quienes se les realizó apendicectomía por laparoscopia, en un hospital universitario entre los años 2014 y 2018. Se utilizaron modelos de regresión logística y lineal para evaluar la relación entre métodos de ligadura del meso y base apendicular, desenlaces operatorios y costos.
Resultados. Se realizaron 2074 apendicectomías por laparoscopia, 58,2 % (n=1207) en mujeres, la edad mediana fue de 32 años. En el 71,5 % (n=1483) la apendicitis aguda no fue complicada. La energía monopolar para la ligadura del meso apendicular fue la utilizada más frecuentemente en 57,2 % (n=1187) y el Hem-o-lok® el más utilizado para la ligadura de la base apendicular en el 84,8 % (n=1759) de los pacientes. No se observaron diferencias estadísticamente significativas en la tasa de infección del sitio operatorio, reintervención o íleo. El uso de energía simple redujo los costos del procedimiento de manera significativa durante el período evaluado.
Discusión. El uso de energía monopolar demostró ser una técnica segura, reproducible y de menor costo en comparación con el uso de energía bipolar, independientemente de la fase de la apendicitis aguda. Lo anterior ha permitido que se realicen más apendicectomías por laparoscopia y que los médicos residentes de cirugía general puedan realizar procedimientos laparoscópicos de forma más temprana.
Collapse
|
178
|
Deodatus JAA, Paas SFE, Wagenvoort GHJ, de Kubber MM. Case report: appendicitis induced Staphylococcus aureus and Klebsiella pneumoniae bacteremia in a young healthy male. Int J Emerg Med 2021; 14:36. [PMID: 34281508 PMCID: PMC8287795 DOI: 10.1186/s12245-021-00358-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Appendicitis is one of the most frequently encountered conditions at the emergency department. Distinction is made between complicated and uncomplicated appendicitis. Complicated appendicitis may cause serious intra-abdominal infection, bacteremia, or sepsis. Emergency health providers should be highly alert to any early signs indicating such complications. Case presentation We present the case of a healthy young male with a gangrenous appendicitis, who received antibiotics and underwent appendectomy. Blood cultures showed unequivocal Staphylococcus aureus and concomitant Klebsiella pneumoniae bacteremia requiring prolonged antibiotic treatment and further diagnostic evaluation. Conclusions Although rare, appendicitis can cause Staphylococcus aureus and Klebsiella pneumoniae bacteremia with extensive implications for workup and antibiotic management. Our case stresses the importance of obtaining cultures in patients with suspicion of bacteremia given its consequences for clinical management.
Collapse
|
179
|
Bracken RL, Harringa JB, Markhardt BK, Kim N, Park JK, Kitchin DR, Robbins JB, Ziemlewicz TJ, Birstler J, Ryan MJ, Hoang L, Pickhardt P, Reeder SB, Repplinger MD. Abdominal fellowship-trained versus generalist radiologist accuracy when interpreting MR and CT for the diagnosis of appendicitis. Eur Radiol 2021; 32:533-541. [PMID: 34268596 PMCID: PMC8665009 DOI: 10.1007/s00330-021-08163-7] [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: 12/13/2020] [Revised: 06/12/2021] [Accepted: 06/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare the diagnostic accuracy of generalist radiologists working in a community setting against abdominal radiologists working in an academic setting for the interpretation of MR when diagnosing acute appendicitis among emergency department patients. METHODS This observational study examined MR image interpretation (non-contrast MR with diffusion-weighted imaging and intravenous contrast-enhanced MR) from a prospectively enrolled cohort at an academic hospital over 18 months. Eligible patients had an abdominopelvic CT ordered to evaluate for appendicitis and were > 11 years old. The reference standard was a combination of surgery and pathology results, phone follow-up, and chart review. Six radiologists blinded to clinical information, three each from community and academic practices, independently interpreted MR and CT images in random order. We calculated test characteristics for both individual and group (consensus) diagnostic accuracy then performed Chi-square tests to identify any differences between the subgroups. RESULTS Analysis included 198 patients (114 women) with a mean age of 31.6 years and an appendicitis prevalence of 32.3%. For generalist radiologists, the sensitivity and specificity (95% confidence interval) were 93.8% (84.6-98.0%) and 88.8% (82.2-93.2%) for MR and 96.9% (88.7-99.8%) and 91.8% (85.8-95.5%) for CT. For fellowship-trained radiologists, the sensitivity and specificity were 96.9% (88.2-99.5%) and 89.6% (82.8-94%) for MR and 98.4% (90.5-99.9%) and 93.3% (87.3-96.7%) for CT. No statistically significant differences were detected between radiologist groups (p = 1.0, p = 0.53, respectively) or when comparing MR to CT (p = 0.21, p = 0.17, respectively). CONCLUSIONS MR is a reliable, radiation-free imaging alternative to CT for the evaluation of appendicitis in community-based generalist radiology practices. KEY POINTS • There was no significant difference in MR image interpretation accuracy between generalist and abdominal fellowship-trained radiologists when evaluating sensitivity (p = 1.0) and specificity (p = 0.53). • There was no significant difference in accuracy comparing MR to CT imaging for diagnosing appendicitis for either sensitivity (p = 0.21) or specificity (p = 0.17). • With experience, generalist radiologists enhanced their MR interpretation accuracy as demonstrated by improved interpretation sensitivity (OR 2.89 CI 1.44-5.77, p = 0.003) and decreased mean interpretation time (5 to 3.89 min).
Collapse
Affiliation(s)
- Rebecca L Bracken
- BerbeeWalsh Department of Emergency Medicine, University of
Wisconsin-Madison, Madison, WI, USA
| | - John B Harringa
- BerbeeWalsh Department of Emergency Medicine, University of
Wisconsin-Madison, Madison, WI, USA
| | - B Keegan Markhardt
- Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA.,Department of Radiology, UnityPoint Health Meriter,
Madison, WI, USA
| | - Newrhee Kim
- Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA.,Department of Radiology, UnityPoint Health Meriter,
Madison, WI, USA
| | - John K Park
- Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA.,Department of Radiology, UnityPoint Health Meriter,
Madison, WI, USA
| | - Douglas R Kitchin
- Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA.,Madison Radiologists, Madison, WI, USA
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA
| | | | - Jen Birstler
- Department of Biostatistics & Medical Informatics,
University of Wisconsin-Madison, Madison, WI, USA
| | - Michael J Ryan
- BerbeeWalsh Department of Emergency Medicine, University of
Wisconsin-Madison, Madison, WI, USA
| | - Ly Hoang
- BerbeeWalsh Department of Emergency Medicine, University of
Wisconsin-Madison, Madison, WI, USA
| | - Perry Pickhardt
- Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA
| | - Scott B Reeder
- BerbeeWalsh Department of Emergency Medicine, University of
Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA
| | - Michael D Repplinger
- BerbeeWalsh Department of Emergency Medicine, University of
Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison,
Madison, WI, USA
| |
Collapse
|
180
|
Hannan E, El-Masry S. The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review. Ir J Med Sci 2021; 191:1361-1367. [PMID: 34247309 PMCID: PMC9135865 DOI: 10.1007/s11845-021-02706-z] [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: 03/21/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Background Acute surgical assessment units (ASAUs) aim to optimise management of surgical patients compared to the traditional ‘on-call’ emergency department (ED) system. Acute appendicitis (AA) is the most common acute surgical condition requiring emergency surgery. Aim We set out to assess if the ASAU improved care provided to patients with AA compared to those managed through the ED. Methods Patients admitted via the ED with AA in the 6 months prior to opening the ASAU were compared to those admitted via the ASAU in the first six months following its implementation. Relevant data was collected on key performance indicators from their charts. Results In the ASAU cohort, the mean time to be seen was one hour less than the ED cohort (21 min vs 74 min). The mean time to surgery was also 8.8 h shorter. Most patients in the ASAU group (78.6%) underwent surgery during the day, compared to 40.3% of ED patients. The ASAU patients also had a lower postoperative complication rate (0.9% vs 3.9%), as well as a lower negative appendicectomy rate (14.2% vs 18.6%) and lower conversion-to-open surgery rate. Greater consultant supervision and presence was observed. Conclusions The ASAU has resulted in better outcomes for patients with AA than those admitted via ED. More operations were performed in safer daytime hours with greater consultant presence, allowing for improved senior support for trainee surgeons. Our study supports the role of the ASAU in improving the quality and efficiency of emergency general surgery.
Collapse
Affiliation(s)
- Enda Hannan
- Department of Surgery, Our Lady of Lourdes Hospital Drogheda, 109 Howth Road, Howth, Dublin 13, Ireland.
| | - Sherif El-Masry
- Department of Surgery, Our Lady of Lourdes Hospital Drogheda, 109 Howth Road, Howth, Dublin 13, Ireland
| |
Collapse
|
181
|
Koumu MI, Jawhari A, Alghamdi SA, Hejazi MS, Alturaif AH, Aldaqal SM. Surgical Site Infection Post-appendectomy in a Tertiary Hospital, Jeddah, Saudi Arabia. Cureus 2021; 13:e16187. [PMID: 34367794 PMCID: PMC8336621 DOI: 10.7759/cureus.16187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Appendectomy considered at the top of emergency surgical procedures worldwide, and surgical site infection (SSI) is not an uncommon complication postoperatively. Many factors may be contributed to SSI occurrence; either during preoperative, intraoperative, or postoperative periods. No recent studies focusing on SSI post-appendectomy and the related factors in our region. So, we aim to find the prevalence and detect the factors that may lead to SSI in post-appendectomy patients at King Abdulaziz University Hospital (KAUH) between 2013 and 2017. METHODS This is a retrospective chart review study. Data were collected by data collection sheet from (KAUH) patient's database, as we include: patients' demographics, blood investigations, operation details, co-morbidities, and hospitalization time. All patients who underwent appendectomy between 2013 and 2017 were included. We used frequencies, Mann-Whitney U test, and binary logistic regression tests for data analysis. RESULT SSI post-appendectomy was found in 31 patients out of 433. SSI was statistically significant related more with an open technique of appendectomy (p=0.0001), longer duration of the surgery (p=0.0001), perforated type of appendicitis (p=0.002), more hospitalization time (p=0.0004), postoperative lab results of high WBC count (p=0.004), and low albumin (p=0.011). Other factors including demographics and clinical characteristics, intraoperative, perioperative, and hemoglobin level showed no significant relations. CONCLUSION Controlling the high rate of SSI by using the optimal technique of approach, decreasing the duration of the surgery, and early intervention may help more in reducing SSI post-appendectomy. Taking into consideration the other perioperative factors will lead to better outcomes for the patients.
Collapse
Affiliation(s)
| | | | | | | | - Ali H Alturaif
- College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Saleh M Aldaqal
- General Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| |
Collapse
|
182
|
Bowen JM, Sheen JRC, Whitmore H, Wright C, Bowling K. Acute appendicitis in the COVID-19 era: A complicated situation? Ann Med Surg (Lond) 2021; 67:102536. [PMID: 34230852 PMCID: PMC8252704 DOI: 10.1016/j.amsu.2021.102536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/29/2022] Open
Abstract
Acute appendicitis is the most common intra-abdominal surgical emergency in the world. Null hypothesis of no difference in the number of cases of complicated appendicitis. What impact did the government's ‘Stay at Home’ message have? Increasing body of evidence to support non-operative treatment in certain cases. A significantly higher rate of complicated cases found in the COVID era.
Collapse
Affiliation(s)
- Joel M Bowen
- Specialty Trainee Department of Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Jonathon R C Sheen
- Specialty Trainee Department of Trauma & Orthopaedics, Torbay and South Devon NHS Foundation Trust, UK
| | - Helen Whitmore
- Specialty Trainee Department of Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Chloe Wright
- Trust Doctor Department of General Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Kirk Bowling
- Consultant Department of Upper G.I. Surgery, Torbay and South Devon NHS Foundation Trust, UK
| |
Collapse
|
183
|
Mann E, Swedien D, Hansen J, Peterson S, Saheed M, Klein E, Munjuluru A, Scheulen J, Kelen G. Reduction in Emergency Department Presentations in a Regional Health System during the Covid-19 Pandemic. West J Emerg Med 2021; 22:842-850. [PMID: 35354014 PMCID: PMC8328168 DOI: 10.5811/westjem.2020.10.49759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Nationally, there has been more than a 40% decrease in Emergency Department (ED) patient volume during the coronavirus disease 2019 (Covid-19) crisis, with reports of decreases in presentations of time-sensitive acute illnesses. We analyzed ED clinical presentations in a Maryland/District of Columbia regional hospital system while health mitigation measures were instituted. METHODS We conducted a retrospective observational cohort study of all adult ED patients presenting to five Johns Hopkins Health System (JHHS) hospitals comparing visits from March 16 through May 15, in 2019 and 2020. We analyzed de-identified demographic information, clinical conditions, and ICD-10 diagnosis codes for year-over-year comparisons. RESULTS There were 36.7% fewer JHHS ED visits in 2020 compared to 2019 (43,088 vs. 27,293, P<.001). Patients 75+ had the greatest decline in visits (-44.00%, P<.001). Both genders had significant decreases in volume (-41.9%, P<.001 females vs -30.6%, P<.001 males). Influenza like illness (ILI) symptoms increased year-over-year including fever (640 to 1253, 95.8%, P<.001) and shortness of breath (2504 to 2726, 8.9%, P=.002). ICD-10 diagnoses for a number of time-sensitive illnesses decreased including deep vein thrombosis (101 to 39, -61%, P<.001), acute myocardial infarction (157 to 105, -33%, P=.002), gastrointestinal bleeding (290 to 179, -38.3%, P<.001), and strokes (284 to 234, -17.6%, P=0.03). CONCLUSION ED visits declined significantly among JHHS hospitals despite offsetting increases in ILI complaints. Decreases in presentations of time-sensitive illnesses were of particular concern. Efforts should be taken to inform patients that EDs are safe, otherwise preventable morbidity and mortality will remain a problem.
Collapse
Affiliation(s)
- Edana Mann
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Daniel Swedien
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Jonathan Hansen
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Susan Peterson
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
| | - Mustapha Saheed
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Eili Klein
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Ajit Munjuluru
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - James Scheulen
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Gabor Kelen
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins Office of Critical Care Event Preparedness and Response, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
| |
Collapse
|
184
|
Oh SJ, Pimentel M, Leite GGS, Celly S, Villanueva-Millan MJ, Lacsina I, Chuang B, Parodi G, Morales W, Weitsman S, Singer-Englar T, Barlow GM, Zhai J, Pichestshote N, Rezaie A, Mathur R, Pimentel M. Acute appendicitis is associated with appendiceal microbiome changes including elevated Campylobacter jejuni levels. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000412. [PMID: 32499276 PMCID: PMC7279619 DOI: 10.1136/bmjgast-2020-000412] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To compare the appendiceal microbiomes and examine the prevalence of Campylobacter species in the appendices of adult subjects with confirmed acute non-perforated appendicitis and controls with healthy appendices. DESIGN Archived samples of formalin-fixed paraffin-embedded appendiceal tissues were obtained from 50 consecutive female subjects who underwent appendectomy for acute, non-perforated appendicitis, and 35 consecutive female controls who underwent incidental appendectomy during gynaecological surgery. RESULTS 16S rRNA gene sequencing revealed that the relative abundances (RAs) of the major phyla in appendiceal tissues (Firmicutes, Proteobacteria, Bacteroidetes, and Actinobacteria) were similar in both groups. Beta diversity was significantly different due to differences in Bacteroidetes and Proteobacteria (p<0.0001). Within Proteobacteria, RAs of classes Alphaproteobacteria (~21%, fold change (FC)=1.31, false discovery rate (FDR) p value=0.03) and Epsilonproteobacteria (~1%, FC=0.25, FDR p value>0.05) were increased in acute appendicitis samples. RAs of unknown genera from families Burkholderiaceae and Enterobacteriaceae were decreased in appendicitis samples, and 14 genera were increased, including Neisseria, Acinetobacter and Campylobacter. Quantitative PCR revealed that levels of Campylobacter jejuni DNA, but not other Campylobacter species or pathogens tested, were significantly higher in appendicitis samples than in controls (p=0.013). Using a cut-off of 0.31 pg/µL, 40% of appendicitis cases and 6% of controls were positive for C. jejuni, indicating specificity of 93.7% (95% Cl 79.2 to 99.2), sensitivity of 40.9% (95% Cl 24.7 to 54.5), and OR of 10.38 (Fisher's p value=0.0006, 95% Cl 2.3 to 47.4). CONCLUSIONS Our findings indicate that Campylobacter jejuni may be a significant cause of acute appendicitis. This supports earlier studies and suggests that targeted antibiotic therapies could be an alternative treatment for a subset of non-complicated acute appendicitis cases.
Collapse
Affiliation(s)
- Sun Jung Oh
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maya Pimentel
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gabriela G S Leite
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shreya Celly
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maria Jesus Villanueva-Millan
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Isabela Lacsina
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan Chuang
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gonzalo Parodi
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Walter Morales
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stacy Weitsman
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tahli Singer-Englar
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gillian M Barlow
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jing Zhai
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nipaporn Pichestshote
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ali Rezaie
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ruchi Mathur
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Pimentel
- Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA .,Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
185
|
Gebre Selassie H, Tekle Selassie H, Ashebir D. Pattern and Outcome of Acute Appendicitis: Observational Prospective Study from a Teaching Hospital, Addis Ababa, Ethiopia. Open Access Emerg Med 2021; 13:265-271. [PMID: 34188562 PMCID: PMC8235934 DOI: 10.2147/oaem.s315228] [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: 04/19/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acute appendicitis is the most common cause of acute abdomen surgery. Despite its commonness and the abundance of literature on the subject, its diagnosis remains challenging. Delay in intervention results in complications of the process leading to increased morbidity and mortality. Methodology An observational prospective cohort study was conducted, and all patients who had undergone appendectomy for a clinical diagnosis of appendicitis were included in the study. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23. Results Half of the study participants were in the age range of 18–25 years with male preponderance (63.9%). The mean duration of symptoms was 51.3 hours. The most common presenting symptom was abdominal pain (98.2%), while right lower quadrant tenderness was the most common sign (93.4%). Abdominal ultrasound was done in 81% of the study population with a sensitivity and specificity of 95.7% and 33.3%, respectively. Three-quarters (74.4%) of the patients had uncomplicated appendicitis, while 1.8% had a grossly normal appendix. None of the appendectomy specimens were sent for pathology. The mean hospital stay was 3.2 days. The morbidity and mortality rate were 3.8% and 0.4%, respectively. Conclusion Acute appendicitis was the most common emergency surgical procedure in the study period. Abdominal ultrasound was used in the majority of the patients as supplementary imaging for the diagnosis of acute appendicitis. Uncomplicated appendicitis took the major share of the intraoperative finding leading to acceptable morbidity and mortality rates.
Collapse
Affiliation(s)
- Hana Gebre Selassie
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Henok Tekle Selassie
- Department of Surgery, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Daniel Ashebir
- Department of Surgery, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| |
Collapse
|
186
|
Stöß C, Nitsche U, Neumann PA, Kehl V, Wilhelm D, Busse R, Friess H, Nimptsch U. Acute Appendicitis: Trends in Surgical Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:244-249. [PMID: 34114553 DOI: 10.3238/arztebl.m2021.0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/17/2020] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendectomy is the gold standard for treatment of acute appendicitis. However, recent studies favor primary antibiotic therapy. The aim of this observational study was to explore changes in the numbers of operations for acute appendicitis in the period 2010-2017, paying special attention to disease severity. METHODS Data from diagnosis-related group statistics were used to analyze the trends, mortality, and complication rates in the surgical treatment of appendicitis in Germany between 2010 and 2017. All cases of appendectomy after a diagnosis of appendicitis were included. RESULTS Altogether, 865 688 inpatient cases were analyzed. The number of appendectomies went down by 9,8%, from 113 614 in 2010 to 102 464 in 2017, while the incidence fell from 139/100 000 in 2010 to 123/100 000 in 2017 (standardized by age group). This decrease is due to the lower number of operations for uncomplicated appendicitis (79 906 in 2017 versus 93 135 in 2010). Hospital mortality decreased both in patients who underwent surgical treatment of complicated appendicitis (0.62% in 2010 versus 0.42% in 2017) and in those with a complicated clinical course (5.4% in 2010 versus 3.4% in 2017). CONCLUSION Decisions on the treatment of acute appendicitis in German hospitals follow the current trend towards non-surgical management in selected patients. At the same time, the care of acute appendicitis has improved with regard to overall hospital morbidity and hospital mortality.
Collapse
Affiliation(s)
- Christian Stöß
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of MunichMünchner Studienzentrum, Klinikum rechts der Isar, School of Medicine,Technical University ofMunichDepartment of Health Care Management, Institute of Technology and Management, TechnischeUniversität Berlin
| | | | | | | | | | | | | | | |
Collapse
|
187
|
Degrate L, Chiappetta MF, Nigro A, Fattori L, Perrone S, Garancini M, Romano F, Braga M. The uncharted severity of complications after appendectomy for acute appendicitis in children: results from 348 consecutive patients. Updates Surg 2021; 74:667-673. [PMID: 34095965 DOI: 10.1007/s13304-021-01101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
Appendectomy is the most frequently performed emergent procedure in paediatric patients. However, there is a wide heterogeneity in outcome definitions and, conversely, a lack of information about complications' severity. This study aims to analyse the outcome of children operated for acute appendicitis, with reference to complications' severity grading. This is a retrospective analysis of a prospectively collected database including all children who underwent emergent appendectomy between September 2013 and March 2020. Postoperative complications were defined according to standardized definitions and graded following Clavien-Dindo classification (CDC). The outcome was analysed in terms of postoperative morbidity, severity of complications, hospital readmission and length of hospital stay (LOS). 348 patients were analysed. Postoperative complications occurred in 18 (5.2%) patients; superficial and organ/space surgical site infections represented the most frequent complications (1.7% and 2.9%, respectively). Major complications (CDC ≥ IIIa) were seen in 4 (1.1%) patients. Median postoperative LOS was 4 (iqr 3-5) days, while hospital readmission was 1.1%. Postoperative complications, preoperative C-reactive protein values and presence of drainage were significantly associated with longer LOS at multivariate analysis. No difference in incidence and severity of complications was found in relation to children's adolescent age. Major complications among paediatric patients undergoing appendectomy for acute appendicitis in a general surgery department are rare. The application of standardized definitions and severity-based grading of complications is crucial for outcome analysis: our results are a useful reference for comparison between forthcoming studies.
Collapse
Affiliation(s)
- Luca Degrate
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
| | | | - Alice Nigro
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Luca Fattori
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Stefano Perrone
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Braga
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
188
|
Skjold-Odegaard B, Ersdal HL, Assmus J, Nedrebo BSO, Sjo O, Soreide K. Development and clinical implementation of a structured, simulation-based training programme in laparoscopic appendectomy: description, validation and evaluation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:517-523. [PMID: 35520958 PMCID: PMC8936767 DOI: 10.1136/bmjstel-2020-000728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 01/22/2023]
Abstract
Background Laparoscopic appendectomy is a common procedure in general surgery but is likely underused in structured and real-life teaching. This study describes the development, validation and evaluation of implementing a structured training programme for laparoscopic appendectomy. Study design A structured curriculum and simulation-based programme for trainees and trainers was developed. All general surgery trainees and trainers were involved in laparoscopic appendectomies. All trainees and trainers underwent the structured preprocedure training programme before real-life surgery evaluation. A standardised form evaluated eight technical steps (skills) of the procedure as well as an overall assessment, and nine elements of communication (feedback), and was used for bilateral evaluation by each trainee and trainer. A consecutive, observational cohort over a 12-month period was used to gauge real-life implementation. Results During 277 eligible real-life appendectomies, structured evaluation was performed in 173 (62%) laparoscopic appendectomies, for which 165 forms were completed by 19 trainees. Construct validity was found satisfactory. Inter-rater reliability demonstrated good correlation between trainee and trainer. The trainees’ and trainers’ stepwise and overall assessments of technical skills had an overall good reliability (intraclass correlation coefficient of 0.88). The vast majority (92.2%) of the trainees either agreed or strongly agreed that the training met their expectations. Conclusion Structured training for general surgery residents can be implemented for laparoscopic appendectomy. Skills assessment by trainees and trainers indicated reliable self-assessment. Overall, the trainees were satisfied with the training, including the feedback from the trainers.
Collapse
Affiliation(s)
- Benedicte Skjold-Odegaard
- Gastrointestinal Surgery, Haugesund Hospital, Haugesund, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Jörg Assmus
- Center for Clinical research, Haukeland University Hospital, Bergen, Norway
| | | | - Ole Sjo
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Hordaland, Norway
| |
Collapse
|
189
|
Song MY, Ullah S, Yang HY, Ahmed MR, Saleh AA, Liu BR. Long-term effects of appendectomy in humans: is it the optimal management of appendicitis? Expert Rev Gastroenterol Hepatol 2021; 15:657-664. [PMID: 33350352 DOI: 10.1080/17474124.2021.1868298] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Appendectomy remains the gold standard for treating uncomplicated and complicated appendicitis. However, the vermiform appendix may play a significant role in the immune system (secondary immune function) and maintain a reservoir of the normal microbiome for the human body. The aim of this study was to summarize the long-term effects after appendectomy and discuss whether appendectomy is suitable for all appendicitis patients. AREAS COVERED A comprehensive and unbiased literature search was performed in PubMed. The terms 'appendix,' 'appendicitis,' 'appendectomy,' and 'endoscopic retrograde appendicitis therapy' were searched in the title and/or abstract. This review summarizes the long-term effects of appendectomy on some diseases in humans and describes three methods including appendectomy, medical treatment, and an 'organ-sparing' technique, named endoscopic retrograde appendicitis therapy (ERAT) to treat appendicitis. EXPERT OPINION Appendectomy remains the first-line therapy for appendicitis. The patient's problem is appendix, not appendicitis. If we treat appendicitis, the problem should be resolved. During COVID-19, an initial antibiotic treatment of mild appendicitis represents a promising strategy. For patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment, or ERAT could be proposed.
Collapse
Affiliation(s)
- Ming-Yang Song
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,The Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui-Yu Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Md Robin Ahmed
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
190
|
Tian Y, Ingram MCE, Hall M, Raval MV. ICD-10 Transition Influences Trends in Perforated Appendix Admission Rate. J Surg Res 2021; 266:345-351. [PMID: 34077864 DOI: 10.1016/j.jss.2021.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/27/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study sought to evaluate the influence of International Classification of Diseases, Tenth Revision (ICD-10) transition on Perforated Appendix Admission Rate (PAAR), which is a commonly used indicator representing access to care developed by Agency for Healthcare Research and Quality (AHRQ). MATERIALS AND METHODS In this interrupted time series study of Pediatric Health Information System database from 2013 to 2018, we employed three study phases (pre-implementation, washout, and initial implementation) to evaluate the influence of ICD-10 transition on trends in PAAR. ICD-10 diagnosis codes suggested by AHRQ's specifications were used to identify perforated and simple appendicitis, and PAAR was estimated accordingly. Generalized linear mixed models were used to examine the association of ICD-10 initial implementation and being documented as perforated appendicitis on encounter level. RESULTS We identified a total of 94,810 encounters diagnosed with appendicitis, and almost all patients' characteristics were similar over the three study phases, except for PAAR. The pre-implementation PAAR in October 2013 was 33.1%, and the immediate influence of ICD-10 transition on PAAR was 3.2% (P = 0.002), with a 0.38% per quarter increase over time (P = 0.02). After adjusting for age, gender, race/ethnicity, payer, and year, the likelihood of being documented as having perforated appendicitis in 2016 was 1.5 times higher than the estimated likelihood before the implementation (adjusted Odds Ratio: 1.51; 95% Confidence Interval: 1.40-1.63; P < 0.001). CONCLUSIONS The 2015-2018 ICD-10 transition may be erroneously associated with an increasing trend of PAAR. Care should be taken when interpreting the metric during this period.
Collapse
Affiliation(s)
- Yao Tian
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Martha-Conley E Ingram
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois 60611
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Mehul V Raval
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois 60611.
| |
Collapse
|
191
|
Abramov R, Neymark M, Harbi A, Gilshtein H. Laparoscopic Appendectomy in the Days of COVID-19. Surg Laparosc Endosc Percutan Tech 2021; 31:599-602. [PMID: 34049368 DOI: 10.1097/sle.0000000000000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute appendicitis is one of the most common emergencies treated by general surgeons. The treatment of choice in the majority of cases is laparoscopic appendectomy. In the era of the COVID-19 pandemic, there is a concern for a delayed referral of patients and thus a more advanced presentation of the disease leading to a prolonged and complicated course. METHODS Retrospective review of a computerized database of patients who were admitted with acute appendicitis and underwent laparoscopic appendectomy during the COVID pandemic in a single tertiary center in Israel. Patients were compared with those who were admitted and operated for appendicitis in the same period in the previous year. RESULTS One hundred twenty-three patients underwent laparoscopic appendectomy in the study period in 2020, compared with 109 who had surgery in 2019. During the COVID pandemic 41 patients presented with complicated appendicitis versus 22 patients in 2019 (P=0.0174). The placement of peritoneal drains was more prevalent during the pandemic, 5.5% versus 11.4%, and the use of stapler device for appendicular stump closure (P=0.0105). CONCLUSIONS During the first stage of the COVID-19 pandemic, there was a significant increase in the rate of complicated appendicitis. Patients should be strongly encouraged not to refrain from medical treatment and go to the emergency room with the persistence of symptoms.
Collapse
Affiliation(s)
| | | | - Asaf Harbi
- Department of General Surgery
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - Hayim Gilshtein
- Department of General Surgery
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
192
|
Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: A meta-analysis. Ann Med Surg (Lond) 2021; 66:102448. [PMID: 34136215 PMCID: PMC8181186 DOI: 10.1016/j.amsu.2021.102448] [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: 04/14/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Acute appendicitis is one of the most common surgical emergencies worldwide. Clinical scoring system systems have been developed to diagnose acute appendicitis, but insufficient to predict the complication. The amount of serum biomarkers elevates in response to acute inflammation, which could be beneficial for diagnostic tools. Accordingly, a meta-analysis was conducted to evaluate the efficacy of platelet indices, including mean platelet volume (MVP) and platelet distribution width (PDW) as potential biomarkers for the diagnosis of a diagnosis of acute appendicitis. Material and methods The dataset was defined by searching for articles published until December 2020 from PubMed, EMBASE, Google Scholar and the Cochrane database. The meta-analysis was performed using Review Manager Software version 5.4.1. Results The final analysis was made from 9 studies, including 3124 patients. The results demonstrated that lower MPV values was significantly associated with acute appendicitis (odds ratio (OR) = 0.81, 95% confidence interval (CI) = −1.51 to −0.11, P = 0.02), but not associated with complicated appendicitis by comparing it with the control (OR = −0.13,95% CI = −0.33 to −0.07, P = 0.19) and non-complicated appendicitis groups (OR = −0.13,95% CI = −0.30 to −0.04, P = 0.14). The present study failed to demonstrate the diagnostic value of PDW for the prediction of appendicitis and its complication. Conclusion The results of the meta-analysis strongly indicate that a lower MVP values could function as a marker for predicting the acute appendicitis. Platelet play an important role in the response to systemic inflammation and sepsis. Inflammatory process activated platelets destruction consequence in the release of small platelets into bloodstream. This studycompared the association between the platelet indices and the diagnosis of acute appendicitis. Lower mean platelet volume(MVP) is a significant diagnostic marker for acute appendicitis.
Collapse
|
193
|
Das MK. Association of meteorological parameters with intussusception in children aged under 2 years: results from a multisite bidirectional surveillance over 7 years in India. BMJ Open 2021; 11:e043687. [PMID: 34035093 PMCID: PMC8154980 DOI: 10.1136/bmjopen-2020-043687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations. DESIGN A bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017. SETTING At 20 hospitals in India, retrospective case record review during July 2010 and March 2016 and prospective surveillance during April 2016 and September 2017 were performed. PARTICIPANTS 2161 children aged 2-24 months with first intussusception episode were included. INTERVENTIONS The monthly mean meteorological parameters (temperature, sunshine, rainfall, humidity and wind speed) for the study sites were collected. METHODS The association between monthly intussusception cases and meteorological parameters was examined at pooled, regional and site levels using Pearson (r) and Spearman's rank-order (ρ) correlation, factorial analysis of variance, and Poisson regression or negative binomial regression analyses. RESULTS The intussusception cases were highest in summer and lowest in autumn seasons. Pearson correlation analysis showed that temperature (r=0.056; p<0.05), wind speed (r=0.134; p<0.01) and humidity (r=0.075; p<0.01) were associated with monthly intussusception cases. Spearman's rank-order correlation analysis found that temperature (ρ=0.049; p<0.05), wind speed (ρ=0.096; p<0.01) and sunshine (ρ=0.051; p<0.05) were associated with monthly intussusception cases. Poisson regression analysis resulted that monthly intussusception case was associated with rising temperature (North region, p<0.01 and East region, p<0.05), sunshine (North region, p<0.01), humidity (East region, p<0.01) and wind speed (East region, p<0.01). Factorial analysis of variance revealed a significant seasonal difference in intussusception cases for pooled level (p<0.05), 2-6 months age group (p<0.05) and North region (p<0.01). Significant differences in intussusception cases between summer and autumn seasons were observed for pooled (p<0.01), children aged 2-6 months (p<0.05) and 7-12 months (p<0.05). CONCLUSIONS Significant correlations between intussusception cases and temperature, humidity, and wind speed were observed at pooled and regional level in India. A peak in summer months was noted, which may be used for prediction, early detection and referral for appropriate management of intussusception.
Collapse
|
194
|
Song H, Lee S, Park JH, Kim HY, Min HD, Jeon JJ, Lee KH. Can Patient Triaging with Clinical Scoring Systems Reduce CT Use in Adolescents and Young Adults Suspected of Having Appendicitis? Radiology 2021; 300:350-358. [PMID: 34003054 DOI: 10.1148/radiol.2021203884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background There are ongoing efforts to reduce CT radiation exposure for the diagnosis of appendicitis. Recent guidelines recommend using clinical scoring systems to triage patients who need imaging examinations. Purpose To determine whether patient triaging with scoring systems can reduce CT use without a loss of diagnostic accuracy in adolescents and young adults suspected of having appendicitis. Materials and Methods This retrospective study used data from a previous multicenter randomized controlled trial conducted between December 2013 and August 2016. Five scoring systems (adult appendicitis, appendicitis inflammatory response, modified Alvarado, Broek, and Christian scores) were used to categorize patients into low-, intermediate-, or high-probability groups. CT use was simulated for only the intermediate-probability group. The primary outcomes were CT reduction rate, sensitivity, and specificity. The CT reduction rate was defined as the proportion of patients in low- and high-probability groups who would not have to undergo CT among all patients. Sensitivity and specificity were calculated in the overall diagnostic pathway using each scoring system and subsequent CT. As a secondary analysis, to maintain the diagnostic accuracy to a level of when CT was used for all patients with suspected appendicitis, new cutoff values for probability group stratification targeting 97.6% sensitivity and 94.9% specificity were applied for each of the scoring systems. Results A total of 2888 patients (mean age ± standard deviation, 28 years ± 9; 1580 women and 1308 men) with suspected appendicitis were evaluated, of whom 1088 had and 1800 did not have appendicitis. The CT reduction rates of the five scoring systems ranged from 55.6% (1606 of 2888 patients) to 71.1% (2053 of 2888), but at the cost of sensitivity (range, 48.7% [530 of 1088] to 81.2% [883 of 1088]) and specificity (range, 79.0% [1422 of 1800] to 97.8% [1761 of 1800]). Targeting 97.6% sensitivity and 94.9% specificity, the CT reduction rates of all five scoring systems were 0% (0 of 2888). Conclusion Using clinical scoring systems in triaging patients for selective CT use led to a considerable loss of diagnostic accuracy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mellnick in this issue.
Collapse
Affiliation(s)
- Hyunjoo Song
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Seungjae Lee
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Ji Hoon Park
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Hae Young Kim
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Hooney Daniel Min
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Jong-June Jeon
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Kyoung Ho Lee
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | -
- From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| |
Collapse
|
195
|
Eshagh Hoseini SJ, Vahedian M, Sharifi A. Comparing the Accuracy of Ohmann and Alvarado Scoring Systems in Detection of Acute Appendicitis; a Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e37. [PMID: 34223182 PMCID: PMC8221549 DOI: 10.22037/aaem.v9i1.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Alvarado Scoring System (ASS) and Ohmann Scoring System (OSS) are two scoring systems for diagnosing acute appendicitis (AA). This study was designed to compare the diagnostic accuracy of the two mentioned scores in detection of acute abdominal cases at risk for AA. Methods: In this prospective cross-sectional study, patients admitted to the emergency departments of two academic hospitals in Qom, Iran, with right lower quadrant (RLQ) abdominal pain suspected to AA were evaluated. All cases were scored using ASS and OSS, and screening performance characteristics of the two scores were calculated and reported considering the pathologic findings as a gold standard. Results: 174 patients with a preliminary AA diagnosis and the mean age of 38.1 ± 10.63 years (11- 73) were included in this study (62.07% male). At the optimal cutoff point of ≥7 for the ASS, the sensitivity and the specificity were 46.43% (95% CI: 37.97%-55.07%), 97.05% (95% CI: 84.67%-92.93%), respectively. At the optimal cutoff point of ≥11 for the OSS, the sensitivity and the specificity were 74.29% (95% CI: 66.22%-81.29%), and 55.88% (95% CI: 37.89% - 72.82%), respectively. Conclusion: Based on the finding of this study, the ASS ≥ 7 was more accurate than the OSS ≥ 11 for detection of AA. But it should be considered that the overall accuracy of Alvarado and Ohmann scores in this regard were fair (0.83) and poor (0.67), respectively.
Collapse
Affiliation(s)
- Seyed Jalal Eshagh Hoseini
- Department of Surgery, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Vahedian
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Sharifi
- Student research committee, Qom University of Medical Sciences, Qom, Iran
| |
Collapse
|
196
|
Skendelas JP, Alemany VS, Au V, Rao D, McNelis J, Kim PK. Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age. BMC Surg 2021; 21:228. [PMID: 33934697 PMCID: PMC8088755 DOI: 10.1186/s12893-021-01224-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 02/20/2023] Open
Abstract
Background Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.
Collapse
Affiliation(s)
- John P Skendelas
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Vincent Au
- Jacobi Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Devika Rao
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - John McNelis
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter K Kim
- Jacobi Medical Center, Bronx, NY, USA. .,North Central Bronx Hospital, Bronx, NY, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA. .,Jacobi Medical Center, 1400 Pelham Parkway, Building 1, Room 510, Bronx, NY, 10461, USA.
| |
Collapse
|
197
|
Surgical Diseases are Common and Complicated for Criminal Justice Involved Populations. J Surg Res 2021; 265:27-32. [PMID: 33872846 DOI: 10.1016/j.jss.2021.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND At any given time, almost 2 million individuals are in prisons or jails in the United States. Incarceration status has been associated with disproportionate rates of cancer and infectious diseases. However, little is known about the burden emergency general surgery (EGS) in criminal justice involved (CJI) populations. MATERIALS AND METHODS The California Office of Statewide Health Planning and Development (OSHPD) database was used to evaluate all hospital admissions with common EGS diagnoses in CJI persons from 2012-2014. The population of CJI individuals in California was determined using United States Bureau of Justice Statistics data. Primary outcomes were rates of admission and procedures for five common EGS diagnoses, while the secondary outcome was probability of complex presentation. RESULTS A total of 4,345 admissions for CJI patients with EGS diagnoses were identified. The largest percentage of EGS admissions were with peptic ulcer disease (41.0%), followed by gallbladder disease (27.5%), small bowel obstruction (14.0%), appendicitis (13.8%), and diverticulitis (10.5%). CJI patients had variable probabilities of receipt of surgery depending on condition, ranging from 6.2% to 90.7%. 5.6% to 21.0% of admissions presented with complicated disease, the highest being with peptic ulcer disease and appendicitis. CONCLUSION Admissions with EGS diagnoses were common and comparable to previously published rates of disease in general population. CJI individuals had high rates of complicated presentation, but low rates of surgical intervention. More granular evaluation of the burden and management of these common, morbid, and costly surgical diagnoses is essential for ensuring timely and quality care delivery for this vulnerable population.
Collapse
|
198
|
Diagnostic performance and radiation dose of reduced vs. standard scan range abdominopelvic CT for evaluation of appendicitis. Eur Radiol 2021; 31:7817-7826. [PMID: 33856521 DOI: 10.1007/s00330-021-07945-3] [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: 12/24/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the diagnostic performance and radiation dose of reduced vs. standard scan range CT in diagnosing appendicitis. METHODS We retrospectively evaluated 531 consecutive adults who underwent emergency contrast-enhanced CT for abdominal pain or suspected appendicitis between July 2018 and March 2019. One hundred eighty-one young adults (mean age, 26 ± 6 years) were imaged from L2 to the symphysis pubis (reduced protocol). A total of 350 older patients (mean age, 55 ± 17 years) and those with a wider differential diagnosis were imaged from the diaphragm to the ischium (standard protocol). The reference standard was histopathology (surgical cases) or 3 months of medical record follow-up (nonsurgical cases). Sensitivity, specificity, and accuracy were calculated. Mean dose-length products (DLP) were compared (t-test). Using an anthropomorphic phantom, organ doses were measured on CT scanners with (scanner 1) and without (scanner 2) automatic voltage selection; effective radiation doses were calculated. RESULTS The frequency of appendicitis was 57/181 (31.5%) and 80/350 (22.9%) in the reduced and standard groups, respectively. Results of the reduced and standard protocols respectively were as follows (95% CI in parentheses): sensitivity, 98.2% (90.4-99.9%) and 100.0 (95.3-100.0%); specificity, 99.2% (95.6-100.0%) and 99.6% (97.9-100.0%); accuracy, 97.8% and 97.4%; mean DLPs, 363 ± 191mGy∙cm and 633 ± 591mGy∙cm (p < 0.0001). Phantom-based measurements of effective dose were 47% lower on scanner 1 (4.64 vs. 2.48 mSv) and 26% lower on scanner 2 (4.68 vs. 3.45 mSv) with the reduced protocol. CONCLUSION For young adults with clinically suspected appendicitis, a reduced scan range CT protocol is as sensitive, specific, and accurate as a standard scan range CT and imparts significantly less radiation dose. KEY POINTS • A reduced scan range CT protocol in young adults with high suspicion of appendicitis demonstrates similar diagnostic performance as a full-range abdominopelvic CT in undifferentiated adult patients. • The reduced scan range CT protocol imparts significantly less radiation dose: 57% based on dose-length product data and 26-47% based on anthropomorphic phantom data.
Collapse
|
199
|
Ceresoli M, Coccolini F, Magnone S, Lucianetti A, Bisagni P, Armao T, Ansaloni L, Zago M, Chiarugi M, Catena F, Braga M. The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic. Eur J Trauma Emerg Surg 2021; 47:1359-1365. [PMID: 33844036 PMCID: PMC8040760 DOI: 10.1007/s00068-021-01663-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Background During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment. Methods This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March–April 2020) compared with the same period of the previous 2 years (2018–2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded. Results The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411–0.648 p < 0.001) during the 2020 lockdown. The number of complicated acute appendicitis did not change (− 18%, OR 0.763 95% CI 0.517–1.124 p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (− 56%, OR 0.424 95% CI 0.319–0.564 p < 0.001). Non-operative treatment rate remained similar (12.1% vs. 11.6% p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006). Conclusions The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change. Trial registration: NCT04649996.
Collapse
Affiliation(s)
- Marco Ceresoli
- General and Emergency Surgery Dept, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy.
| | - Federico Coccolini
- Emergency Surgery and Trauma Center Dept, Pisa University Hospital, Pisa, Italy
| | - Stefano Magnone
- General and Emergency Surgery Dept, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Pietro Bisagni
- General and Emergency Surgery Dept, ASST Lodi, Lodi, Italy
| | - Teodora Armao
- General and Emergency Surgery Dept, ASST Lodi, Lodi, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Dept, IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Mauro Zago
- Robotic and Emergency Surgery Dept, ASST Lecco, Ospedale Manzoni, Lecco, Italy
| | - Massimo Chiarugi
- Emergency Surgery and Trauma Center Dept, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Emergency Surgery Dept, Parma University Hospital, Parma, Italy
| | - Marco Braga
- General and Emergency Surgery Dept, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy
| | | |
Collapse
|
200
|
Vaziri M, Nafissi N, Jahangiri F, Nasiri M. Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children. J Med Life 2021; 14:75-80. [PMID: 33767789 PMCID: PMC7982267 DOI: 10.25122/jml-2020-0031] [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: 12/01/2022] Open
Abstract
Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient’s score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.
Collapse
Affiliation(s)
- Mohammad Vaziri
- Department of Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Nafissi
- Department of Breast Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Jahangiri
- Department of Pediatric Surgery, Ali-Asghar children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasiri
- Department of Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|