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Adams SE, Perera MRS, Fung S, Maxton J, Karpelowsky J. Non-operative management of uncomplicated appendicitis in children: a randomized, controlled, non-inferiority study evaluating safety and efficacy. ANZ J Surg 2024. [PMID: 38873960 DOI: 10.1111/ans.19119] [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: 06/12/2022] [Revised: 03/29/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Appendicitis is the commonest paediatric surgical emergency. Adult studies suggest non-operative management (NOM) may have a place in care. There have been no adequately powered randomized controlled trials in children. OBJECTIVE to determine the safety and efficacy of NOM for paediatric simple appendicitis. METHODS A non-inferiority randomized controlled trial was conducted comparing operative (OM) to NOM of SA in children aged five-15 years. Primary outcome was treatment success (no unplanned or unnecessary operation, or complication) at 30 days and 12 months, with a non-inferiority margin of 15%. (anzctr.org.au: ACTRN12616000788471). RESULTS From 11 June 2016 to 30 November 2020, 222 children were randomized: 94 (42.34%) to OM and 128 (57.66%) to NOM. Non-inferiority of NOM was not demonstrated at either time point, with 45.67% of NOM patients subsequently undergoing operation. There was no significant difference in complications. CONCLUSIONS While noninferiority was not shown, NOM was safe, with no difference in adverse outcomes between the two groups. Further research to refine the place of NOM of simple appendicitis in children is required, including nuanced patient selection, longer term evaluation, the place of choice, and the acceptability of the treatment for children and their carers.
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Affiliation(s)
- Susan Elizabeth Adams
- Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Meegodage Roshell Swindri Perera
- Discipline of Paediatrics, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Saskia Fung
- Discipline of Paediatrics, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jordon Maxton
- Discipline of Paediatrics, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Karpelowsky
- Discipline of Paediatrics, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Paediatric Surgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Laverde BLB, Maak M, Langheinrich M, Kersting S, Denz A, Krautz C, Weber GF, Grützmann R, Brunner M. Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections. Langenbecks Arch Surg 2024; 409:180. [PMID: 38850459 PMCID: PMC11162365 DOI: 10.1007/s00423-024-03367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis. MATERIALS AND METHODS In this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed. RESULTS The two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4-21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2-29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4-20.0), p = 0.016) were identified as independent risk factors for wound infections. CONCLUSION The duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred.
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Affiliation(s)
- Bruno Leonardo Bancke Laverde
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Matthias Maak
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Melanie Langheinrich
- Department of General, Visceral, Thoracic and Vascular Surgery, University Greifswald, Ferdinand- Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Stephan Kersting
- Department of General, Visceral, Thoracic and Vascular Surgery, University Greifswald, Ferdinand- Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Axel Denz
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Christian Krautz
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Georg F Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.
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Liang X, Gu F, Wu S, Zhu Z, Yu M. Introducing the ratio of cross diameters of the appendix for ultrasound diagnosis of acute appendicitis can significantly increase specificity. Abdom Radiol (NY) 2024:10.1007/s00261-024-04402-9. [PMID: 38832943 DOI: 10.1007/s00261-024-04402-9] [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: 03/31/2024] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To validate whether the introduction of the ratio of the cross diameters on the transverse section of the appendix (RATIO) ≤ 1.18 is useful for improving the ultrasound diagnosis of acute appendicitis (AA). METHODS Data from 220 patients with AA and 110 patients with a normal appendix were retrospectively studied. The RATIO ≤ 1.18, maximal outer diameter (MOD) > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm were used for predicting AA. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. RESULTS The RATIO ≤ 1.18, MOD > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm for predicting AA showed a sensitivity of 90, 100, and 90%; specificity of 79.1, 27.3, and 88.2%; and AUC of 0.845, 0.636, and 0.891, respectively. When comparing the outcomes between MOD > 6 mm and a combination of MOD > 6 mm and RATIO ≤ 1.18, the specificity and PPV increased from 27.3 to 88.2% and 73.3 to 93.8%, respectively (all P < 0.0001). The sensitivity and NPV decreased from 100 to 90% and 100 to 81.5%, respectively (all P < 0.0001). The AUC increased from 0.636 to 0.891 (P < 0.0001). When comparing the AUC of MOD > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm for predicting AA with the AUC in a previous study, there were no significant differences between each other (all P > 0.05). CONCLUSION Introducing the RATIO ≤ 1.18 for the evaluation of AA can improve the diagnostic performance and significantly increase specificity.
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Affiliation(s)
- Xian Liang
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No.31, Longhua Road, Haikou, 570102, China
| | - Fengwa Gu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No.31, Longhua Road, Haikou, 570102, China
| | - Size Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No.31, Longhua Road, Haikou, 570102, China.
| | - Zhixian Zhu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No.31, Longhua Road, Haikou, 570102, China
| | - Mingxing Yu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No.31, Longhua Road, Haikou, 570102, China
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Bayleyegn NS, Zelelew AN, Sisay AL. Evaluation of clinical profiles, surgical experience and outcomes of ileosigmoid knotting in low-resource setup: A retrospective cohort study at Jimma University Medical Center. World J Surg 2024; 48:1331-1347. [PMID: 38526512 DOI: 10.1002/wjs.12155] [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: 11/26/2023] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. It poses significant morbidity and mortality in both high-income and low-to-middle-income countries. Ileosigmoid knotting is a special form of obstruction where the small bowel often ileum wraps around the sigmoid colon or vice versa. It is the severest form of bowel obstruction, involving both the small and large bowels in a compound manner. It is common where sigmoid volvulus is common and geographic areas with a bulky diet. METHODS An institution-based retrospective cohort study was employed among purposively selected 40 surgical patients with ileosigmoid knotting records from July 2020 to July 2023 at Jimma University Medical Center. To estimate and compare the survival probabilities, the Kaplan-Meir method and log-rank test were used. A Cox-regression analysis was fitted to identify independent predictors of time to death. RESULTS Among a cohort of 40 patients followed for 347 person-days at Jimma University Medical Center, 11 (27.5%) had died. The overall incidence rate of death was 3.2 (95% CI 1.8, 5.7) per 100 person-days. In multivariable Cox-regression analysis, age (AHR = 1.15; 95% CI: 1.04-1.28), shock at presentation (AHR = 30.50: 95% CI 1.25-742.54), comorbidities (AHR = 5.81; 95% CI 1.19-28.23), pulse rate intraoperatively (AHR = 1.19; 95% CI: 1.01-1.40), postoperative pulse rate (AHR = 1.07; 95% CI: 1.01-1.14) were independently associated with time to death. CONCLUSION The incidence of death among surgical patients with ileosigmoid knotting was high and also had a shorter median survival time. Age, shock at presentation, comorbidities, pulse rate intraoperatively, and postoperative pulse rate were found to be statistically significant predictors of time to death and outcome among surgical patients with Ileosigmoid knotting.
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Affiliation(s)
- Nebiyou Simegnew Bayleyegn
- Department of Surgery, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abebe Nega Zelelew
- Department of Statistics, College of Natural Science, Jimma University, Jimma, Ethiopia
| | - Assefa Legesse Sisay
- Department of Epidemiology, Institute of Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Fu G, Xu Z, Zhang S. Navigating appendicitis care during the Covid-19 pandemic: a retrospective cohort study in China. BMC Surg 2024; 24:166. [PMID: 38807152 PMCID: PMC11131191 DOI: 10.1186/s12893-024-02466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR testing mandates for medical treatment seekers were introduced to mitigate virus transmission. AIMS This study examines the impact of these changes on the management of patients with appendicitis. METHODS We conducted a retrospective analysis of medical records for 748 patients diagnosed with appendicitis who underwent surgery at a tertiary care hospital during two distinct periods, the pre-pandemic year 2019 and the post-pandemic year 2021. Patient demographics, clinical characteristics, laboratory data, surgical outcomes, and hospital stay duration were assessed. RESULTS While no significant differences were observed in the general characteristics of patients between the two groups, the time from hospital visit to operation increased significantly during the pandemic. Unexpectedly, delayed surgical intervention was associated with shorter hospital stays but did not directly impact complication rates. There was no discernible variation in the type of surgery or surgical timing based on symptom onset. The pandemic also prompted an increase in appendicitis cases, potentially related to coronavirus protein expression within the appendix. CONCLUSIONS The COVID-19 pandemic has reshaped the landscape of appendicitis management. This study underscores the complex interplay of factors, including changes in hospital protocols, patient concerns, and surgical timing. Further research is needed to explore the potential link between COVID-19 and appendicitis. These insights are valuable for informing healthcare practices during and beyond the pandemic.
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Affiliation(s)
- Guang Fu
- The First Affiliated Hospital, Department of Gastrointestinal Surgery Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Zishun Xu
- The First Affiliated Hospital, Department of Gastrointestinal Surgery Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Shao Zhang
- The First Affiliated Hospital, Department of Gastrointestinal Surgery Hengyang Medical School, University of South China, Hengyang, 421001, China.
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Dahiya DS, Akram H, Goyal A, Khan AM, Shahnoor S, Hassan KM, Gangwani MK, Ali H, Pinnam BSM, Alsakarneh S, Canakis A, Sheikh AB, Chandan S, Sohail AH. Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review. J Clin Med 2024; 13:3034. [PMID: 38892745 PMCID: PMC11172822 DOI: 10.3390/jcm13113034] [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: 04/21/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8-12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.
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Affiliation(s)
- Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Hamzah Akram
- Department of Internal Medicine, Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | - Abdul Moiz Khan
- Department of Internal Medicine, Ayub Medical College, Abbottabad 22020, Pakistan
| | - Syeda Shahnoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Khawaja M. Hassan
- Department of Internal Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Manesh Kumar Gangwani
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Hassam Ali
- Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC 27858, USA
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico, Albuquerque, NM 87131, USA
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Casas MA, Monrabal Lezama M, Schlottmann F. Medical and surgical treatment of acute appendicitis: Past, present and future. Curr Probl Surg 2024; 61:101458. [PMID: 38704174 DOI: 10.1016/j.cpsurg.2024.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Maria A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina; Department of Surgery, University of Illinois at Chicago, Chicago, IL.
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Yap DRY, Lui RN, Samol J, Ngeow J, Sung JJ, Wong SH. Beyond a vestigial organ: effects of the appendix on gut microbiome and colorectal cancer. J Gastroenterol Hepatol 2024; 39:826-835. [PMID: 38303116 DOI: 10.1111/jgh.16497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
The role of appendectomy in the pathogenesis of colorectal cancer (CRC) is a recent topic of contention. Given that appendectomy remains one of the most commonly performed operations and a first-line management strategy of acute appendicitis, it is inherently crucial to elucidate the association between prior appendectomy and subsequent development of CRC, as there may be long-term health repercussions. In this review, we summarize the data behind the relationship of CRC in post-appendectomy patients, discuss the role of the microbiome in relation to appendectomy and CRC pathogenesis, and provide an appraisal of our current understanding of the function of the appendix. We seek to piece together the current landscape surrounding the microbiome and immunological changes in the colon post-appendectomy and suggest a direction for future research involving molecular, transcriptomic, and immunologic analysis to complement our current understanding of the alterations in gut microbiome.
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Affiliation(s)
- Daniel Ren Yi Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rashid N Lui
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Faculty of Medicine, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Clinical Oncology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jens Samol
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Medical Oncology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
- Johns Hospital University, Baltimore, Maryland, USA
| | - Joanne Ngeow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Cancer Centre Singapore, Singapore Health Services, Singapore, Singapore
| | - Joseph Jy Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - Sunny H Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
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Stolarski Ł, Zawada T, Tokarczyk W, Patrzałek P. Unusual Acute Appendicitis Complicated by Sepsis, Evisceration, and Ileostomy: A Case Report. Cureus 2024; 16:e60360. [PMID: 38883094 PMCID: PMC11177243 DOI: 10.7759/cureus.60360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Acute appendicitis stands as a prevalent cause necessitating surgical intervention globally, predominantly affecting young adults and children, with notably lower incidence among the elderly. Timely diagnosis facilitates effective management, mitigating the risk of severe complications. In this report, we present the case of a 59-year-old patient whose delayed diagnosis and consequently delayed surgical treatment led to serious complications. After the appendectomy, the patient, due to developing sepsis, was transferred to the intensive care unit. On the seventh postoperative day, complications were found in the form of wound dehiscence along with perforation of the jejunum. The second surgery involved a classic laparotomy, encompassing partial resection of the small intestine, and the creation of a single-barrel ileostomy. Further conservative treatment was implemented, and drainage of the abscess was performed. After treatment in the ICU, the patient was transferred to the surgical ward for further treatment. During the hospital stay, further conservative treatment was implemented, resulting in the improvement of the patient's general condition and resolution of symptoms. The patient was discharged home in optimal general condition with recommendations. After six months, the patient was brought to the surgical ward for reconstructive surgery to reestablish gastrointestinal continuity, which was carried out successfully.
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Affiliation(s)
| | - Tomasz Zawada
- Intensive Care Unit, District Hospital in Rawicz, Rawicz, POL
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Abdul Rahim K, Shaikh NQ, Lakhdir MPA, Afzal N, Merchant AAH, Mahmood SBZ, Bakhshi SK, Ali M, Samad Z, Haider AH. No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes. Trauma Surg Acute Care Open 2024; 9:e001165. [PMID: 38616789 PMCID: PMC11015297 DOI: 10.1136/tsaco-2023-001165] [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: 04/26/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians. Methods Data of patients aged >60 years with EGS conditions defined by the American Association for the Surgery of Trauma at primary index admission from 2010 to 2019 operated and non-operated at a large South Asian tertiary care hospital were analyzed. The primary outcome was primary index admission inpatient 30-day mortality. Parametric survival regression using Weibull distribution was performed. Factors such as patients' insurance status and surgical intervention were assessed using adjusted HR and 95% CI with a p-value of <0.05 considered statistically significant. Results We included 9551 primary index admissions of patients diagnosed with the nine most common primary EGS conditions. The mean patient age was 69.55±7.59 years. Overall mortality and complication rates were 3.94% and 42.29%, respectively. Primary index admission inpatient mortality was associated with complications including cardiac arrest and septic shock. Multivariable survival analysis showed that insurance status was not associated with mortality (HR 1.13; 95% CI 0.79, 1.61) after adjusting for other variables. The odds of developing complications among self-paid individuals were higher (adjusted OR 1.17; 95% CI 1.02, 1.35). Conclusion Lack of healthcare coverage for older adults can result in delayed presentation, leading to increased morbidity. Close attention should be paid to such patients for timely provision of treatment. There is a need to expand primary care access and proper management of comorbidities for overall patient well-being. Government initiatives for expanding insurance coverage for older population can further enhance their healthcare access, mitigating the risk of essential treatments being withheld due to financial limitations. Level of evidence III.
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Affiliation(s)
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
| | - Noreen Afzal
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Adil H Haider
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
- Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
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Takeda K, Yamada T, Uehara K, Matsuda A, Shinji S, Yokoyama Y, Takahashi G, Iwai T, Kuriyama S, Miyasaka T, Kanaka S, Yoshida H. The benefits of interval appendectomy and risk factors for nonoperative management failure in the therapeutic strategy for complicated appendicitis. Surg Today 2024:10.1007/s00595-024-02842-w. [PMID: 38598170 DOI: 10.1007/s00595-024-02842-w] [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: 12/07/2023] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Emergency surgery (ES) for complicated appendicitis (CA) is associated with high morbidity. Interval appendectomy (IA) decreases this rate; however, nonoperative management (NOM) is not always successful. Some patients require unplanned ES due to NOM failure (IA failure: IA-F). This study aimed to verify the benefits of IA and to evaluate the risk factors for NOM failure. METHODS Patients diagnosed with CA who underwent surgery between January 2012 and December 2021 were included in this study. We compared the surgical outcomes of the ES group with those of the IA success (IA-S) and IA-F groups. We also analyzed 14 factors that predicted NOM failure. RESULTS Among 302 patients, the rate of severe complications (Clavien-Dindo grade ≥ III) was significantly higher in the ES group (N = 165) than in the IA-S group (N = 102). The rates were equal between the ES (N = 165) and IA-F (N = 35) groups. NOM was successful in 110 patients and failed in 27. Lack of abscesses, comorbidities, high WBC count, and free air were independent risk factors for NOM failure. CONCLUSIONS Considering the benefits of IA and the non-inferior surgical outcomes of IA-F compared to ES, IA is a good therapeutic strategy for CA. However, in patients exhibiting four independent risk factors for NOM failure, careful monitoring of unplanned ES is necessary.
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Affiliation(s)
- Kohki Takeda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kay Uehara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yasuyuki Yokoyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Goro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Takuma Iwai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Toshimitsu Miyasaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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12
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Gal M, Maya P, Ofer K, Mansoor K, Benyamine A, Boris K. Acute Appendicitis in the Elderly: A Nationwide Retrospective Analysis. J Clin Med 2024; 13:2139. [PMID: 38610904 PMCID: PMC11012554 DOI: 10.3390/jcm13072139] [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: 01/28/2024] [Revised: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities. Methods: This retrospective study analyzed data from the American National Inpatient Sample between 2016 and 2019 to compare AA characteristics in patients younger and older than 60 years. Results: Of the 538,400 patients included, 27.5% were older than 60 years. Younger patients had a higher appendectomy rate (p < 0.01), while the complicated appendicitis rate was higher in older patients. Superficial wound infection, systemic infection, and mortality rates were higher in older patients (p < 0.01). Risk factors for superficial wound infection in patients younger than 60 years included cerebrovascular disease, chronic kidney disease, hypertension, heart failure, and obesity, whereas only heart failure was a risk factor in older patients. Risk factors for systemic infection in young patients included hypertension, heart failure, obesity, and diabetes mellitus, while in older patients they included hypertension, heart failure, and obesity. Complicated appendicitis was not a risk factor for infections in either group. Conclusions: This study highlights a higher incidence of AA in older individuals than previously reported, with comorbidities posing differing risks for infections between age groups.
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Affiliation(s)
- Malkiely Gal
- Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Paran Maya
- Department of Pediatric and Adolescent Surgery, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
| | - Kobo Ofer
- Division of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Khan Mansoor
- Department of Major Trauma, Hull University Teaching Hospitals, Hull HU3 2JZ, UK
| | - Abbou Benyamine
- Hospital Administration Hillel Yaffe Medical Center, Hadera 38100, Israel;
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
| | - Kessel Boris
- Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
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13
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Agnesi S, Mauro Di Lucca G, Benedetti F, Fattori L, Degrate L, Roccamatisi L, Braga M, Ceresoli M. Effect of in-hospital delay on acute appendicitis severity: does time really matter? Updates Surg 2024:10.1007/s13304-024-01823-5. [PMID: 38565830 DOI: 10.1007/s13304-024-01823-5] [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: 09/13/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Patients were grouped into low, medium, and high preoperative risk for acute appendicitis based on the Alvarado scoring system. Appendicitis was defined as complicated in cases of perforation, abscess, or diffuse peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. The study includes 804 patients: 278 (30.4%) had complicated appendicitis and median time delay to surgery in low-, medium-, and high-risk group was 23.15 h (13.51-31.48), 18.47 h (10.44-29.42), and 13.04 (8.13-24.10) h, respectively. In-hospital delay was not associated with the severity of appendicitis or with the presence of postoperative complications. It appears reasonably safe to delay appendicectomy for acute appendicitis up to 24 h from hospital admission. Duration of symptoms was a predictor of complicated appendicitis and morbidity. Timing for appendicectomy in acute appendicitis should be calculated from symptoms onset rather than hospital presentation.
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Affiliation(s)
- Stefano Agnesi
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Gabriele Mauro Di Lucca
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Fabio Benedetti
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Luca Fattori
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Luca Degrate
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Linda Roccamatisi
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Marco Braga
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Marco Ceresoli
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy.
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14
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Layrisse Landaeta V, Dincheva GR, Hong JS, Kim A, Verzani Z, Yuan V, Zhang C, Chao SY. Acute Appendicitis in the Epicenter of the COVID-19 Pandemic: A New York City Single-Center Experience. Am Surg 2024; 90:780-787. [PMID: 37915247 DOI: 10.1177/00031348231204909] [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] [Indexed: 11/03/2023]
Abstract
BACKGROUND Appendectomy is the gold standard for simple appendicitis. During the coronavirus-19 pandemic, it was estimated that appendectomies in the United States decreased by 24%. We aimed to describe trends in acute appendicitis management at a center located in one of the largest epicenters of the pandemic. METHODS This is a retrospective cohort study in a single institution located in Queens, New York, of patients who presented with acute appendicitis. A pre-COVID time period, March-June 2019, was compared to peak-COVID, March-June 2020, and late-COVID, March-June 2021. RESULTS Of the 382 patients admitted with appendicitis during the time periods, 164 were admitted pre-COVID. Appendicitis presentations decreased by 44% during peak-COVID and 23% in late-COVID. Patients were younger during peak-COVID compared to pre-COVID (39 vs 34 years old, P = .036). Incidence of complicated appendicitis in pre-, peak-, and late-COVID was equivalent (41% vs 46% vs 45%) and operative management was similar (85% vs 76% vs 79%). Non-operative patients had shorter lengths of stay (pre- vs peak-COVID: 4.6 vs 2.9 days, P = .006). Readmission rates were similar between the cohorts across time periods. CONCLUSIONS During peak-COVID, there was a significant decrease in presentation of acute appendicitis but clinical presentation and outcomes remained similar between the cohorts. Patients who were managed non-operatively may be discharged earlier without increased rates of readmissions.
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Affiliation(s)
| | | | - Julie S Hong
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Angelina Kim
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Zoe Verzani
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Victoria Yuan
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Charles Zhang
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Steven Y Chao
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
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15
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Taib AG, Kler A, Prayle M, Kanakalingam D, Fani M, Asaad P. Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study. Ann R Coll Surg Engl 2024; 106:237-244. [PMID: 37609681 PMCID: PMC10904264 DOI: 10.1308/rcsann.2023.0055] [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] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Evidence suggests that delaying an appendicectomy for up to 24 hours does not increase the risk of complicated appendicitis. Appendicoliths are a risk factor for perforation. No study has explored the temporal relationship between appendicolith presence and time to perforation. In this retrospective cohort study, we hypothesise that the presence of an appendicolith confirmed on preoperative computerised tomography scan (pCT) leads to a shorter time to complicated appendicitis. METHODS We undertook a retrospective single-centre study of patients admitted between 2018 and 2020. Inclusion criteria included: age ≥18 years, appendicitis confirmed on histopathology following an operation and a pCT scan. Complicated appendicitis was defined intraoperatively as an appendicular abscess, gangrenous or perforated appendix. RESULTS Some 310 patients were included in the study. Forty-five per cent presented with complicated appendicitis (n = 138). Appendicoliths were present in 79 (25.5%) patients. Multivariate logistic regression identified an appendicolith as a significant risk factor for perforation (odds ratio 3.50, 95% confidence interval [CI] 1.16-10.59; p = 0.027). Within the first 12 hours of admission, patients with an appendicolith accounted for a significantly greater proportion of those with complicated appendicitis intraoperatively compared with those without (56.7% vs 43.3%, respectively; p = 0.003). Within 12 hours of admission, those with an appendicolith were 2.05 times more likely to suffer from complicated appendicitis than those without (95% CI 1.28-3.29). CONCLUSIONS Patients with an appendicolith appendicitis should be considered for an early appendicectomy. Future large-scale multicentre prospective studies are required to explore this further, perhaps informing future guidelines.
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Affiliation(s)
| | | | - M Prayle
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
| | - D Kanakalingam
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
| | - M Fani
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
| | - P Asaad
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
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16
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Bhowmik S, Singh CB, Neogi S, Roy S. Evaluating the Emergency Surgery Score (ESS) in Predicting Postoperative Outcomes Following Emergency Laparotomy: Insights From an Indian Tertiary Center. Cureus 2024; 16:e56455. [PMID: 38638730 PMCID: PMC11025309 DOI: 10.7759/cureus.56455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
AIMS AND OBJECTIVES To determine the predictive value of Emergency Surgery Score (ESS) with regard to mortality and morbidity rates of patients undergoing emergency laparotomy. METHOD The ESS ranging from 0 to 29 is an extensive risk calculator based on 22 variables including important parameters like demographics, preoperative treatment, comorbidities, and laboratory values. Twenty patients who underwent emergency laparotomy were preoperatively assessed and ESS was calculated for each. After establishment of diagnosis and resuscitation, the patient was taken up for emergency laparotomy. Postoperatively, patients were monitored clinically as well as with laboratory and radiological investigations as per case needed till discharge and further followed up physically in OPD/ward or interviewed telephonically for 30 days on a weekly basis. Incidence of mortality and morbidity in terms of postoperative complications, ICU admission, reoperation and readmission among the cases occurring within 30 days of procedure were recorded. RESULTS ESS correlated well with the outcome in the current study, 10 out of 14 patients with score less than 8 were discharged without any complications. Mean ESS was higher among non-survivors. Ability of ESS to predict postoperative mortality, morbidity and ICU stay was proven statistically with c-statistics of 0.853, 0.84, 0.879 respectively. ESS was found to be a good predictor for the development of postoperative lower respiratory tract infection (LRTI) (c-statistic=0.828), sepsis (c-statistic=0.867), disseminated intravascular coagulation (DIC) (c-statistic=0.805), acute kidney injury (AKI) (c-statistic=0.804). ESS showed poor correlation with reoperation and readmission rates. CONCLUSION The current study underscores the critical importance of employing risk stratification through ESS for patients undergoing emergency laparotomy. By employing ESS, healthcare professionals can accurately anticipate resuscitation requirements and stabilize patients preoperatively. This proactive approach enables the identification and optimization of patients unsuitable for immediate surgery, facilitating informed decisions on targeted treatment, surgical intervention, and postoperative care pathways.
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Affiliation(s)
- Srishti Bhowmik
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Chandra B Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Sushanto Neogi
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Sarmista Roy
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
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17
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Liu F, Zhou J, Wu X. Effects of evidence-based nursing on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis. Int Wound J 2024; 21:e14539. [PMID: 38506317 PMCID: PMC10952117 DOI: 10.1111/iwj.14539] [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: 11/10/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 03/21/2024] Open
Abstract
This study aimed to comprehensively evaluate the effects of evidence-based nursing (EBN) intervention on wound infection and postoperative complications in patients after appendectomy for acute appendicitis (AA), with the expectation of providing a theoretical basis for postoperative care in AA. Randomised controlled trials (RCTs) on the postoperative application of EBN in patients with AA were searched in PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure from the inception of databases to October 2023. Two authors screened and evaluated the literature based on the inclusion and exclusion criteria, and data were extracted from the final included literature. Stata software (version 17.0) was employed for data analysis. In total, 29 RCTs involving 2848 patients with AA were included, with 1424 in the EBN group and 1424 in the conventional care group. The analyses revealed that patients with AA who experienced EBN were significantly less likely to develop postoperative wound infections (odds ratio [OR] = 0.23, 95% confidence intervals [CIs]: 0.14-0.38, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.26, p < 0.001) as opposed to conventional care. Available evidence suggests that EBN can effectively reduce the risk of wound infection and postoperative complications in patients undergoing appendectomy for AA, thereby improving patient prognosis. This finding is worth promoting in the clinical practice.
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Affiliation(s)
- Feng Liu
- Department of EmergencyThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
| | - Juan Zhou
- Department of General SurgeryThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
| | - Xue‐Lian Wu
- Department of Child HealthcareThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
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18
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Muenyi CS, Bowers AF, Aregbe A, Smith J, Maina RM, Zalamea NN, Foretia DA. Interests and Barriers to Medical Students Participation in a Dedicated Global Surgery Curriculum. J Surg Res 2024; 295:603-610. [PMID: 38096774 DOI: 10.1016/j.jss.2023.11.053] [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: 05/10/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Despite many institutions establishing global surgery (GS) programs to support clinical care and education in resource-limited settings, few have established a specific curriculum in GS. This study's objective was to assess medical student interest in such a curriculum and prospects for future careers in GS/global health (GH), and to define the barriers to pursuing an international rotation. METHODS We conducted an anonymous online survey of all 495 medical students at a major academic medical center in the mid-South that collected demographic data, country of origin, interest in a GS/GH elective, and barriers to pursuing a GS/GH rotation abroad. The data were analyzed using SPSS software. RESULTS Prior international experience increased the likelihood of a student's involvement in GS/GH and more preclinical (years 1 & 2) students (90%) than clinical students. (years 3 & 4) (70%) felt strongly about the value of a GS/GH experience. Of the 163 students who completed the survey, 80% expressed interest in a GS/GH elective, with preclinical students expressing more interest (90%) than clinical students (71%). This interest strongly correlated with an interest in pursuing a career in GH (94%) and/or GS (100%). Identified barriers to engagement in a GS/GH experience abroad included financing (74%), scheduling (58%), family obligations (23%), and personal safety (19%). CONCLUSIONS The students we surveyed were very interested in a GS/GH curriculum that included a rotation abroad, especially if they were to receive financial support. Preclinical students expressed more willingness to self-fund such experiences. The findings of this survey further strengthen the need to incorporate GS/GH in medical school curricula.
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Affiliation(s)
- Clarisse S Muenyi
- University of North Carolina Health Nash, Rocky Mount, North Carolina.
| | - Alexander F Bowers
- College Of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adegbemisola Aregbe
- College Of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jessica Smith
- College Of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Renee M Maina
- Department Of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nia N Zalamea
- Department Of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center For Multicultural And Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Denis A Foretia
- Department Of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center For Multicultural And Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
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19
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Rapp DE, Zillioux J, Sun F, Jones M, Little M, Mitchell J. Pelvic floor therapy program for the treatment of female urinary incontinence in Belize: a pilot study. Front Glob Womens Health 2024; 5:1325259. [PMID: 38404953 PMCID: PMC10884173 DOI: 10.3389/fgwh.2024.1325259] [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: 10/20/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited. Methods We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry). Results Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale. Discussion Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.
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Affiliation(s)
- David E. Rapp
- Department of Urology, University of Virginia, Charlottesville, VA, United States
- Global Surgical Expedition, Glen Allen, VA, United States
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia, Charlottesville, VA, United States
| | - Fionna Sun
- Department of Urology, University of Virginia, Charlottesville, VA, United States
| | - Marieke Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Michelle Little
- Global Surgical Expedition, Glen Allen, VA, United States
- Women in Motion Physical Therapy, Charlottesville, VA, United States
| | - Jeanice Mitchell
- Global Surgical Expedition, Glen Allen, VA, United States
- Integrity Rehab and Home Health, Killeen, TX, United States
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20
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Chawla M, Baselice H, Negash R, Helkin A, Young A. Adjusting the Split: Examining Complications After Emergency Exploratory Laparotomy in Older Adults. J Surg Res 2024; 294:58-65. [PMID: 37864960 PMCID: PMC10841194 DOI: 10.1016/j.jss.2023.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Older adults experience higher rates of complications after an emergency exploratory laparotomy (EEL). To better understand the shift to an aging population in the United States, identifying how age may influence these complications in older patients is important. The current standard age category for older adult patients is ≥65. We analyzed postlaparotomy complications using a lower age split. METHODS A retrospective analysis was done on patients who required an EEL from October 2015 to December 2019 at an academic medical center. Patient demographics and hospital course variables were collected. Differences in complications in patients aged ≥/<55 y and ≥/<65 y were measured using univariate and multivariable analyses. RESULTS A total of 481 patients were reviewed. Both patient groups of ≥55 and ≥65 were typically male, White, had 3+ comorbidities, Medicare insurance, were retired, and presented in extremis to the emergency department. Patients aged ≥55 y had significant rates of pulmonary complications and inpatient mortality (odds ratio 2.2, 2.7, respectively). Patients aged ≥65 y had significant rates of genitourinary and cardiac complications (odds ratio 2.3, 1.8, respectively). CONCLUSIONS Patients aged ≥55 y undergoing EEL had higher odds of experiencing pulmonary complications and death during their index hospitalizations, which was not present with the standard ≥/<65-y-old patient analysis. Those aged ≥65 y experienced index genitourinary and cardiac complications. The ≥/<55 age split has a unique set of complications that should be considered. Given the increased odds of inpatient mortality and types of complications in patients aged ≥55 y, the current age split for older adults should be reconsidered.
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Affiliation(s)
- Mehak Chawla
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Holly Baselice
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rosa Negash
- The Ohio State University College of Public Health, Columbus, Ohio
| | - Alex Helkin
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew Young
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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21
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Naumann DN, Bhangu A, Brooks A, Martin M, Cotton BA, Khan M, Midwinter MJ, Pearce L, Bowley DM, Holcomb JB, Griffiths EA. Novel Textbook Outcomes following emergency laparotomy: Delphi exercise. BJS Open 2024; 8:zrad145. [PMID: 38949628 PMCID: PMC10823418 DOI: 10.1093/bjsopen/zrad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/03/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy. METHODS A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1-5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round. RESULTS A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into 'early' and 'longer-term'. For non-trauma patients the proposed early Textbook Outcome was 'Discharged from hospital without serious postoperative complications (Clavien-Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was 'Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien-Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)'. The longer-term Textbook Outcome for both non-trauma and trauma was 'Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year'. CONCLUSION Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.
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Affiliation(s)
- David N Naumann
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aneel Bhangu
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Global Health Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham, UK
| | - Matthew Martin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles County & USC Medical Center, Los Angeles, California, USA
| | - Bryan A Cotton
- The Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mansoor Khan
- Department of General Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Mark J Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Lyndsay Pearce
- Department of General Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Douglas M Bowley
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John B Holcomb
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ewen A Griffiths
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Turhan N, Duran C, Kuzan TY, Kuzan BN, Zarbaliyev E. Risk of Conversion from Laparoscopic Appendectomy to Open Surgery: The Role of Clinical and Radiological Factors in Prediction. J Laparoendosc Adv Surg Tech A 2023; 33:1176-1183. [PMID: 37768845 DOI: 10.1089/lap.2023.0293] [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] [Indexed: 09/30/2023] Open
Abstract
Introduction: Laparoscopic appendectomy is the most preferred surgical method in the treatment of acute appendicitis. In our study, we aim to determine the clinical and radiological factors affecting conversion from laparoscopic appendectomy to open surgery. Materials and Methods: All patients older than 18 years, who were operated on with the diagnosis of acute appendicitis in the General Surgery clinic of Prof. Dr. İlhan Varank Training and Research hospital between January 2020 and January 2022, were included in the study. The data consisting of clinical, laboratory, and radiological (computed tomography) findings of the patients were evaluated retrospectively. The patients were divided into two groups as those whose surgery was completed laparoscopically (Group 1) and those converted from laparoscopic appendectomy to open surgery (Group 2). The risk of conversion to open surgery was analyzed by binary logistic regression analysis as univariate and multivariate models. Results: Appendectomy was performed in 831 patients within the specified period. The surgery of 31 (3.73%) patients started laparoscopically; however, they were completed by converting to open surgery. Multivariable analysis showed that the risk of conversion to open surgery increased with leukocyte count, Alvarado score and with the presence of periappendiceal fluid and lymphadenopathy on CT. Conclusion: Our study shows that patients with high risk of returning to open surgery can be identified preoperatively with the risk analysis method in which clinical, laboratory, and radiological findings are evaluated together. We conclude that, starting the operation of these patients with the open technique from the beginning will prevent unnecessary expenditures and reduce morbidities.
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Affiliation(s)
- Nihan Turhan
- Department of General Surgery and Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Cengiz Duran
- Department of General Surgery and Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Taha Yusuf Kuzan
- Department of Radiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Beyza Nur Kuzan
- Department of Radiology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
| | - Elbrus Zarbaliyev
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyıl University, İstanbul, Türkiye
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Gobishangar S, Gobinath S, Thevamirtha C, Sarmila S, Kasthuri S, Paramanathan S. Prevalence of Neuroendocrine Tumours (NET) in Patients Undergoing Appendicectomy for Acute Appendicitis: A Tertiary Care Study. Cureus 2023; 15:e50783. [PMID: 38239530 PMCID: PMC10795718 DOI: 10.7759/cureus.50783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Acute appendicitis is one of the common causes of acute abdomen in adults, which is managed widely with appendicectomy. Neuroendocrine tumours are the most common appendiceal tumours diagnosed incidentally on appendicectomy specimens. Methods Demographic data, presenting complaints, indications for appendicectomy, and the histology findings based on histopathological reports of the patients who have undergone appendicectomy for appendicitis at surgical units of Teaching Hospital, Jaffna, from 1st of January 2019 to 31st of December 2022 were retrospectively analyzed. Results Of the 1341 histopathology reports, 0.2% (n=3) were neuroendocrine tumours (NET). The mean age of the patients with NET was 48.6, and 66.6% of them were females. All three NETs identified in appendicectomy specimens were well differentiated and smaller than 2 cm. All three had negative resection margins and were managed only with appendicectomy. Conclusion NETs of the appendix are the commonest appendiceal neoplasms. The majority of them are diagnosed incidentally in appendicectomy specimens. Surgical management of the tumours is either by appendicectomy or hemicolectomy, which depends mainly on tumor size. Surgical decisions should be tailor-made to the patients based on multi-disciplinary team decisions.
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Affiliation(s)
| | | | | | | | | | - Shathana Paramanathan
- Surgery, University of Jaffna, Jaffna, LKA
- Health Sciences, Management and Science University, Kula Lampur, MYS
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Suzuki T, Matsumoto A, Akao T, Matsumoto H. Interval appendectomy as a safe and feasible treatment approach after conservative treatment for appendicitis with abscess: a retrospective, single-center cohort study. Updates Surg 2023; 75:2257-2265. [PMID: 37987979 PMCID: PMC10710379 DOI: 10.1007/s13304-023-01679-1] [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: 07/17/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
Emergency appendectomy (EA) is the gold standard management for acute appendicitis (AA). However, whether EA or interval appendectomy (IA) after conservative treatment is the optimal approach in AA with abscess remains controversial. This study compared IA and EA in patients presenting with AA accompanied by abscess. This was a retrospective single-center study including 446 consecutive patients undergoing appendectomy between April 2009 and March 2023. AA with abscess was defined as a pericecal abscess observed by computed tomography or abdominal ultrasonography, and patients with signs of peritoneal irritation were excluded. Perioperative outcomes were compared between the patients who directly underwent EA and those who underwent IA after conservative treatment. Among 42 patients (9.4%) with AA and abscess, 34 and 8 patients underwent IA and EA, respectively. The rates of ileocecal resection and postoperative complications were lower in the IA group than in the EA group (3% vs. 50%, P < 0.001 and 9% vs. 75%, P < 0.001, respectively). Colonoscopy before IA was performed in 16 of the 17 patients aged ≥ 40 years in the IA group, and one patient underwent ileocecal resection because of suspicious neoplasm in the root of the appendix. IA after conservative treatment might be considered as the useful therapeutic option for AA with abscess. Colonoscopy during the waiting period between the initial diagnosis and IA should be considered in patients aged ≥ 40 years who may have malignant changes. Implementing IA as a first-line treatment will be beneficial to both patients and healthcare providers.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan.
| | - Akiyo Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan
| | - Takahiko Akao
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan
| | - Hiroshi Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan
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25
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Zhang S, Liu C, Sun J, Li Y, Lu J, Xiong X, Hu L, Zhao H, Zhou H. Bridging the Gap: Investigating the Link between Inflammasomes and Postoperative Cognitive Dysfunction. Aging Dis 2023; 14:1981-2002. [PMID: 37450925 PMCID: PMC10676784 DOI: 10.14336/ad.2023.0501] [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: 12/03/2022] [Accepted: 05/01/2023] [Indexed: 07/18/2023] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a cluster of cognitive problems that may arise after surgery. POCD symptoms include memory loss, focus inattention, and communication difficulties. Inflammasomes, intracellular multiprotein complexes that control inflammation, may have a significant role in the development of POCD. It has been postulated that the NLRP3 inflammasome promotes cognitive impairment by triggering the inflammatory response in the brain. Nevertheless, there are many gaps in the current literature to understand the underlying pathophysiological mechanisms and develop future therapy. This review article underlines the limits of our current knowledge about the NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3) inflammasome and POCD. We first discuss inflammasomes and their types, structures, and functions, then summarize recent evidence of the NLRP3 inflammasome's involvement in POCD. Next, we propose a hypothesis that suggests the involvement of inflammasomes in multiple organs, including local surgical sites, blood circulation, and other peripheral organs, leading to systemic inflammation and subsequent neuronal dysfunction in the brain, resulting in POCD. Research directions are then discussed, including analyses of inflammasomes in more clinical POCD animal models and clinical trials, studies of inflammasome types that are involved in POCD, and investigations into whether inflammasomes occur at the surgical site, in circulating blood, and in peripheral organs. Finally, we discuss the potential benefits of using new technologies and approaches to study inflammasomes in POCD. A thorough investigation of inflammasomes in POCD might substantially affect clinical practice.
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Affiliation(s)
- Siyu Zhang
- Anesthesiology Department, Zhejiang Chinese Medical University, Hangzhou, China.
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
| | - Cuiying Liu
- School of Nursing, Capital Medical University, Beijing, China.
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Joint Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
| | - Jintao Sun
- Anesthesiology Department, Zhejiang Chinese Medical University, Hangzhou, China.
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
| | - Yang Li
- Anesthesiology Department, Zhejiang Chinese Medical University, Hangzhou, China.
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
| | - Jian Lu
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Hu
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
| | - Heng Zhao
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Joint Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
| | - Hongmei Zhou
- Anesthesiology Department, Zhejiang Chinese Medical University, Hangzhou, China.
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.
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Giriteka T, Bulakali DP, Wendler CB. Essential human and material resources for emergency care in the district hospitals of Burundi. Afr J Emerg Med 2023; 13:300-305. [PMID: 37859728 PMCID: PMC10582767 DOI: 10.1016/j.afjem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Burundi, like many African nations, faces challenges in providing accessible emergency care. The aim of this study was to assess the type of staff training, accessibility to imaging, and availability of essential equipment in the district hospitals of Burundi in order to inform strategic planning for healthcare delivery. Methods In June 2022 an online survey was sent to each district hospital of the country. Complete responses were analysed and, where appropriate, significance determined by chi-square analysis, with p<0.05 considered significant. Results Forty of 45 district hospitals completed the survey, of which 35 were rural (matching national demographics). The majority of district hospitals (21/40) had ready access to ≥4/5 critical drugs while few (5/40) were equipped with ≥4/5 key material. One quarter had 24/7 physician coverage and X-ray available. Only 3 had continuous access to ultrasound studies despite most district hospitals having ultrasound machines. Trained emergency room staff were almost totally absent from the field, with only 6 nurses, 4 generalists, and 1 specialist reported across 9 sites. Even a single EM-trained staff member was significantly correlated with being better equipped for emergencies (p<0.01). Conclusion Burundi needs a strategic investment in emergency preparedness and care. Policy initiatives and technology purchases have demonstrated reasonable penetration down to the district hospital level, however, trained personnel are essential to develop sustainable emergency capacity.
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Affiliation(s)
| | | | - Carlan Bruce Wendler
- Kibuye Hope Hospital, Kibuye, Bukirasazi, Gitega, Burundi
- Hope Africa University, Ngagara II, Bujumbura, Burundi
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Xu Z, Jin L, Wu W. Clinical efficacy and safety of endoscopic retrograde appendicitis treatment for acute appendicitis: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102241. [PMID: 37925019 DOI: 10.1016/j.clinre.2023.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of endoscopic retrograde appendicitis treatment (ERAT) for acute appendicitis (AA) by conducting a meta-analysis of clinical randomized trials (RCTs). METHODS Eight electronic databases were searched. Study quality was assessed using the Cochrane risk of bias tool. RevMan5.3 and STATA14 software were used to for statistical analysis. RESULTS Twenty-six RCTs with 2236 subjects were analyzed. First, operative time, length of hospital stay and duration of bed rest were shorter in the ERAT groups than in the control groups, with the pooled MD and 95 % CI being -13.22(-20.09, -6.35)(p = 0.0002), -2.13 (-2.47, -1.80)(p < 0.00001) and -3.15 (-3.76, -2.53)(p < 0.00001), respectively. Second, patients in the ERAT groups had a lower incidence of complications than the control groups, with a pooled RR and 95 % CI of 0.25(0.18, 0.35)(p < 0.00001). Third, patients who received ERAT returned to normal temperature faster than the control groups, the pooled MD and 95 % CI was -3.39(-4.36, -2.42)(p<0.00001). Finally, the result showed that the recurrence rate in the ERAT groups was approximately twice that of control groups, with the pooled RR and 95 % CI being 2.10(1.02, 4.32)(p < 0.00001). CONCLUSIONS ERAT results in fewer complications and shorter recovery time. And compared to appendectomy, ERAT reduces operative time and intraoperative bleeding. However, the recurrence of acute appendicitis after ERAT remains a concern. And more multicenter and large-scale RCTs are needed to confirm the benefits of ERAT. SYSTEMATIC REVIEW REGISTRATION We have registered on the PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], and the registration number is CRD42023420171.
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Affiliation(s)
- Zhigang Xu
- Department of Anorectal, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518034, China
| | - Liang Jin
- Department of Anorectal, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518034, China
| | - Wenjiang Wu
- Department of Anorectal, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518034, China.
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Li H, Luo J, Wang H, Guo Q, Huang P, Lei H, Li W, Yang J. Non-operative treatment strategy for appendiceal abscess in children under 3 years old: a retrospective observational study. Front Pediatr 2023; 11:1234820. [PMID: 37954431 PMCID: PMC10634424 DOI: 10.3389/fped.2023.1234820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
Background There are few studies on appendiceal abscess with appendicolith in children under 3 years old. This study aims to explore the success rate of non-surgical treatment of appendiceal abscess and assess the potential influence of an appendicolith on non-surgical treatment outcomes in children under 3 years old. Methods The clinical data of children under 3 years old who were diagnosed with appendiceal abscess at the Wuhan Children's Hospital, China, from February 2013 to May 2020 were collected. According to the findings of ultrasonography and CT imaging, they were divided into two groups, namely, the appendicolith group and the non-appendicolith group. Results A total of 94 children with appendiceal abscess were identified, meeting the specified study criteria, and categorized into two groups, namely, the appendicolith group (n = 51, 54.3%) and the non-appendicolith group (n = 43, 45.7%). Non-surgical treatment was unsuccessful in six out of the 94 children, yielding an overall success rate of 93.6% for non-surgical management of appendiceal abscess in children under 3 years old. The success rate for non-surgical treatment in the appendicolith subgroup was 90.2%, whereas that for the non-appendicolith subgroup was 97.7%. No statistically significant distinction was observed between the two groups (P = 0.292). Likewise, there were no significant differences in gender, age, duration of symptoms, fever, vomiting, diarrhea, rebound pain, white blood cell count, C-reactive protein level, and abscess cross-sectional area between the appendicolith group and the non-appendicolith group. However, there is a statistical difference in tenderness in the right lower abdomen. Conclusion Non-surgical treatment of appendiceal abscess has a high success rate and can be considered an effective treatment strategy. In pediatric patients under 3 years old without evidence of complete intestinal obstruction or diffuse peritonitis, non-surgical treatment may be considered for appendiceal abscess.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Yang
- Department of General Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Handler C, Weiner N, Meir E, Abu-Hatoum O, Kopelman D, Kaplan U. Is acute appendicitis more severe in foreign workers of northern Israel? A retrospective cohort study. Eur J Trauma Emerg Surg 2023; 49:2235-2240. [PMID: 35524779 DOI: 10.1007/s00068-022-01980-5] [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: 11/03/2021] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute appendicitis (AA) is one of the most common surgical emergencies worldwide. It's classified into simple or complicated disease. Due to the high prevalence of the disease, AA has been studied as a marker to assess the quality of care afforded to minority groups. The purpose of this study was to compare AA outcomes in foreign workers (FW) to the general population in northern Israel. METHODS This is a retrospective cohort study. We identified all patients aged 18-50 who were admitted to our institution between January 1st, 2013 and October 31st, 2018, with the diagnosis of acute appendicitis. The study group included all FW and the control group included citizens of Israel. Study patients were matched based on age, sex, and co-morbidities. We compared time to presentation, admission parameters and disease outcomes. Our study outcomes were disease severity and length of hospital stay. RESULTS We identified 20 FW and 97 matched local patients. FW presented with significantly higher heart rate, temperature, and white blood cell count (WBC). Duration of symptoms was comparable between the two groups. The rates of complicated disease were significantly higher among FW (45 vs 17.5%, p < 0.0001). Length of hospitalization was significantly longer in the FW group (4.8 vs. 3.9 days, p = 0.01). The odds ratio of FWs for having a complicated disease was OR = 3.85 [95% CI: 1.38, 10.72], p = 0.01. Multivariate analysis identified FW and duration of symptoms as significantly contributing to a complicated disease outcome. CONCLUSIONS Although duration of symptoms was comparable to the local population, FW in northern Israel are at increased risk for a complicated disease which resulted in longer hospital stay. Further studies may enlighten the reason for this disparity.
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Affiliation(s)
- Chovav Handler
- Department of General Surgery, Ziv Medical Center, Rambam St, 13100, Zefat, Israel
| | - Noam Weiner
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Eyal Meir
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Ossama Abu-Hatoum
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron st. 1, Bat Galim, 3525433, Haifa, Israel
| | - Doron Kopelman
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron st. 1, Bat Galim, 3525433, Haifa, Israel
| | - Uri Kaplan
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron st. 1, Bat Galim, 3525433, Haifa, Israel.
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Boateng-Osei EA, Osei I, Diji AKA, Pambour BA, Wireko-Gyebi R, Okyere P, Lomotey AY. Emergency preparedness capacity of a university hospital in Ghana: a cross-sectional study. Afr J Emerg Med 2023; 13:152-156. [PMID: 37692455 PMCID: PMC10491938 DOI: 10.1016/j.afjem.2023.05.001] [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: 11/22/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 09/12/2023] Open
Abstract
Background The health and safety of people are often endangered during emergencies and disasters. Efficient emergency management systems ensure that mitigation, preparedness, response, and recovery actions exist to preserve the health, safety, and welfare of the public. Failure to carry out appropriate responses can have adverse consequences for both emergency responders and casualties; hence, the need for emergency preparedness. This study sought to assess the state of emergency preparedness capacity of the Kwame Nkrumah University of Science and Technology hospital in Ghana. Methods A facility-based cross-sectional study was conducted between December 2018 and February 2019 using three guidelines developed respectively by the World Health Organization, the Ministry of Health-Ghana, and the Ghana Health Service. The hospital's emergency preparedness was assessed regarding the emergency policies, plan, protocol, equipment, and medications. Results Overall, the hospital's emergency preparedness level was weak (57.36%). Findings revealed that the hospital had inadequate emergency equipment, and supplies for emergency care delivery, especially during upsurge. It also did not have an emergency planning committee. There were noticeable deficiencies in some emergency resources such as chest tubes, basic airway supplies, and many emergency drugs. Other vital emergency tools such as pulse oximeter, thermometer, and emergency medications were inadequate. The hospital had a strong emergency plan and policies on assessment (77.8% and 78%) respectively. Conclusion The Kwame Nkrumah University of Science and Technology hospital is not prepared sufficiently for an emergency surge, and this poses a major health challenge. Emergency items must be made available, and the organization and planning of emergency service provisions must be improved to avoid preventable deaths during an emergency surge.
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Affiliation(s)
- Estella Antoinette Boateng-Osei
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Osei
- MRC Unit, The Gambia at LSHTM Atlantic Boulevard, Fajara
| | | | | | - Rejoice Wireko-Gyebi
- Department of Planning and Sustainability, University of Energy and Natural Resources, Sunyani
| | - Portia Okyere
- Department of Public Health Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Habib Bedwani N, Smith C, Kelada M, Patten DK, Mak WK, English W, Shatkar V. Two-year outcomes of conservatively managed appendicitis during the COVID-19 pandemic-a multicentre cohort study. Langenbecks Arch Surg 2023; 408:307. [PMID: 37578533 DOI: 10.1007/s00423-023-03059-0] [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: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE During the COVID-19 pandemic, the new RCSEng guidelines resulted in appendicitis being more commonly managed conservatively to avoid aerosol-generating procedures. This resulted in shorter hospital stays without increased short-term complications. The 2-year outcomes of this change, specifically recurrence and re-admission rates remain unknown. METHODS We conducted a multicentre, prospective, observational study including all adult patients treated as appendicitis after the implementation of the new surgical guidelines during the COVID-19 pandemic. Outcomes included initial management failure, re-admission rate, appendicitis recurrence, and interval appendicectomy. A historical cohort prior to the COVID-19 pandemic was used for comparison. Patients were followed up for 2-years post index admission. Categorical and continuous variables were compared using Fisher's exact test and Student's T or Mann-Whitney U tests as appropriate. RESULTS Sixty-three and 79 patients with appendicitis were included from four NHS trusts, before (A) and after (B) the new intercollegiate guidelines respectively. Operative management was used less frequently in cohort B (28/79 vs 52/63; p<0.001). More patients re-presented in cohort B (14/79 vs 3/63; p=0.020), but not when comparing only those managed conservatively (2/11 vs 13/52; p=1.000). A similar trend was observed for appendicitis recurrence although without statistical significance (2/63 vs 9/79; p=0.112); with loss of trend when comparing those managed conservatively-only (2/11 vs 9/52; p=1.000). Among all patients, four (2.8%) were found to have underlying neoplasia of which three were initially managed conservatively (3/63; 4.8%). CONCLUSION Conservative management of appendicitis has previously been shown to have short-term benefits in expedited hospital discharge without early complications. The present study shows it has a higher readmission and appendicitis recurrence rates. The risks of this alongside missed/delayed management of neoplasia needs to be considered alongside the benefits including avoidance of aerosol-generating general anaesthesia and laparoscopy during the COVID-19 pandemic or similar future health crises. Small case numbers limit analysis.
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Affiliation(s)
- N Habib Bedwani
- Digestive Diseases Centre, Barking, Havering and Redbridge University Hospital NHS Trust, London, UK.
| | - C Smith
- Department of General Surgery/Colorectal Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - M Kelada
- Faculty of Medicine, Imperial College London, London, UK
| | - D K Patten
- Department of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, London, UK
- Department of Breast Oncoplastic and General Surgery, Barts Health NHS Trust, London, UK
| | - W K Mak
- Department of General Surgery/Colorectal Surgery, Royal Devon Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - W English
- Applied Biomedical Engineering Group, University College London, London, UK
- Department of Digestive Diseases, Cleveland Clinic London, London, UK
| | - V Shatkar
- Digestive Diseases Centre, Barking, Havering and Redbridge University Hospital NHS Trust, London, UK
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Fuglseth H, Søreide K, Vetrhus M. Acute mesenteric ischaemia. Br J Surg 2023; 110:1030-1034. [PMID: 36748996 PMCID: PMC10416693 DOI: 10.1093/bjs/znad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Hanne Fuglseth
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- SAFER Surgery, Surgical Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- SAFER Surgery, Surgical Research Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Morten Vetrhus
- SAFER Surgery, Surgical Research Group, Stavanger University Hospital, Stavanger, Norway
- Department of Surgery, Vascular Surgery Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Ghali MS, Hasan S, Al-Yahri O, Mansor S, Al-Tarakji M, Obaid M, Shah AA, Shehata MS, Singh R, Al-Zoubi RM, Zarour A. Adult appendicitis score versus Alvarado score: A comparative study in the diagnosis of acute appendicitis. Surg Open Sci 2023; 14:96-102. [PMID: 37577253 PMCID: PMC10413131 DOI: 10.1016/j.sopen.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 08/15/2023] Open
Abstract
Background Acute Appendicitis (AA) is the most common abdominal surgical emergency. It requires proper management to decrease mortality and morbidity. Clinical scoring systems for diagnosing AA aimed to decrease the use of radiological scans and the rate of negative appendectomies (NA). We aim to assess the adult appendicitis score (AAS) in the diagnosis prediction of AA. Method A retrospective study with 1303 cases of AA is performed. We compared the correlation of AAS and Alvarado scores to postoperative histopathology. Specificity, sensitivity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were assessed. ROC was used. Results AAS risk stratification was applied to the study population. Group I for a low probability, and groups II and III for an intermediate and high probability of AA. We found that 159 patients were matched in group I, 505, and 639 were in groups II and III of AAS, respectively. The correlation between Alvarado and AAS with HP was significant. AAS ≥ 16 presented sensitivity and specificity of 50 % and 75.47 %, respectively, with PPV of 97.96 % and NPV of 6.02 %, with an accuracy of 51.04 %. Regarding AAS ≥ 11, the sensitivity was 88.96 %, specificity was 39.62 %, PPV was 97.2 %, NPV was 13.21 %, and accuracy was 86.95 %. Conclusion AAS is relatively more accurate than Alvarado's score, especially in selecting a safe candidate for discharge from an emergency. In addition, AAS is found to decrease the need for radiological images and NA rate more than Alvarado.
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Affiliation(s)
- Mohamed Said Ghali
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Samer Hasan
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Salah Mansor
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohannad Al-Tarakji
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Munzir Obaid
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Amjad Ali Shah
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mona S. Shehata
- Department of Pharmacy, Women's Wellness and Research center, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid 22110, Jordan
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, Doha 2713, Qatar
| | - Ahmad Zarour
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell medical college, Doha, Qatar
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Kemberi M, Salmasi Y, Santamaria S. The Role of ADAMTS Proteoglycanases in Thoracic Aortic Disease. Int J Mol Sci 2023; 24:12135. [PMID: 37569511 PMCID: PMC10419162 DOI: 10.3390/ijms241512135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Thoracic aortic aneurysm and dissection (TAAD) are complex disease states with high morbidity and mortality that pose significant challenges to early diagnosis. Patients with an aneurysm are asymptomatic and typically present to the emergency department only after the development of a dissection. The extracellular matrix (ECM) plays a crucial role in regulating the aortic structure and function. The histopathologic hallmark termed medial degeneration is characterised by smooth muscle cell (SMC) loss, the degradation of elastic and collagen fibres and proteoglycan (PG) accumulation. Covalently attached to the protein core of PGs are a number of glycosaminoglycan chains, negatively charged molecules that provide flexibility, compressibility, and viscoelasticity to the aorta. PG pooling in the media can produce discontinuities in the aortic wall leading to increased local stress. The accumulation of PGs is likely due to an imbalance between their synthesis by SMCs and decreased proteolysis by A Disintegrin-like and Metalloproteinase with Thrombospondin motifs (ADAMTS) proteoglycanases in the ECM. Mouse models of TAAD indicated that these proteases exert a crucial, albeit complex and not fully elucidated, role in this disease. This has led to a mounting interest in utilising ADAMTS proteoglycanases as biomarkers of TAAD. In this review, we discuss the role of ADAMTSs in thoracic aortic disease and their potential use in facilitating the clinical diagnosis of TAAD and disease progression.
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Affiliation(s)
- Marsioleda Kemberi
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK;
| | - Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK;
| | - Salvatore Santamaria
- Department of Biochemical and Physiological Sciences, School of Biosciences, Faculty of Health and Medical Sciences, Edward Jenner Building, University of Surrey, Guildford GU2 7XH, UK
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Ndong A, Diallo AC, Rouhi AD, Diao ML, Yi W, Tendeng JN, Williams NN, Cissé M, Dumon KR, Konaté I. Evolution of laparoscopic surgery in a sub-Saharan African country: a 30-year literature review in Senegal. Surg Endosc 2023:10.1007/s00464-023-10192-w. [PMID: 37308759 DOI: 10.1007/s00464-023-10192-w] [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: 03/13/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The advent of laparoscopy has significantly reduced the morbidity associated with the majority of abdominal surgeries. In Senegal, the first studies evaluating this technique were published in the 1980s. The objective of this systematic review is to assess the evolution of laparoscopy research in Senegal. METHODS A search of PubMed and Google Scholar was carried out without limit of publication date. The keywords used were "senegal" AND "laparoscop*". Duplicates were removed, and remaining articles were assessed for selection criteria. We included all articles about laparoscopy published in Senegal. The parameters studied in each included article were the place and year of study, average age, sex ratio, assessed indications and results. RESULTS 41 Studies published between 1984 and 2021 met selection criteria. The average age of patients was 33 years (range 4.7-63). The sex ratio was 0.33. The main indications for laparoscopy according to the studies were: benign gastrointestinal disorders in 11 studies (26.8%), abdominal emergencies in 9 studies (22%), gallbladder surgery in 5 studies (12.2%), benign gynecological pathology in 6 studies (14.6%), malignant gynecological pathology in 2 studies (4.9%), diagnostic laparoscopy in 2 studies (4.9%), groin hernia repair in 2 studies (4.9%) and testicular pathology in 1 study (2.4%). Overall mortality was estimated at 0.9% (95% CI 0.6-1.3) and overall morbidity for all complications was estimated at 5% (95% CI 3.4-6.9). CONCLUSIONS This systematic review showed a predominance of the laparoscopy publications from the capital in Dakar with favorable outcomes. This technique should be popularized in the different regions of the country and its indications expanded.
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Affiliation(s)
- Abdourahmane Ndong
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint Louis, Senegal.
| | - Adja C Diallo
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint Louis, Senegal
| | - Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamed L Diao
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint Louis, Senegal
| | - William Yi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacques N Tendeng
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint Louis, Senegal
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mamadou Cissé
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint Louis, Senegal
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ibrahima Konaté
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint Louis, Senegal
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Shiihara M, Sudo Y, Matsushita N, Kubota T, Hibi Y, Osugi H, Inoue T. Usefulness of Preoperative Predictors of Pathological Complicated Appendicitis. Dig Surg 2023; 40:121-129. [PMID: 37285808 DOI: 10.1159/000531284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Complicated appendicitis (CA) is often indicated for emergency surgery; however, preoperative predictors of pathological CA (pCA) remain unclear. Furthermore, characteristics of CA that can be treated conservatively have not yet been established. METHODS 305 consecutive patients diagnosed with acute appendicitis were reviewed. The patients were divided into two groups: an emergency surgery and a conservative treatment group. The emergency surgery group was pathologically classified as having uncomplicated appendicitis (pUA) and pCA, and the preoperative predictors of pCA were retrospectively assessed. Based on the preoperative pCA predictors, a predictive nomogram whether conservative treatment would be successful or not was created. The predictors were applied to the conservative treatment group, and the outcomes were investigated. RESULTS In the multiple logistic regression analysis of the factors contributing to pCA, C-reactive protein ≥3.5 mg/dL, ascites, appendiceal wall defect, and periappendiceal fluid collection were independent risk factors. Over 90% of cases without any of the above four preoperative pCA predictors were pUA. The accuracy of the nomogram was 0.938. CONCLUSION Our preoperative predictors and nomogram are useful to aid in distinguishing pCA and pUA and to predict whether or not conservative treatment will be successful. Some CA can be treated with conservative treatment.
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Affiliation(s)
| | - Yasuhiro Sudo
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | | | - Takeshi Kubota
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Yasuhiro Hibi
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Harushi Osugi
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Tatsuo Inoue
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
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Kobayashi T, Hidaka E, Koganezawa I, Nakagawa M, Yokozuka K, Ochiai S, Gunji T, Sano T, Tomita K, Tabuchi S, Chiba N, Kawachi S. Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis. BMC Gastroenterol 2023; 23:198. [PMID: 37286951 DOI: 10.1186/s12876-023-02767-7] [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: 10/03/2022] [Accepted: 04/15/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The mortality rate of gangrenous/perforated appendicitis is higher than that of uncomplicated appendicitis. However, non-operative management of such patients is ineffective. This necessitates their careful exam at presentation to identify gangrenous/perforated appendicitis and aid surgical decision-making. Therefore, this study aimed to develop a new scoring model based on objective findings to predict gangrenous/perforated appendicitis in adults. METHODS We retrospectively analyzed 151 patients with acute appendicitis who underwent emergency surgery between January 2014 and June 2021. We performed univariate and multivariate analyses to identify independent objective predictors of gangrenous/perforated appendicitis, and a new scoring model was developed based on logistic regression coefficients for independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test were performed to assess the discrimination and calibration of the model. Finally, the scores were classified into three categories based on the probability of gangrenous/perforated appendicitis. RESULTS Among the 151 patients, 85 and 66 patients were diagnosed with gangrenous/perforated appendicitis and uncomplicated appendicitis, respectively. Using the multivariate analysis, C-reactive protein level, maximal outer diameter of the appendix, and presence of appendiceal fecalith were identified as independent predictors for developing gangrenous/perforated appendicitis. Our novel scoring model was developed based on three independent predictors and ranged from 0 to 3. The area under the ROC curve was 0.792 (95% confidence interval, 0.721-0.863), and the Hosmer-Lemeshow test showed a good calibration of the novel scoring model (P = 0.716). Three risk categories were classified: low, moderate, and high risk with probabilities of 30.9%, 63.8%, and 94.4%, respectively. CONCLUSIONS Our scoring model can objectively and reproducibly identify gangrenous/perforated appendicitis with good diagnostic accuracy and help in determining the degree of urgency and in making decisions about appendicitis management.
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Affiliation(s)
- Toshimichi Kobayashi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Eiji Hidaka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Itsuki Koganezawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Satoshi Tabuchi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University, Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan.
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Lluís N, Carbonell S, Villodre C, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F. Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes. Int J Surg 2023; 109:1603-1611. [PMID: 37060247 PMCID: PMC10389196 DOI: 10.1097/js9.0000000000000384] [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: 08/30/2022] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIMS Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. METHODS Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. RESULTS The study included 2 645 patients with acute appendicitis [32 years (22-51), 44.3% women], 1 182 with acute cholecystitis [65 years (48-76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50-76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2-4); lap, 2 days (1-4); P <0.001], acute cholecystitis [open, 7 days (4-12); lap, 4 days (3-6); P <0.001], and gastrointestinal tract perforation [open, 11 days (7-17); lap, 6 days (5-8.5); P <0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P <0.001), acute cholecystitis (open, 41%; lap, 21.7%; P <0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P <0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P =0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P =0.013). CONCLUSIONS This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract.
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Affiliation(s)
- Núria Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL
| | - Silvia Carbonell
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Celia Villodre
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Pedro Zapater
- Clinical Pharmacology
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Miguel Cantó
- Institute for Health and Biomedical Research of Alicante, ISABIAL
- Computing, BomhardIP, Alicante, Spain
| | - Luís Mena
- Clinical Documentation, Dr. Balmis General University Hospital
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - José M. Ramia
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
| | - Félix Lluís
- Departments of Surgery
- Institute for Health and Biomedical Research of Alicante, ISABIAL
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Henriksen SR, Christophersen C, Rosenberg J, Fonnes S. Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:205. [PMID: 37219616 DOI: 10.1007/s00423-023-02935-z] [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: 11/22/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Appendicitis is a common cause of acute abdominal pain, and treatment with laparoscopy has become increasingly common during the past two decades. Guidelines recommend that normal appendices are removed if operated for suspected acute appendicitis. It is unclear how many patients are affected by this recommendation. The aim of this study was to estimate the rate of negative appendectomies in patients undergoing laparoscopic surgery for suspected acute appendicitis. METHODS This study was reported following the PRISMA 2020 statement. A systematic search was conducted in PubMed and Embase for retrospective or prospective cohort studies (with n ≥ 100) including patients with suspected acute appendicitis. The primary outcome was the histopathologically confirmed negative appendectomy rate after a laparoscopic approach with a 95% confidence interval (CI). We performed subgroup analyses on geographical region, age, sex, and use of preoperative imaging or scoring systems. The risk of bias was assessed using the Newcastle-Ottawa Scale. Certainty of the evidence was assessed using GRADE. RESULTS In total, 74 studies were identified, summing up to 76,688 patients. The negative appendectomy rate varied from 0% to 46% in the included studies (interquartile range 4-20%). The meta-analysis estimated the negative appendectomy rate to be 13% (95% CI 12-14%) with large variations between the individual studies. Sensitivity analyses did not change the estimate. The certainty of evidence by GRADE was moderate due to inconsistency in point estimates. CONCLUSION The overall estimated negative appendectomy rate after laparoscopic surgery was 13% with moderate certainty of evidence. The negative appendectomy rate varied greatly between studies.
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Affiliation(s)
- Siri R Henriksen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark.
| | - Camilla Christophersen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| | - Jacob Rosenberg
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| | - Siv Fonnes
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
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Mohammed M, Wondimu B, Abera E. A rare case report of viable ileo-ileal knotting of acute abdomen in adults. Int J Surg Case Rep 2023; 106:108285. [PMID: 37148727 DOI: 10.1016/j.ijscr.2023.108285] [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: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Regardless of the cause, bowel obstruction is described as the absence of abnormal transit of intestinal contents. It may involve only the small intestine, the large intestine, or both. It might be brought on by a bodily impediment or widespread modifications to the metabolism, electrolyte balance, or neuroregulatory systems. In the field of general surgery, there are several well-known causes that can vary between developing and developed nations. CASE PRESENTATION In this case report, we describe a case of acute small bowel obstruction secondary to ileo-ileal knotting in 35 years old female patient with a complaint of crampy abdominal pain of 7 hour duration. She had associated frequent vomiting of ingested matter followed by bilious matter. She had also mild abdominal distention. She had history of caesarian section delivery 3 times the last time was 4 months back. CLINICAL DISCUSSION Ileoileal knotting is a unique and rare clinical entity in which a loop of proximal ileum wrap around the distal part of ileum. The presentation includes abdominal pain and distension, vomiting, and obstipation. The majority of cases require resection and anastomosis or exteriorization of the affected segment, and management entails a high index of suspicion and emergent investigation. CONCLUSION We demonstrate an instance of ileo-ileal knotting to highlight the fact that it is an unusual intraoperative finding and, given the rarity of cases, should be taken into account in the alternative diagnosis of patients exhibiting SBO signs and symptoms.
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Affiliation(s)
- Million Mohammed
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Wachemo University, P.O. Box 667, Hossana, Ethiopia
| | - Besufikad Wondimu
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Wollega University, P.O. Box 395, Nekemite, Ethiopia
| | - Ermias Abera
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Wachemo University, P.O. Box 667, Hossana, Ethiopia.
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De Simone B, Kluger Y, Moore EE, Sartelli M, Abu-Zidan FM, Coccolini F, Ansaloni L, Tebala GD, Di Saverio S, Di Carlo I, Sakakushev BE, Bonavina L, Sugrue M, Galante JM, Ivatury R, Picetti E, Chirica M, Wani I, Bala M, Sall I, Kirkpatrick AW, Shelat VG, Pikoulis E, Leppäniemi A, Tan E, Broek RPGT, Gurmu Beka S, Litvin A, Chouillard E, Coimbra R, Cui Y, De' Angelis N, Sganga G, Stahel PF, Agnoletti V, Rampini A, Testini M, Bravi F, Maier RV, Biffl WL, Catena F. The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study. World J Emerg Surg 2023; 18:32. [PMID: 37118816 PMCID: PMC10147354 DOI: 10.1186/s13017-023-00499-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The "timing in acute care surgery" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. METHODS This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. RESULTS Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. CONCLUSION The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a "safe" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
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Affiliation(s)
- Belinda De Simone
- Department of General and Emergency Surgery, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy.
- Unit of General and Metabolic Surgery, Clinique de St Louis, Poissy, France.
| | - Yoram Kluger
- Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, USA
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Federico Coccolini
- Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy
| | - Luca Ansaloni
- Department of General Surgery, University Hospital of Pavia, Pavia, Italy
| | - Giovanni D Tebala
- U.O.C. Chirurgia Digestiva e d'Urgenza, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - Boris E Sakakushev
- Research Institute at Medical University Plovdiv/University Hospital St George, Plovdiv, Bulgaria
| | - Luigi Bonavina
- Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | | | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Solomon Gurmu Beka
- Department of General and Trauma Surgery, Ethiopian Air Force Hospital, Bishoftu, Ethiopia.
| | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Elie Chouillard
- Unit of General and Metabolic Surgery, Clinique de St Louis, Poissy, France
| | - Raul Coimbra
- CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA
| | - Yunfeng Cui
- Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Nicola De' Angelis
- Colorectal and Digestive Surgery Unit - DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Gabriele Sganga
- Department of Emergency Surgery, "A. Gemelli Hospital", Catholic University of Rome, Rome, Italy
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, USA
| | | | - Alessia Rampini
- Department of General and Emergency Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Mario Testini
- Department of Surgery, University Hospital of Bari, Bari, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- Department of General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, eCampus University, CREAS, Ser.In.Ar. Bologna University, Cesena, Italy
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Li Y, Choi H, Leung K, Jiang F, Graham DY, Leung WK. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:553-564. [PMID: 37086739 DOI: 10.1016/s2468-1253(23)00070-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Few studies have examined the temporal trends of Helicobacter pylori prevalence worldwide. We aimed to identify the changes in global prevalence of H pylori infection between 1980 and 2022. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, Scopus, and Web of Science, with no language restrictions, for observational studies on the prevalence of H pylori infection published between Jan 1, 1980, and Dec 31, 2022. Conference papers, meta-analyses, reviews, and case reports were excluded. We divided the study timeframe into four periods: 1980-90, 1991-2000, 2001-10, and 2011-22. Summary data were extracted from each selected publication. The prevalence of H pylori and its temporal trend were analysed according to WHO region, World Bank income level, WHO universal health coverage service coverage index of the country or region, sex and age of the patient, study type, and diagnostic method. The pooled prevalence was estimated by a random-effect meta-analysis, and the significance of the associated factors was analysed by multivariable meta-regression. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 2022100026. FINDINGS Of the 56 967 records identified, 5236 were included in the quality assessment stage and 224 studies-from 71 countries or regions from all six WHO regions and including 2 979 179 individuals-were included in the final analysis. Significant heterogeneity was found between studies (I2=99·9%). The estimated global prevalence of H pylori infection decreased from 58·2% (95% CI 50·7-65·8) in the 1980-90 period to 43·1% (40·3-45·9) in the 2011-22 period. Prevalence was relatively static between 1991 and 2010 but declined sharply between 2011 and 2022, with the largest decline in the WHO African region. Overall, a lower prevalence of H pylori infection was reported in younger people, high-income countries, or countries with high levels of universal health coverage, and by retrospective studies. Studies based on serological diagnostic methods generally reported higher H pylori prevalence than studies based on non-serological methods (53·2% [49·8-56·6] vs 41·1% [38·1-44·2]) and fluctuated less over time. INTERPRETATION This meta-analysis shows a declining trend of H pylori prevalence globally, particularly in the 2011-22 period. These results could help to inform future health policy on prevention and management of this important infection. However, a considerable degree of heterogeneity exists between studies and further population-based epidemiological studies are needed. FUNDING None.
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Affiliation(s)
- Yunhao Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Horace Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Kathy Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China; Department of Research, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fang Jiang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - David Y Graham
- Department of Medicine, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Wai K Leung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Peeters T, Houben B, Cools P, Thys Y, D'Onofrio V, Martens S, Jaeger M, Doppenberg-Oosting M, Netea MG, Gyssens IC. An observational study on lifestyle and environmental risk factors in patients with acute appendicitis. Heliyon 2023; 9:e15131. [PMID: 37128345 PMCID: PMC10147974 DOI: 10.1016/j.heliyon.2023.e15131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
Purpose Acute appendicitis is a common abdominal emergency worldwide. This study aimed at characterizing environmental risk factors influencing the development and severity of acute appendicitis. Methods Patients from a Belgian acute appendicitis cohort (n = 374) and healthy controls from the 500 functional genomics (500FG) cohort (n = 513) were compared. Individuals with a history of appendectomy (n = 1067) and without a history of appendectomy (n = 8656) were available from the Nijmegen Biomedical Study (NBS). Questionnaires on demographics, lifestyle and environment were available. Binary logistic regression was used for prediction models. Results Fifteen risk factors for developing acute appendicitis were identified. Binary logistic regression showed that 7 were independent risk factors: family history of acute appendicitis, having grown up in a rural environment, having a lower education, probiotic use as well as antibiotic use increased the risk of developing appendicitis. Fruit and fiber-rich vegetable consumption decreased the risk. Findings on vegetable consumption, smoking and level of education were replicated in the NBS population. Independent risk factors for complicated appendicitis were being male, higher age, and a delay to diagnosis of more than 48 h. Conclusions Environmental exposures influence the risk of developing appendicitis. Further research into these factors is needed.
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Titus NET, Liekeh NM, George NFF, Akayun S, Rosine SG, Richie NJ, Ndouh NR, Christopher PT. Spectrum, Management, and Outcomes of Abdominal Surgical Emergencies at a Referral Hospital in North West Cameroon. JOURNAL OF ACUTE CARE SURGERY 2023. [DOI: 10.17479/jacs.2023.13.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Purpose: Abdominal surgical emergencies are a major health burden in low- and middle-income countries where management is often very challenging, and associated with high morbidity and mortality. The spectrum, management, and outcomes of abdominal surgical emergencies needs to be updated.Methods: This was a hospital-based retrospective cross-sectional study carried out in Bamenda, Cameroon over a 2-year period. Records of patients who met the inclusion criteria were reviewed, with pre-, intra- and postoperative data collected and analyzed.Results: There were 207 patients included in this retrospective review (male to female ratio of 1.4:1. The mean age was 47.4 (± 19.4) years. Intestinal obstruction (34.8%) and perforated peptic ulcers (15.5%) were the most common abdominal surgical emergencies. The median delay and interquartile range to presentation and in-hospital delay were 6 (4) days and 8 (12) hours, respectively. The mean length of hospital stay post-surgery was 11days. There were 48.3% of patients who developed a complication; 34.78% were major, 17.9% had an unplanned reoperation, and 15 (7.2%) were readmitted after discharge. The 30-day in hospital mortality was 19.8%. Mortality was independently associated with a high American Society of Anesthesiologists (ASA) score; ASA score > 3, age > 60 years, and referral from other health facilities.Conclusion: Intestinal obstructions from intraperitoneal neoplasm is the most common cause of abdominal surgical emergency in North West Cameroon. Abdominal emergencies here are associated with a very high morbidity and mortality in males > 60 years with an ASA score > 3 and with more than one comorbidity.
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Pinto MYP, Hool G. An Ovarian Teratoma Mimicking Complicated Acute Appendicitis: A Case Report and Literature Review. Cureus 2023; 15:e36713. [PMID: 37113339 PMCID: PMC10129350 DOI: 10.7759/cureus.36713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Acute appendicitis is one of the most common causes of right iliac fossa (RIF) pain in the younger population. However, multiple other pathologies presenting with RIF pain can mimic acute appendicitis. In the female gender, the differentials for RIF pain are broader. Multiple pathologies can present with similar symptomatology that can mimic acute appendicitis, leading to an incorrect diagnosis, unnecessary surgical interventions, and complications. In females of reproductive age, gynaecological causes can present similarly. Here, we present a case of an ovarian teratoma mimicking acute complicated appendicitis. A female of reproductive age presented to our hospital with RIF pain of six days, associated with fever, nausea, vomiting, and anorexia. A clinical diagnosis of acute complicated appendicitis was suspected, and further imaging was arranged to confirm the diagnosis. Imaging showed a normal appendix with a right adnexal mass separated from the ovary, representing a teratoma. She underwent elective surgery for the excision of teratoma after further investigations. Ovarian teratomas are not a common mimicker of appendicitis. One should consider possible gynaecological causes as a differential for RIF pain. Due to the wide variety of differentials, when in doubt, especially in the female gender, further imaging should be considered for confirmation of diagnosis.
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Nwanna-Nzewunwa O, Agwang E, Carvalho M, Ajiko MM, Oke R, Yoon C, Diab MM, Kirya F, Marseille E, Juillard C, Dicker RA. A cost-effectiveness analysis of surgical care delivery in Eastern Uganda-a societal perspective. BMC Health Serv Res 2023; 23:256. [PMID: 36918844 PMCID: PMC10015833 DOI: 10.1186/s12913-023-09216-x] [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: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The mismatch between the global burden of surgical disease and global health funding for surgical illness exacerbates disparities in surgical care access worldwide. Amidst competing priorities, governments need to rationally allocate scarce resources to address local needs. To build an investment case for surgery, economic data on surgical care delivery is needed. This study focuses on femur fractures. METHODS This prospective cohort study at Soroti Regional Referral Hospital (SRRH), captured demographic, clinical, and cost data from all surgical inpatients and their caregivers at SRRH from February 2018 through July 2019. We performed descriptive and inferential analyses. We estimated the cost effectiveness of intramedullary nailing relative to traction for femur fractures by using primary data and making extrapolations using regional data. RESULTS Among the 546 patients, 111 (20.3%) had femur fractures and their median [IQR] length of hospitalization was 27 days [14, 36 days]. The total societal cost and Quality Adjusted Life Year (QALY) gained was USD 61,748.10 and 78.81 for femur traction and USD 23,809 and 85.47 for intramedullary nailing. Intramedullary nailing was dominant over traction of femur fractures with an Incremental Cost Effectiveness Ratio of USD 5,681.75 per QALY gained. CONCLUSION Femur fractures are the most prevalent and most expensive surgical condition at SRRH. Relative to intramedullary nailing, the use of femur traction at SRRH is not cost effective. There is a need to explore and adopt more cost-effective approaches like internal fixation.
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Affiliation(s)
- Obieze Nwanna-Nzewunwa
- Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Esther Agwang
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rasheedat Oke
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher Yoon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mohamed M Diab
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Fred Kirya
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Elliot Marseille
- Principal, Health Strategies International, 555 59th Street, Oakland, CA, USA
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA
| | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA.
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The global, regional, and national burden of appendicitis in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. BMC Gastroenterol 2023; 23:44. [PMID: 36814190 PMCID: PMC9945388 DOI: 10.1186/s12876-023-02678-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Appendicitis is the most common abdominal surgical emergency worldwide, and its burden has been changing. We report the level and trends of appendicitis prevalence, and incidence; and years lived with disability (YLD) in 204 countries and territories from 1990 to 2019, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS The numbers and age-standardized prevalence, incidence, and YLD rates per 100,000 population of appendicitis were estimated across regions and countries by age, sex, and sociodemographic index (SDI). All the estimates were reported with 95% uncertainty intervals (UIs). RESULTS Globally, the age-standardized prevalence and incidence rates of appendicitis in 2019 were 8.7 (95% UI 6.9 to 11.0) and 229.9 (95% UI 180.9 to 291.0) per 100,000 population, with increases of 20.8% (95% UI 18.9 to 23.0%) and 20.5% (95% UI 18.7 to 22.8%) from 1990 to 2019, respectively. Additionally, the age-standardized YLDs rate was 2.7 (95% UI 1.8 to 3.9) in 2019, with an increase of 20.4% (95% UI 16.2 to 25.1%) from 1990 to 2019. In 2019, the age-standardized prevalence, incidence, and YLD rates peaked in the 15-to-19-year age groups in both male and female individuals. However, no statistically significant differences were observed between the male and female individuals in all groups. Ethiopia, India, and Nigeria showed the largest increases in the age-standardized prevalence rate between 1990 and 2019. Generally, positive associations were found between the age-standardized YLD rates and SDI at the regional and national levels. CONCLUSIONS Appendicitis remains a major public health challenge globally. Increasing awareness of appendicitis and its risk factors and the importance of early diagnosis and treatment is warranted to reduce its the burden.
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Forssten MP, Kaplan LJ, Tolonen M, Martinez-Casas I, Cao Y, Walsh TN, Bass GA, Mohseni S. Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective. Eur J Trauma Emerg Surg 2023; 49:57-67. [PMID: 36658305 PMCID: PMC9851576 DOI: 10.1007/s00068-022-02149-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/14/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. METHODS Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020-May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. RESULTS Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. CONCLUSION During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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Affiliation(s)
- Maximilian Peter Forssten
- Division of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, USA
| | - Matti Tolonen
- Helsinki University Hospital HUS Meilahden Tornisairaala, Helsinki, Finland
| | - Isidro Martinez-Casas
- Servicio de Cirugía General, Unidad de Cirugía de Urgencias, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Thomas N Walsh
- Royal College of Surgeons in Ireland Medical University, Busaiteen, Bahrain
| | - Gary Alan Bass
- Division of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Örebro, Sweden
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Örebro, Sweden.
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Jumbam DT, Amoako E, Blankson PK, Xepoleas M, Said S, Nyavor E, Gyedu A, Ampomah OW, Kanmounye US. The state of surgery, obstetrics, trauma, and anaesthesia care in Ghana: a narrative review. Glob Health Action 2022; 15:2104301. [PMID: 35960190 PMCID: PMC9586599 DOI: 10.1080/16549716.2022.2104301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Conditions amenable to surgical, obstetric, trauma, and anaesthesia (SOTA) care are a major contributor to death and disability in Ghana. SOTA care is an essential component of a well-functioning health system, and better understanding of the state of SOTA care in Ghana is necessary to design policies to address gaps in SOTA care delivery. Objective The aim of this study is to assess the current situation of SOTA care in Ghana. Methods A situation analysis was conducted as a narrative review of published scientific literature. Information was extracted from studies according to five health system domains related to SOTA care: service delivery, workforce, infrastructure, finance, and information management. Results Ghanaians face numerous barriers to accessing quality SOTA care, primarily due to health system inadequacies. Over 77% of surgical operations performed in Ghana are essential procedures, most of which are performed at district-level hospitals that do not have consistent access to imaging and operative room fundamentals. Tertiary facilities have consistent access to these modalities but lack consistent access to oxygen and/or oxygen concentrators on-site as well as surgical supplies and anaesthetic medicines. Ghanaian patients cover up to 91% of direct SOTA costs out-of-pocket, while health insurance only covers up to 14% of the costs. The Ghanaian surgical system also faces severe workforce inadequacies especially in district-level facilities. Most specialty surgeons are concentrated in urban areas. Ghana’s health system lacks a solid information management foundation as it does not have centralized SOTA databases, leading to incomplete, poorly coded, and illegible patient information. Conclusion This review establishes that surgical services provided in Ghana are focused primarily on district-level facilities that lack adequate infrastructure and face workforce shortages, among other challenges. A comprehensive scale-up of Ghana’s surgical infrastructure, workforce, national insurance plan, and information systems is warranted to improve Ghana’s surgical system.
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Affiliation(s)
- Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.,Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Emmanuella Amoako
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana.,Department of Paediatrics and Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Paa-Kwesi Blankson
- Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Meredith Xepoleas
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Shady Said
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Elikem Nyavor
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Surgery, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Opoku W Ampomah
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.,Plastics and Reconstructive Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ulrick Sidney Kanmounye
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.,Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
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Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies. Heliyon 2022; 8:e11911. [PMID: 36478845 DOI: 10.1016/j.heliyon.2022.e11911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
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