1
|
Rodríguez-Méndez BG, López-Callejas R, Mercado-Cabrera A, Peña-Eguiluz R, Valencia-Alvarado R, Betancourt-Ángeles M, Berrones-Stringel G, Jaramillo-Martínez C. Harnessing Non-Thermal Plasma to Supercharge Recovery in Abdominal Surgeries: A Pilot Study. J Clin Med 2024; 13:408. [PMID: 38256546 PMCID: PMC10816705 DOI: 10.3390/jcm13020408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: This study aims to evaluate the efficacy and safety of non-thermal plasma (NTP) therapy in accelerating wound healing in patients who have undergone laparoscopic and open surgeries. (2) Methods: NTP was applied using a needle-type reactor with an irradiance of 0.5 W/cm2 on the surgical wounds of fifty patients after obtaining informed consent. Three NTP treatments, each lasting three minutes, were administered hourly. (3) Results: The pilot study showed that NTP-treated surgical wounds healed completely without any signs of infection, dehiscence, pain, or itching. Notably, patients reported minimal pain after the NTP treatment. Visual assessments conducted twenty-four hours after surgery revealed no redness or fluid discharge. Comparisons with traditionally sutured wounds indicated that NTP-treated wounds healed at a rate equivalent to seven days. (4) Conclusions: The application of NTP in laparoscopic and open wounds proved safe and effective, expediting the wound healing process and eliminating clinical risks post-surgery. Significantly, NTP facilitated a healing rate within twenty-four hours, equivalent to seven days for suture-treated wounds, significantly reducing the hospitalization time to a single day. These findings highlight the potential of NTP to be a transformative approach for promoting postoperative recovery.
Collapse
Affiliation(s)
- Benjamín G. Rodríguez-Méndez
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Régulo López-Callejas
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Antonio Mercado-Cabrera
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Rosendo Peña-Eguiluz
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Raúl Valencia-Alvarado
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Mario Betancourt-Ángeles
- Medical Center ISSEMyM Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Mexico
| | - Guillermo Berrones-Stringel
- Medical Center ISSEMyM Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Mexico
| | - César Jaramillo-Martínez
- Medical Center ISSEMyM Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Mexico
| |
Collapse
|
2
|
Durán Muñoz-Cruzado V, Navarro Morales L, Pareja Ciuró F, Aparicio Sánchez D, Tallón Aguilar L, Padillo-Ruiz J. Safety, Efficacy, and Cost-effectiveness of Outpatient Surgery for Uncomplicated Acute Appendicitis: The PENDI-CSI Randomized Clinical Trial. Ann Surg 2024; 279:24-28. [PMID: 37641981 DOI: 10.1097/sla.0000000000006083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To evaluate the safety, efficacy, and cost-effectiveness of outpatient appendectomy in patients with uncomplicated acute appendicitis. BACKGROUND Given that acute appendicitis is the most common cause of acute abdomen, the introduction of outpatient appendectomy protocols could significantly improve the effectiveness and sustainability of health care systems. METHODS A total of 300 patients were enrolled from October 2018 to June 2021 in the PENDI-CSI randomized clinical trial: 149 were assigned to the outpatient surgery (OPS) group and 151 to the inpatient surgery (IPS) group, followed by 1 month postoperatively. All patients were aged older than 14 years and had uncomplicated acute appendicitis. Exclusion criteria were pregnancy, neoplasms, inflammatory bowel disease, and high anesthetic risk (ASA IV). The OPS group was discharged from the postanesthesia care unit while the IPS group was admitted. RESULTS In total, 128 patients in the OPS group (85.9%) were discharged without admission. Predictors whether patients in the OPS group had to be admitted were aged over 31 years [relative risk (RR): 2.42 (1.04-5.65)], hypertension [RR: 6.21 (3.22-11.97)], anesthetic risk II-III [RR: 2.63 (1.17-5.94)], previous abdominal surgery [RR: 3.34 (1.55-7.20)], postoperative pain with visual analog scale >6 [RR: 4.28 (2.67-6.86)], and postoperative fear [RR: 2.2 (1.04-4.67)]. There were no differences in terms of complications, readmissions, and reinterventions, and the perceived quality was similar in both groups. The outpatient modality produced savings of €1 034.97 per patient ( P < 0.001). CONCLUSIONS Outpatient appendectomy is safe and effective for uncomplicated acute appendicitis. Patient-perceived quality is similar to that of IPS, although it successfully reduces hospital costs compared with inpatient appendectomy.
Collapse
Affiliation(s)
- Virgina Durán Muñoz-Cruzado
- Division of General Surgery, Biomedical Institute of Seville (IBIS), Virgen del Rocío University Hospital. Seville, Spain
| | | | | | | | | | | |
Collapse
|
3
|
Ambulatory appendectomy for acute appendicitis: Can we treat all the patients? A prospective study of 451 consecutive ambulatory appendectomies out of nearly 2,000 procedures. Surgery 2023; 173:1129-1136. [PMID: 36775758 DOI: 10.1016/j.surg.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Acute appendicitis represents the leading cause of acute gastrointestinal disorders, but only a small series regarding ambulatory appendectomies are available. The aim of this study was to report the results of ambulatory (day-case) appendectomy for acute appendicitis in a large consecutive cohort and to improve selection criteria in order to extend the indications. METHODS All appendectomy procedures for acute appendicitis (March 2013 to June 2020) were included retrospectively. Criteria to select patients eligible for ambulatory appendectomy were based on our clinico-radiological St-Antoine's score ≥4. RESULTS In total, 1,730 consecutive patients had an appendectomy for acute appendicitis: 1,279 (74%) in conventional settings and 451 (26%) in ambulatory settings. In the conventional group, 360 (28%) patients had surgery deferred to the next morning, whereas in the ambulatory group, 309 patients (70%) were readmitted the next morning (P < .0001). In the ambulatory group, 376 (83%) patients satisfied the criteria (score ≥4), and 90.9% were discharged on postoperative day 0. Rates of unplanned consultation and readmission were not significantly different (5.1% vs 6.6% P = .243). Multivariate analysis of the entire cohort confirmed absence of radiological perforation as highly predictive of early discharge (odds ratio = 6.073). In our cohort, these patients had an early discharge rate of 86.4% compared to 90.2% in those with a St-Antoine's score ≥4. Considering only radiological evidence of perforation as a selection criterion for ambulatory appendectomy, 581 more patients would be eligible for ambulatory surgery (+60%). CONCLUSION Ambulatory surgery for acute appendicitis based on St-Antoine's score is safe. We propose to extend the indication for ambulatory management to all patients without radiological evidence of perforation.
Collapse
|
4
|
Sookpotarom P, Na Ayudhya VC, Tangsirapat V. Are only a few hours adequate for hospitalisation following mini-incision open appendectomy in paediatric patients? Afr J Paediatr Surg 2023; 20:28-33. [PMID: 36722566 PMCID: PMC10117014 DOI: 10.4103/ajps.ajps_174_21] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A very short hospital length of stay following an open appendectomy in children with acute simple appendicitis has never been mentioned yet in the literature. The authors reviewed the outcome of these paediatric patients who were treated with the open technique. MATERIALS AND METHODS In this analytical cohort observational study, we retrospectively reviewed the medical records of the 115 consecutive patients who underwent open appendectomy from June 2017 to July 2021. RESULTS There were 84 patients whose appendices were inflammatory or suppurative and appendectomies were done only through McBurney's point. Of these, the average age was 9.11 ± 2.67 years. The mean length of the incision was 1.95 ± 0.48 cm. Nearly one-third (25/85) were discharged within 3 h following surgery. Of the remaining cases, nine patients were discharged within the same day. There were increased percentages of patients who were eligible for early discharge in each consecutive year. CONCLUSION The idea of immediate discharge within 3 h seems to be feasible for children with acute simple appendicitis who were treated with open appendectomy. We believe that the practice will be widely acknowledged and proceed to reduce the resources and the expenses in the hospital.
Collapse
Affiliation(s)
- Paiboon Sookpotarom
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Vichack Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Vorapatu Tangsirapat
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| |
Collapse
|
5
|
Elvira López J, Sales Mallafré R, Padilla Zegarra E, Carrillo Luna L, Ferreres Serafini J, Tully R, Memba Ikuga R, Jorba Martin R. Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial. World J Emerg Surg 2022; 17:59. [PMID: 36419071 PMCID: PMC9685067 DOI: 10.1186/s13017-022-00465-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol. METHODS Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay. RESULTS Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention. CONCLUSION Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost. TRIAL REGISTRATION Registration: www. CLINICALTRIALS gov (NCT05401188) Clinical Trial ID: NCT05401188.
Collapse
Affiliation(s)
- Jordi Elvira López
- grid.410367.70000 0001 2284 9230General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain ,grid.420268.a0000 0004 4904 3503Institut d’investigació Sanitaria Pere Virgili (IISPV), 43007 Tarragona, Spain
| | - Ricard Sales Mallafré
- grid.410367.70000 0001 2284 9230General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain ,grid.420268.a0000 0004 4904 3503Institut d’investigació Sanitaria Pere Virgili (IISPV), 43007 Tarragona, Spain
| | - Erlinda Padilla Zegarra
- grid.410367.70000 0001 2284 9230General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain ,grid.420268.a0000 0004 4904 3503Institut d’investigació Sanitaria Pere Virgili (IISPV), 43007 Tarragona, Spain
| | - Luis Carrillo Luna
- grid.410367.70000 0001 2284 9230Anesthesiology Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain
| | - Joan Ferreres Serafini
- grid.410367.70000 0001 2284 9230General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain ,grid.420268.a0000 0004 4904 3503Institut d’investigació Sanitaria Pere Virgili (IISPV), 43007 Tarragona, Spain
| | - Roisin Tully
- grid.412751.40000 0001 0315 8143General Surgery Department, St Vincent’s University Hospital, Dublin, Ireland
| | - Robert Memba Ikuga
- grid.410367.70000 0001 2284 9230General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain ,grid.420268.a0000 0004 4904 3503Institut d’investigació Sanitaria Pere Virgili (IISPV), 43007 Tarragona, Spain
| | - Rosa Jorba Martin
- grid.410367.70000 0001 2284 9230General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili University, Tarragona, Spain ,grid.420268.a0000 0004 4904 3503Institut d’investigació Sanitaria Pere Virgili (IISPV), 43007 Tarragona, Spain
| |
Collapse
|
6
|
Fazzalari A, Srinivas S, Panjwani S, Pozzi N, Friedrich A, Sheoran R, Sabato J, Durocher D, Reznek M, Aiello F, Litwin D, Cahan MA. A Fast-track Pathway for Emergency General Surgery at an Academic Medical Center. J Surg Res 2021; 267:1-8. [PMID: 34116389 DOI: 10.1016/j.jss.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fast Track Pathways (FTP) directed at reducing length of stay (LOS) and overall costs are being increasingly implemented for emergency surgeries. The purpose of this study is to evaluate implementation of a FTP for Emergency General Surgery (EGS) at an academic medical center (AMC). METHODS The study included 165 patients at an AMC between 2016 and 2018 who underwent laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), or laparoscopic inguinal hernia repair (LI). The FTP group enrolled 89 patients, and 76 controls prior to FTP implementation were evaluated. Time to surgery (TTS), LOS, and post-operative LOS between groups were compared. Direct costs, reimbursements, and patient reported satisfaction (satisfaction 1 = never, 4 = always) were also studied. RESULTS The sample was 60.6% female, with a median age of 40 years. Case distribution differed slightly (56.2% versus 42.1% LA, 40.4% versus 57.9% LC, FTP versus control), but TTS was similar between groups (11h39min versus 10h02min, P = 0.633). LOS was significantly shorter in the FTP group (15h17min versus 29h09min, P < 0.001), reflected by shorter post-operative LOS (3h11min versus 20h10min, P< 0.001), fewer patients requiring a hospital bed and overnight stay (P < 0.001). Direct costs were significantly lower in the FTP group, reimbursements were similar (P < 0.001 and P = 0.999 respectively), and average patient reported satisfaction was good (3.3/4). CONCLUSION In an era focused on decreasing cost, optimizing resources, and ensuring patient satisfaction, a FTP can play a significant role in EGS. At an AMC, an EGS FTP significantly decreased LOS, hospital bed utilization while not impacting reimbursement or patient satisfaction.
Collapse
Affiliation(s)
- Amanda Fazzalari
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - Shruthi Srinivas
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Suraj Panjwani
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - Natalie Pozzi
- The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - Ann Friedrich
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Reeti Sheoran
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joseph Sabato
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dawn Durocher
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Martin Reznek
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Francesco Aiello
- Department of Vascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Demetrius Litwin
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mitchell A Cahan
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
| |
Collapse
|
7
|
Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:1297-1309. [PMID: 33575890 PMCID: PMC8119270 DOI: 10.1007/s00384-021-03872-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce costs and improve patient satisfaction. The purpose of this study was to assess the safety of same-day discharge after appendectomy for acute appendicitis. METHODS A systematic review was performed according to PRISMA guidelines. A literature search of EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central, and Google Scholar was conducted from inception to April 14, 2020. Two reviewers independently screened the literature and selected studies that addressed discharge on the same calendar day as the appendectomy. Risk of bias was assessed with the ROBINS-I tool. Main outcomes were hospital readmission, complications, and unplanned hospital visits in the postoperative course. A random effects model was used to pool risk ratios for the main outcomes. RESULTS Of the 1912 articles screened, 17 comparative studies and 8 non-comparative studies met the inclusion criteria. Most only included laparoscopic procedure for uncomplicated appendicitis. Most studies were considered at moderate or serious risk of bias. In meta-analysis, same-day discharge (vs. overnight hospitalization) was not associated with increased rates of readmission, complication, and unplanned hospital visits. Non-comparative studies demonstrated low rates of readmission, complications, and unplanned hospital visits after same-day discharge. CONCLUSION This study suggests that same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis is safe without an increased risk of readmission, complications, or unplanned hospital visits. Hence, same-day discharge may be further encouraged in selected patients. TRIAL REGISTRATION PROSPERO registration no. CRD42018115948.
Collapse
|
8
|
Risk Factors for Readmission After Short-Hospital-Stay Laparoscopic Appendectomy. World J Surg 2020; 44:4006-4011. [PMID: 32794034 DOI: 10.1007/s00268-020-05730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Single-day discharge is a common practice among patients undergoing laparoscopic appendectomy (LA). We aimed to determine risk factors associated with readmission in patients with short hospital stay after LA. METHODS We performed a retrospective analysis of all patients who underwent LA during the period 2006-2019. Patients with length of hospital stay shorter than 24 h were included. Demographics, operative variables, and postoperative outcomes were analyzed. Multivariable logistic regression was performed to determine risk factors for readmission. RESULTS A total of 2009 LA were performed during the study period; 1506 (75%) patients had short hospital stay and were included in the analysis. Median age was 31 (14-85) years, and 720 (48%) were female. Mild peritonitis was diagnosed in 423 (28%) patients, and 121 (8%) had gangrenous/perforated appendicitis. Mean surgical time was 51(14-180) min. Conversion rate was 0.4%. There were 143 (9%) postoperative complications, including 29 (1.9%) patients with postoperative intra-abdominal abscess. Nine patients (0.6%) underwent reoperation, and only 26 (1.7%) patients were readmitted. The mean time to hospital readmission was 6 (1-14) days. Although age >50 years, obesity, mild peritonitis, and complicated appendicitis were more frequent among patients readmitted, only age >50 years (OR 3.54 95% CI 1.51-8.30) and mild peritonitis (OR 6.16 95% CI 1.80-34.93) were found as independent risk factors for readmission. CONCLUSION Most patients undergoing LA can be safely discharged within 24 h of admission. Patients over 50 years old and/or with localized peritonitis have significantly higher risk of readmission and therefore may need a closer postoperative follow-up.
Collapse
|
9
|
Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, Maggiori L. [Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis]. ACTA ACUST UNITED AC 2020; 157:S33-S43. [PMID: 32355509 PMCID: PMC7190476 DOI: 10.1016/j.jchirv.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
La saturation intrahospitalière liée à l’arrivée massive de patients atteints du COVID-19 nécessitant une prise en charge urgente conduit à reconsidérer la prise en charge des autres patients. Différer au maximum les hospitalisations et les opérations chirurgicales non urgentes est un des objectifs des chirurgiens afin de désengorger autant que possible le système de soins. Alors que la majorité des opérations programmées sont annulées, la réduction de la chirurgie d’urgence est évidemment compliquée à proposer sans altérer la qualité de la prise en charge et conduire à une perte de chance pour le patient. Cependant, l’appendicite aiguë constitue une situation spécifique bien particulière et la fréquence de cette pathologie conduit à considérer ce cas particulier. En effet, tandis que le traitement recommandé de l’appendicite aiguë non compliquée est chirurgical, l’alternative non chirurgicale par antibiothérapie seule a été largement évaluée dans la littérature au cours de travaux de qualité. Dans la mesure où la limite principale du traitement médical exclusif de l’appendicite aiguë non compliquée est le risque de récidive à distance, cette option thérapeutique représente une alternative de choix pour réduire la surcharge intrahospitalière dans ce contexte de crise sanitaire. L’objectif de ce travail est donc de mettre à disposition des médecins et des chirurgiens un guide pratique issu d’une analyse de la littérature sur le traitement médical de l’appendicite aiguë non compliquée de l’adulte afin de pouvoir proposer ce traitement alternatif aux bons patients et dans des bonnes conditions, notamment lorsque l’accès au bloc opératoire est impossible.
Collapse
Affiliation(s)
- M Collard
- Service de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012, Paris, France
| | - Z Lakkis
- Service de chirurgie digestive et oncologique , et de transplantation hépatique, CHU de Besançon, 2, boulevard Alexander-Fleming, 25000, Besançon, France
| | - J Loriau
- Service de chirurgie viscérale, groupe hospitalier Paris Saint-Joseph, 75014, Paris, France
| | - D Mege
- Service de chirurgie digestive, assistance publique hôpitaux de Marseille, hôpital de la Timone, CHU de Marseille, France
| | - C Sabbagh
- Service de chirurgie digestive, CHU Amiens-Picardie, 8000 Amiens, France.,Unité de recherche SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules-Verne, 80025 Amiens, France
| | - J H Lefevre
- Service de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012, Paris, France
| | - L Maggiori
- Service de chirurgie colorectale, hôpital Beaujon, université de Paris, AP-HP, 92110 Clichy, France
| |
Collapse
|
10
|
Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, Maggiori L. Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis. J Visc Surg 2020; 157:S33-S42. [PMID: 32362368 PMCID: PMC7181971 DOI: 10.1016/j.jviscsurg.2020.04.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The massive inflow of patients with COVID-19 requiring urgent care has overloaded hospitals in France and impacts the management of other patients. Deferring hospitalization and non-urgent surgeries has become a priority for surgeons today in order to relieve the health care system. It is obviously not simple to reduce emergency surgery without altering the quality of care or leading to a loss of chance for the patient. Acute appendicitis is a very specific situation and the prevalence of this disease leads us to reconsider this particular disease in the context of the COVID-19 crisis. Indeed, while the currently recommended treatment for uncomplicated acute appendicitis is surgical appendectomy, the non-surgical alternative of medical management by antibiotic therapy alone has been widely evaluated by high-quality studies in the literature. Insofar as the main limitation of exclusively medical treatment of uncomplicated acute appendicitis is the risk of recurrent appendicitis, this treatment option represents an alternative of choice to reduce the intra-hospital overload in this context of health crisis. The aim of this work is therefore to provide physicians and surgeons with a practical guide based on a review of the literature on the medical treatment of uncomplicated acute appendicitis in adults, to offer this alternative treatment to the right patients and under good conditions, especially when access to the operating room is limited or impossible.
Collapse
Affiliation(s)
- M Collard
- Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, 2, boulevard Alexander Fleming, 25000, Besançon, France
| | - J Loriau
- Department of Visceral Surgery, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - D Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - C Sabbagh
- Digestive surgery department, CHU Amiens-Picardie, 80000 Amiens, France; Research Unit SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules Verne, 80025 Amiens, France
| | - J H Lefevre
- Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - L Maggiori
- Department of Colorectal surgery, Beaujon Hospital, Paris University, AP-HP, 92110, Clichy, France.
| |
Collapse
|