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Uttinger K, Baum P, Diers J, Seehofer D, Germer CT, Wiegering A. The impact of surgical timing on outcome in acute appendicitis in adults: a retrospective observational population-based cohort study. Int J Surg 2024; 110:4850-4858. [PMID: 38701524 PMCID: PMC11325913 DOI: 10.1097/js9.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Acute appendicitis is a global disease with high incidence. The main objective was to assess the association between time from admission to surgery (TAS) and surgery during emergency hours with operative outcome in light of conflicting evidence. METHODS This is a retrospective population-wide analysis of hospital billing data (2010-2021) of all adult patient records of surgically treated cases of acute appendicitis in Germany by TAS. The primary outcome was a composite clinical endpoint (CCE; prolonged length of stay, surgical site infection, interventional draining after surgery, revision surgery, ICU admission and/or in-hospital mortality). Cases of complicated appendicitis were identified using diagnosis (ICD-10) and procedural codes (resection beyond appendectomy). RESULTS 855 694 patient records were included, of which 27·6% (236,481) were complicated cases of acute appendicitis. 49·0% (418,821) were females and median age was 37 (interquartile range 22·5-51·5). Age, male sex, and comorbidity were associated with an increased proportion of CCE and in-hospital mortality. TAS was associated with a clinically relevant increase of CCE after 12 h in complicated appendicitis [Odd's ratio (OR), 1·19, 95% CI: 1·14-1·21] and after 24 h in uncomplicated appendicitis (OR 1·10, 95% CI: 1·02-1·19). Beyond the primary endpoint, the proportion of complicated appendicitis increased after TAS of 72 h. Surgery during emergency hours (6 pm-6.59 am) was associated with an increase of CCE and mortality (OR between 1·14 and 1·49). Age, female sex, night-time admission, weekend admission, a known previous surgery, obesity, and therapeutic anticoagulation were associated with delayed performance of surgery. CONCLUSION This work found an increase of a CCE after TAS of 12 h for complicated appendicitis and an increase of the CCE after TAS of 24 h for uncomplicated appendicitis with a stable proportion of complicated appendicitis in these time windows. Both CCE and mortality were increased if appendectomy was performed during emergency hours.
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Affiliation(s)
- Konstantin Uttinger
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Medical Centre
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Medical Centre, Leipzig
| | - Philip Baum
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Medical Centre
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Medical Centre, Heidelberg, Germany
| | - Johannes Diers
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Medical Centre
- Marienkrankenhaus, Hamburg
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Medical Centre, Leipzig
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Medical Centre
- Comprehensive Cancer Centre Mainfranken, Würzburg University Medical Centre
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Medical Centre
- Comprehensive Cancer Centre Mainfranken, Würzburg University Medical Centre
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg
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Dibekoğlu C. Does the length matter in acute appendicitis for the perforation risk?: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e32001. [PMID: 36482564 PMCID: PMC9726347 DOI: 10.1097/md.0000000000032001] [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] [Indexed: 12/13/2022] Open
Abstract
It has been hypothesized that short appendices increase intraluminal pressure more rapidly and perforate more frequently than long appendices. Two hundred seventy-seven adult patients were retrospectively analyzed and underwent an appendectomy between January 2015 and August 2021. Data extracted from patient records included sex, age, time from admission to operation (hospital interval), weekday or weekend operation time, and operative and pathological findings. Operation was performed on 273 patients, of whom 178 (65.2%) were male and 95 (34.8%) female. The mean age of the male patients was 31.7 ± 08 (range 18-67), and that of the female patients was 38.9 ± 1.4 (range 18-78). Perforation was observed in 57 (20.9%) patients. Sex was not a factor in the development of perforation (P = .95). The mean age of the patients with and without perforation was 40.1 ± 2.2 and 32.7 ± 0.7, respectively. The perforation rate increased with age (P = .003). Appendix lengths were similar in both groups, and length was not a factor in the development of perforation (P = .83). This study found that the development of perforated appendicitis is not related to the length of the appendix. The risk of perforation increased with age.
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Affiliation(s)
- Cengiz Dibekoğlu
- Department of General Surgery, Demiroglu Bilim University, İstanbul, Turkey
- * Correspondence: Cengiz Dibekoğlu, Istanbul Florence Nightingale Hastanesi, Abidei Hurriyet cad No. 156 Sisli Istanbul 34381, Turkey (e-mail: )
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Bayissa BB, Miressa F, Abulkadir A, Fekadu G. Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ugurlu C, Yildirim M, Ozturk A, Ozcan O, Bostan MS, Yilmaz S. Lymphocyte-to-C-reactive Protein Ratio: a New Biomarker to Predict Perforation in Acute Appendicitis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Yamazaki S, Shimodaira Y, Kobayashi A, Takata M, Hayashibara K, Sakon M, Sekino Y, Okada M, Takahashi Y, Shimura M, Seki H, Soejima Y. Predictive factors of perforated appendicitis: Impact of the C-reactive protein level. Surg Open Sci 2021; 6:1-4. [PMID: 34355156 PMCID: PMC8319788 DOI: 10.1016/j.sopen.2021.06.003] [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] [Received: 04/07/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022] Open
Abstract
Background Perforated appendicitis without an associated abscess necessitates emergency surgery. However, it is difficult to predict the presence of perforation before surgery, and the predictive factors are still unclarified. Our purposes were to characterize a patient population with perforated appendicitis without an associated abscess to identify the preoperative predictive factors of appendiceal perforation. Methods We retrospectively identified 150 patients who underwent appendectomy for acute appendicitis at our institution from June 2018 to November 2020. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence of perforated appendicitis. Results Forty (29%) of 150 patients had appendiceal perforation detected intraoperatively. Of these 40 patients, only 19 had appendiceal perforation detected on preoperative computed tomography. Multivariable analysis found that a higher C-reactive protein level, higher total bilirubin level, and the presence of an appendiceal fecalith were independent predictive factors for appendicitis with perforation. Conclusion Our analysis suggests that the presence of an appendiceal fecalith, a total bilirubin level of more than 21.38 μmol/L, and a C-reactive protein level of more than 3.0 × 104 μg/L are predictive factors of perforated appendicitis.
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Affiliation(s)
- Shiori Yamazaki
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan.,Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Shimodaira
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Akira Kobayashi
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Manabu Takata
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Kaori Hayashibara
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Masahiro Sakon
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Yasushi Sekino
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Masao Okada
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Yusuke Takahashi
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Masatoshi Shimura
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Hitoshi Seki
- Nagano Municipal Hospital, Department of Digestive Surgery, Nagano, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Lastunen K, Leppäniemi A, Mentula P. Perforation rate after a diagnosis of uncomplicated appendicitis on CT. BJS Open 2021; 5:6106188. [PMID: 33609386 PMCID: PMC7893470 DOI: 10.1093/bjsopen/zraa034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/01/2020] [Indexed: 12/29/2022] Open
Abstract
Background Appendicectomy is a common emergency operation. The aim of this analysis was to study the effect of preoperative delay on disease progression, and whether a novel scoring system (Atema score) could be useful in predicting complicated appendicitis. Methods Patients with uncomplicated acute appendicitis on CT and who underwent appendicectomy in 2014–2015 were analysed for patient characteristics, preoperative delay and outcomes. Results Of 837 patients with uncomplicated appendicitis on CT, 187 (22.3 per cent) were found to have complicated appendicitis at surgery. The median time estimate for perforation was 25.4 h after CT, with an hourly rate of perforation of 2 per cent. Patients with an Atema score of 6 or less and those with no appendicolith on CT and a C-reactive protein level below 51 mg/l were the slowest to develop perforation, reaching a perforation rate of 5 per cent in 7.1 and 7.6 h respectively. Conclusion A substantial proportion of patients with uncomplicated acute appendicitis on CT have complicated appendicitis at surgery. However, in patients with no risk factors, surgery can be postponed safely for up to 7 h.
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Affiliation(s)
- K Lastunen
- Correspondence to: Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029 Helsinki, Finland (e-mail: )
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Valluru B, Zhou Z, Sah D, Du W, Ali MO, Adam AA, Zhang L, Wang JJ. Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study. Jpn J Radiol 2019; 38:178-191. [PMID: 31823157 PMCID: PMC7002366 DOI: 10.1007/s11604-019-00905-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/25/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To clarify unique non-contrast CT (NCCT) characteristics for early recognition of Schistosomal associated appendicitis (SAA) differentiating from Non-schistosomal associated appendicitis (NSA). MATERIAL AND METHODS Clinical and pathological data of 50 cases with SAA and 60 cases with NSA who underwent emergency appendectomy were retrospectively compared to pre-surgical NCCT features such as direct and indirect signs of acute appendicitis as well as appendicoliths, colon calcifications as diagnostic criteria. Statistical methods such as Chi-square (χ2), t-tests, Principal component analysis (PCA), Binary Logistic regression (LR) and Factor Analysis (FA) were utilized to observe differences and isolate recognizable CT features of SAA. Pre and post hoc diagnostic performance of all criteria was calculated as sensitivity, specificity, and the Odds Ratio (OR). RESULTS Age > 50 years, diameter > 13 mm, pneumatosis, peri appendiceal abscess, focal wall defect, perforation; Orbital, linear and point types of appendicular wall calcifications; sigmoid colon and cecal curvilinear calcifications were observed as unique characteristics with a sensitivity of 84-95% and specificity of 91-98% in predicting SAA by OR of 6.2 times. Pre and post hoc hypothetical analysis did not show any significance for all other factors. CONCLUSION Factors such as elderly age, CT features such as larger appendicular diameter, appendicular wall calcifications along with sigmoid colon, and cecal calcifications, signs of perforation or abscess are characteristic for early recognition of SAA.
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Affiliation(s)
- Bimbadhar Valluru
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China
| | - Zhou Zhou
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China
| | - Dineswar Sah
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China
| | - Wei Du
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China.
| | - Mahamed O Ali
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China
| | - Ahmed A Adam
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China
| | - Liang Zhang
- The Department of Radiology and Interventional Surgery, Dali Bai Autonomous Prefecture Hospital, The Third Affiliated Hospital of Dali University, Dali, People's Republic of China
| | - Juan J Wang
- The Department of Radiology and Interventional Surgery, The First Affiliated Hospital of Dali University, No- 32, Jiashi Bo Da Dao Road, Xiaguan, Dali, 671003, Yunnan, People's Republic of China
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