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Hosokawa Y, Moritani M, Makuuchi Y, Nagakawa Y. Indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis. World J Gastrointest Surg 2024; 16:2538-2545. [PMID: 39220069 PMCID: PMC11362944 DOI: 10.4240/wjgs.v16.i8.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease, and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis. Although the efficacy of conservative treatment for uncomplicated appendicitis is known, its efficacy for complicated appendicitis remains unknown, so are risk factors for the conservative treatment of appendicitis. In our institution, conservative treatment has long been the first choice for most appendicitis cases, except for perforation. Therefore, this novel study investigated the outcomes of conservative treatment for uncomplicated and complicated acute appendicitis and the risk factors associated with conservative treatment. AIM To investigate the indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis. METHODS We investigated 270 patients who received conservative treatment for acute appendicitis at the Nishitokyo Central General Hospital, between April 2011 and February 2022. Twenty-eight (10.3%) patients were resistant to conservative treatment and underwent surgery. We retrospectively investigated the outcomes of conservative treatment for appendicitis and the risk factors for resistance to conservative treatment using the receiver operating characteristic curves and Cox hazard model. RESULTS Two hundred and forty-two (89.7%) patients improved with conservative treatment. The significant and independent predictors of resistance to conservative treatment were body temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid visible on computed tomography (CT). The rate of resistance to conservative treatment was 66.7% (6/9) for patients with the above three factors, 22.9% (8/35) for patients with two factors (appendicolith and body temperature ≥ 37.3 °C), 16.7% (2/12) for patients with two factors (Douglas sinus fluid and appendicolith) and 11.1% (1/9) for patients with two factors (Douglas sinus fluid and body temperature ≥ 37.3 °C). CONCLUSION A temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.
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Affiliation(s)
- Yuichi Hosokawa
- Department of Surgery, Nishitokyo Central General Hospital, Tokyo 188-0014, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 166-0023, Japan
| | - Masato Moritani
- Department of Surgery, Nishitokyo Central General Hospital, Tokyo 188-0014, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 166-0023, Japan
| | - Yosuke Makuuchi
- Department of Surgery, Nishitokyo Central General Hospital, Tokyo 188-0014, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 166-0023, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 166-0023, Japan
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Khoraminejad B, Sakowitz S, Porter G, Chervu N, Ali K, Mallick S, Bakhtiyar SS, Benharash P. Interhospital variation in the non-operative management of uncomplicated appendicitis in adults. Surg Open Sci 2024; 20:32-37. [PMID: 38883576 PMCID: PMC11180347 DOI: 10.1016/j.sopen.2024.05.008] [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: 03/27/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Background Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis. Methods The 2016-2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH). Results Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission. Conclusions We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.
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Affiliation(s)
- Baran Khoraminejad
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Boston University, Boston, MA, United States of America
| | - Sara Sakowitz
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Giselle Porter
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Konmal Ali
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Saad Mallick
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Peyman Benharash
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
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Tayebi A, Olamaeian F, Mostafavi K, Khosravi K, Tizmaghz A, Bahardoust M, Zakaryaei A, Mehr DE. Assessment of Alvarado criteria, ultrasound, CRP, and their combination in patients with suspected acute appendicitis: a single centre study. BMC Gastroenterol 2024; 24:243. [PMID: 39085761 PMCID: PMC11289915 DOI: 10.1186/s12876-024-03333-5] [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: 11/21/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Acute appendicitis (AA) is one of the most common reasons for visiting the emergency room. The lack of proper diagnosis and rapid treatment of AA may lead to severe complications such as intestinal perforation and increased mortality. This study aimed to evaluate the diagnostic accuracy of the Alvarado criteria, ultrasound, and CRP criteria in comparison with their combined use in patients with suspected AA who presented to the emergency room. METHODS In this diagnostic accuracy study, 1411 patients with suspected AA who presented to the emergency department of Firoozabadi Hospital affiliated with Iran University of Medical Sciences and underwent appendectomy from October 2019 to October 2021 were examined. Nine hundred eighty-eight patients were enrolled. All patients were assessed using Alvarado, CRP, and ultrasound. The definitive diagnosis of AA was based on pathological findings and was considered the gold standard. Statistical analyses were performed with STATA VER 11.5. The diagnostic accuracy for each group was compared using the Pearson chi-square test. A value of p < 0.05 was considered statistically significant. RESULTS The mean age was 29.57 ± 13.66 years. The sensitivity and specificity of Alvarado in the diagnostic accuracy of appendicectomy were 75.2% and 61.3% (CI = 95%), respectively. The sensitivity of ultrasound and CRP for predicting appendicitis was significantly higher than the Alvarado criteria. The diagnostic accuracy for CRP was significantly higher than ultrasound (64.9% vs. 60.7%, P: 0.003). The diagnostic accuracy of the simultaneous use of Alvarado + CRP and CRP + Ultrasound was significantly higher than that of Alvarado + ultrasound. The sensitivity, specificity, and diagnostic accuracy of the simultaneous use of all three criteria together (Alvarado + Ultrasound + CRP) were estimated to be 94.9%, 25.8%, and 81.5% (CI = 95%), respectively, which were significantly higher than the use of other criteria. CONCLUSION This study showed that the Alvarado criteria had inadequate diagnostic sensitivity and accuracy for diagnosing acute appendicitis. The diagnostic accuracy of acute appendicitis increases to over 90% using the three Alvarado, ultrasound, and CRP criteria at the same time.
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Affiliation(s)
- Ali Tayebi
- Firoozabadi Clinical Research Development Unit (F A CRD U) School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Faranak Olamaeian
- Firoozabadi Clinical Research Development Unit (F A CRD U) School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Keihan Mostafavi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kasra Khosravi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Adnan Tizmaghz
- Firoozabadi Clinical Research Development Unit (F A CRD U) School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansour Bahardoust
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zakaryaei
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Daniyal Enayat Mehr
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Lin WY, Lee EP, Chen CY, Guo BC, Lin MJ, Wu HP. The Role of Vascular Cell Adhesion Molecule-1 (VCAM-1) in Predicting Complicated Appendicitis in Children. Diagnostics (Basel) 2024; 14:1256. [PMID: 38928671 PMCID: PMC11203331 DOI: 10.3390/diagnostics14121256] [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: 04/24/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children. METHODS Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis. RESULTS Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis (p < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all p < 0.001). CONCLUSION Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation.
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Affiliation(s)
- Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan;
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356006, Taiwan
| | - Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fong-Sing Rd., Tanzi District, Taichung 427213, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzi City 61363, Taiwan
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Pacilli M, Kamaleswaran R. New Genetic Biomarkers to Diagnose Pediatric Appendicitis. JAMA Pediatr 2024; 178:341-342. [PMID: 38372987 DOI: 10.1001/jamapediatrics.2023.6731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
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Faitna P, Harwood R, Kenny SE, Viner RM, Aylin PP, Hargreaves DS, Bottle A. Impact of the COVID-19 pandemic on the clinical management trends for acute appendicitis among the under-25s: a retrospective study. Arch Dis Child 2024; 109:339-346. [PMID: 38325911 PMCID: PMC10958286 DOI: 10.1136/archdischild-2023-326313] [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: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To describe the COVID-19 pandemic's impact on acute appendicitis management on children and young people (CYP). DESIGN Retrospective cohort study. SETTING All English National Health Service hospitals. PATIENTS Acute appendicitis admissions (all, simple, complex) by CYP (under-5s, 5-9s, 10-24s). EXPOSURE Study pandemic period: February 2020-March 2021. Comparator pre-pandemic period: February 2015-January 2020. MAIN OUTCOME MEASURES Monthly appendicectomy and laparoscopic appendicectomy rate trends and absolute differences between pandemic month and the pre-pandemic average. Proportions of appendicitis admissions comprising complex appendicitis by hospital with or without specialist paediatric centres were compared. RESULTS 101 462 acute appendicitis admissions were analysed. Appendicectomy rates fell most in April 2020 for the 5-9s (-18.4% (95% CI -26.8% to -10.0%)) and 10-24s (-28.4% (-38.9% to -18.0%)), driven by reductions in appendicectomies for simple appendicitis. This was equivalent to -54 procedures (-68.4 to -39.6) and -512 (-555.9 to -467.3) for the 5-9s and 10-24s, respectively. Laparoscopic appendicectomies fell in April 2020 for the 5-9s (-15.5% (-23.2% to -7.8%)) and 10-24s (-44.8% (-57.9% to -31.6%) across all types, which was equivalent to -43 (-56.1 to 30.3) and -643 (-692.5 to -593.1) procedures for the 5-9s and 10-24s, respectively. A larger proportion of complex appendicitis admissions were treated within trusts with specialist paediatric centres during the pandemic. CONCLUSIONS For CYP across English hospitals, a sharp recovery followed a steep reduction in appendicectomy rates in April 2020, due to concerns with COVID-19 transmission. This builds on smaller-sized studies reporting the immediate short-term impacts.
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Affiliation(s)
- Puji Faitna
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Rachel Harwood
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Simon E Kenny
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
- National Clinical Director for Children and Young People, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Paul P Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, UK
| | - Alex Bottle
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Lamm R, Kumar SS, Collings AT, Haskins IN, Abou-Setta A, Narula N, Nepal P, Hanna NM, Athanasiadis DI, Scholz S, Bradley JF, Train AT, Pucher PH, Quinteros F, Slater B. Diagnosis and treatment of appendicitis: systematic review and meta-analysis. Surg Endosc 2023; 37:8933-8990. [PMID: 37914953 DOI: 10.1007/s00464-023-10456-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The optimal diagnosis and treatment of appendicitis remains controversial. This systematic review details the evidence and current best practices for the evaluation and management of uncomplicated and complicated appendicitis in adults and children. METHODS Eight questions regarding the diagnosis and management of appendicitis were formulated. PubMed, Embase, CINAHL, Cochrane and clinicaltrials.gov/NLM were queried for articles published from 2010 to 2022 with key words related to at least one question. Randomized and non-randomized studies were included. Two reviewers screened each publication for eligibility and then extracted data from eligible studies. Random effects meta-analyses were performed on all quantitative data. The quality of randomized and non-randomized studies was assessed using the Cochrane Risk of Bias 2.0 or Newcastle Ottawa Scale, respectively. RESULTS 2792 studies were screened and 261 were included. Most had a high risk of bias. Computerized tomography scan yielded the highest sensitivity (> 80%) and specificity (> 93%) in the adult population, although high variability existed. In adults with uncomplicated appendicitis, non-operative management resulted in higher odds of readmission (OR 6.10) and need for operation (OR 20.09), but less time to return to work/school (SMD - 1.78). In pediatric patients with uncomplicated appendicitis, non-operative management also resulted in higher odds of need for operation (OR 38.31). In adult patients with complicated appendicitis, there were higher odds of need for operation following antibiotic treatment only (OR 29.00), while pediatric patients had higher odds of abscess formation (OR 2.23). In pediatric patients undergoing appendectomy for complicated appendicitis, higher risk of reoperation at any time point was observed in patients who had drains placed at the time of operation (RR 2.04). CONCLUSIONS This review demonstrates the diagnosis and treatment of appendicitis remains nuanced. A personalized approach and appropriate patient selection remain key to treatment success. Further research on controversies in treatment would be useful for optimal management.
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Affiliation(s)
- Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Thomas Jefferson University, 1015 Walnut Street, 613 Curtis, Philadelphia, PA, 19107, USA.
| | - Amelia T Collings
- Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Nisha Narula
- Department of Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Pramod Nepal
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Stefan Scholz
- Division of General and Thoracic Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel F Bradley
- Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arianne T Train
- Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Philip H Pucher
- Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Francisco Quinteros
- Division of Colorectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Bethany Slater
- Division of Pediatric Surgery, University of Chicago Medicine, Chicago, IL, USA
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Bancke Laverde BL, Maak M, Langheinrich M, Kersting S, Denz A, Krautz C, Weber GF, Grützmann R, Brunner M. The role of intraoperative swab during appendectomy in patients with uncomplicated and complicated appendicitis. Int J Colorectal Dis 2023; 38:272. [PMID: 37991592 PMCID: PMC10665244 DOI: 10.1007/s00384-023-04566-8] [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] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Bacteria play an important role not only in pathogenesis of appendicitis but also in the postoperative course of patients. However, the usefulness of an intraoperative swab during appendectomy is controversial. The primary aim of this study was to investigate the impact of intraoperative swab during appendectomy on the postoperative outcome in patients with uncomplicated and complicated appendicitis. METHODS A retrospective analysis was conducted on a consecutive series of 1570 adult patients who underwent appendectomy for acute appendicitis at the University Hospital Erlangen between 2010 and 2020. Data regarding the intraoperative swab were collected and analyzed for the entire cohort as well as for patients with uncomplicated and complicated appendicitis. RESULTS An intraoperative swab was taken in 29% of the cohort. The bacterial isolation rate in the obtained intraoperative swabs was 51%, with a significantly higher rate observed in patients with complicated appendicitis compared to those with uncomplicated appendicitis (79% vs. 35%, p < 0.001). The presence of a positive swab was significantly associated with worse postoperative outcomes, including higher morbidity, increased need for re-surgery, and longer hospital stay, when compared to patients without a swab or with a negative swab. A positive swab was an independent risk factor for postoperative morbidity (OR 9.9 (95% CI 1.2-81.9), p = 0.034) and the need for adjustment of postoperative antibiotic therapy (OR 8.8 (95% CI 1.1-72.5), p = 0.043). However, a positive swab resulted in postoperative antibiotic therapy adjustment in only 8% of the patients with bacterial isolation in the swab. CONCLUSION The analysis of swab samples obtained during appendectomy for acute appendicitis can help identify patients at a higher risk of a worse postoperative outcome. However, the frequency of antibiotic regime changes based on the swab analysis is low.
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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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Alfehaid MS, Babiker AM, Alkharraz AH, Alsaeed HY, Alzunaydi AA, Aldubaiyan AA, Sinyan HA, Alkhalaf BK, Alshuwaykan R, Khalil R, Al-Wutayd O. Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia. BMC Surg 2023; 23:342. [PMID: 37950198 PMCID: PMC10638704 DOI: 10.1186/s12893-023-02258-2] [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: 09/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Appendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis. METHODS Observational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained. RESULT Among the overall study population of 158 patients, the age median [IQR] was 24.5 [19-31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67-8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07-10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin. CONCLUSION Elevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.
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Affiliation(s)
- Mohammed S Alfehaid
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ayman M Babiker
- King Saud Hospital, Ministry of Health, Unaizah, Saudi Arabia
| | - Abdullah Hamad Alkharraz
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Hamad Yousef Alsaeed
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ali Abdullah Alzunaydi
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Adi Abdulaziz Aldubaiyan
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | | | | | | | - Rehana Khalil
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Osama Al-Wutayd
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.
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Messias B, Cubas I, Oliveira C, Hashimoto F, Mocchetti E, Ichinose T, Waisberg J, Ribeiro Junior MAF. Usefulness of serum sodium levels as a novel marker for predicting acute appendicitis severity: a retrospective cohort study. BMC Surg 2023; 23:312. [PMID: 37838701 PMCID: PMC10576296 DOI: 10.1186/s12893-023-02224-y] [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: 07/15/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Early and accurate preoperative diagnosis of complicated appendicitis mandates the identification of new markers. The aim of this study is to determine whether preoperative serum sodium levels are useful for predicting the severity of acute appendicitis. METHODS We retrospectively analyzed 475 patients who underwent emergency appendectomies between January 2018 and February 2023 in a general hospital in Brazil. The patients were divided into 2 groups: complicated (n = 254) and uncomplicated (n = 221). Hyponatremia was defined as serum sodium levels < 136 mEq/L. The primary outcome was to evaluate if hyponatremia is associated with complicated appendicitis. RESULTS The patients had a median age of 22 years, and the median serum sodium level was 137 mEq/L in patients with complicated appendicitis and 139 mEq/L in uncomplicated appendicitis (P < 0.001). The analysis of the receiver operating characteristic curve used as the best cutoff value of serum sodium of 136 mEq/L with a sensitivity of 45.7%, specificity of 86.4%, positive predictive value of 79.5%, and negative predictive value of 58.1% for the diagnosis of complicated AA. Of the 254 patients with complicated appendicitis, 84 (33.1%) had serum sodium levels below 136 mEq/L, while only 12 (5.4%) patients with uncomplicated appendicitis had values below this cutoff. Patients with hyponatremia were 5 times more likely to develop complicated appendicitis. (odds ratio: 5.35; 95% confidence interval: 3.39-8.45) CONCLUSIONS: Preoperative serum sodium levels are a useful tool for predicting the severity of acute appendicitis. Due to its low cost and wide availability, it has become an extremely relevant marker.
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Affiliation(s)
- Bruno Messias
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil.
- Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil.
| | - Isabella Cubas
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil
| | - Caio Oliveira
- Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil
| | - Flavia Hashimoto
- Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil
| | - Erica Mocchetti
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil
| | - Tania Ichinose
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil
| | - Jaques Waisberg
- Department of Surgery, ABC Medical School, Lauro Gomes Avenue, Santo André, 2000, 09060-870, SP, Brazil
| | - Marcelo A F Ribeiro Junior
- Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City- Mayo Clinic, P. O. Box 11001, Abu Dhabi, United Arab Emirates
- Catholic University of São Paulo, 290, Joubert Wey Street, Sorocaba, 18030-070, SP, Brazil
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Thapa N, Shrestha O, Basukala S, Shrestha K, Bhugai N, Joshi N, Regmi SK, Karki S, Gurung S. Case of giant appendicolith: A common ailment with a rare finding. Clin Case Rep 2023; 11:e7372. [PMID: 37251744 PMCID: PMC10213707 DOI: 10.1002/ccr3.7372] [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: 03/31/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Giant appendicoliths are rare appendicoliths with the largest diameter of more than 2 cm. It can increase the risk of complications such as perforation or abscess formation. This is a case of an uncommon definitive pathology diagnosed for a right iliac fossa calcification with a rare transoperative finding.
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Affiliation(s)
- Niranjan Thapa
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Oshan Shrestha
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Kala Shrestha
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Nabaraj Bhugai
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Niraj Joshi
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Sagun Karki
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Suman Gurung
- Department of PathologyNepalese Army Institute of Health ScienceskathmanduNepal
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12
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Lin HA, Lin LT, Lin SF. Application of Artificial Neural Network Models to Differentiate Between Complicated and Uncomplicated Acute Appendicitis. J Med Syst 2023; 47:38. [PMID: 36952043 DOI: 10.1007/s10916-023-01932-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
Preoperative prediction of complicated appendicitis is challenging, and many clinical tools are developed to predict complicated appendicitis. This study evaluated whether a supervised learning method can recognize complicated appendicitis in emergency department (ED). Consecutive patients with acute appendicitis presenting to the ED were enrolled and included into training and testing datasets at a ratio of 70:30. The multilayer perceptron artificial neural network (ANN) models were trained to perform binary outcome classification between uncomplicated and complicated acute appendicitis. Measures of sensitivity, specificity, positive and negative likelihood ratio (LR + and LR-), and a c statistic of a receiver of operating characteristic curve were used to evaluate an ANN model. The simplest ANN model by Bröker et al. including the C-reactive protein (CRP) and symptom duration as variables achieved a c statistic value of 0.894. The ANN models developed by Avanesov et al. including symptom duration, appendiceal diameter, periappendiceal fluid, extraluminal air, and abscess as variables attained a high diagnostic performance (a c statistic value of 0.949) and good efficiency (sensitivity of 78.6%, specificity of 94.5%, LR + of 14.29, LR- of 0.23 in the testing dataset); and our own model by H.A. Lin et al. including the CRP level, neutrophil-to-lymphocyte ratio, fat-stranding sign, appendicolith, and ascites exhibited high accuracy (c statistic of 0.950) and outstanding efficiency (sensitivity of 85.7%, specificity of 91.7%, LR + of 10.36, LR- of 0.16 in the testing dataset). The ANN models developed by Avanesov et al. and H.A. Lin et al. developed model exhibited a high diagnostic performance.
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Affiliation(s)
- Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine , Taipei Medical University, Taipei, Taiwan
| | - Li-Tsung Lin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan.
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan.
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13
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Zarog M, O’Leary P, Kiernan M, Bolger J, Tibbitts P, Coffey S, Byrnes G, Peirce C, Dunne C, Coffey C. Circulating fibrocyte percentage and neutrophil-lymphocyte ratio are accurate biomarkers of uncomplicated and complicated appendicitis: a prospective cohort study. Int J Surg 2023; 109:343-351. [PMID: 37093074 PMCID: PMC10389644 DOI: 10.1097/js9.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND There is increasing evidence that uncomplicated appendicitis (UA) may be treated nonoperatively in cases of UA. This study aimed to evaluate and compare the diagnostic accuracy of circulating fibrocyte percentage (CFP), white blood cell count, C-reactive protein, and neutrophil-lymphocyte ratio (NLR) in diagnosing uncomplicated and complicated appendicitis. MATERIALS AND METHODS Eighty consecutive adult patients presenting with suspected appendicitis were recruited in a cohort-based prospective study between June 2015 and February 2016 at University Hospital Limerick in Ireland. Peripheral venous samples were obtained at the presentation. Clinical, biochemical, radiological, and histopathological parameters were recorded. The CFP was determined by dual-staining for CD45 and collagen-I using flow cytometry analysis and correlated with histopathological diagnoses. RESULTS Of the 46 patients who underwent appendicectomy, 34 (73.9%) had histologically proven acute appendicitis. A comparison of the diagnostic accuracy of biomarkers demonstrated the CFP had the highest diagnostic accuracy for UA (area under the curve=0.83, sensitivity=72.7%, specificity=83.3%, P=0.002). The NLR had the highest diagnostic accuracy in relation to complicated appendicitis (area under the curve=0.84, sensitivity=75.5%, specificity=83.3%, P=0.005). CONCLUSIONS CFP and NLR are accurate biomarkers of UA and complicated appendicitis.
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Lescinska AM, Sondore E, Ptasnuka M, Mukans M, Plaudis H. The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020295. [PMID: 36837497 PMCID: PMC9966030 DOI: 10.3390/medicina59020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.
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Affiliation(s)
- Anna Marija Lescinska
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
- Correspondence: ; Tel.: +371-29258517
| | - Elza Sondore
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Margarita Ptasnuka
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Maksims Mukans
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Haralds Plaudis
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
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Niang I, Dieng CK, Diouf PMD, Diop CT, Welle IB, Ndong A, Dia SAM, Sarr PB, Ndiaye O, Sinake RB, Ba AL. "Worm within worm": acute appendicitis containing an adult Ascaris lumbricoïdes. BJR Case Rep 2022; 8:20210035. [PMID: 36101725 PMCID: PMC9461732 DOI: 10.1259/bjrcr.20210035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Appendicitis is the first etiology for abdominal surgical emergency. Ascariasis is the most common helminth infection in tropical countries where it is endemic. The ability of intestinal helminths to wander through the digestive system means that it can end up in the appendix lumen and lead to appendicitis by luminal obstruction. However, this presentation is still rarely described in the literature. In fact, most of the diagnoses of roundworm associated with appendicitis are made retrospectively by the discovery of its eggs on the pathological examination of an appendectomy specimen. We report the case of a 7-year-old patient living in a tropical area who consulted for acute right lower quadrant pain. The ultrasound suspected the diagnosis of appendicitis and also revealed multiple intestinal worms including one in contact with the inflamed appendix. Surgical exploration confirmed appendicitis associated with roundworm partly in the appendicular lumen through a perforation.
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Affiliation(s)
- Ibrahima Niang
- Department of Radiology, Fann University Hospital Center, Dakar, Senegal
| | | | | | | | | | - Abdourahmane Ndong
- Department of Surgery, Gaston Berger University Saint-Louis, Saint-Louis, Senegal
| | | | - Papa Balla Sarr
- Department of Surgery, Albert Royer Hospital, Dakar, Senegal
| | - Ousmane Ndiaye
- Department of Radiology, Albert Royer Hospital, Dakar, Senegal
| | | | - Aissata Ly Ba
- Department of Radiology, Fann University Hospital Center, Dakar, Senegal
- Department of Radiology, Albert Royer Hospital, Dakar, Senegal
- Department of Surgery, Albert Royer Hospital, Dakar, Senegal
- Department of Surgery, Gaston Berger University Saint-Louis, Saint-Louis, Senegal
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16
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Azadbakht M, Azadbakht S, Daniali S, Dehghani M. Comparison of the prevalence of perforated appendicitis during and before COVID19 pandemic. Ann Med Surg (Lond) 2022; 82:104785. [PMID: 36186496 PMCID: PMC9515006 DOI: 10.1016/j.amsu.2022.104785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Coronavirus disease 2019 has significantly impacted the rate of emergency department visits among patients with the non-repository disease. Patients with acute appendicitis are also likely to delay their visit to the health care center, which can lead to complications including perforated appendicitis. The aim of this study was to compare the prevalence of perforated appendicitis during the COVID19 and pre-pandemic periods. Methods This retrospective study was performed on all appendectomies performed during COVID-19, Group A, and one year earlier, Group B. A questionnaire comprising demographic variables (age, gender, occupation, education), clinical variables (white blood cell count, fever), location and type of appendicitis, the status of appendectomy, and duration of hospitalization was completed for all the patients included in the study. Results The demographic variables were not significantly different among the two groups. The perforation appendicitis rate during the COVID19 pandemic increased compared to the previous year, The difference was not statistically significant. The number of negative appendectomy in group A was significantly less compared to group B. The mean time from the onset of pain to the time of referral was significantly lesser in group A. The mean length of hospital stay in group B was longer than in group A. In terms of fever, patients with perforated appendicitis in group B had a higher fever than in group A, which was statistically significant. Conclusion A non-significant increase in the number of perforated appendicitis cases during the pandemic period. Duration of hospitalization and fever was significantly greater in pre-pandemic perforated appendicitis cases. Coronavirus disease has significantly impacted the rate of emergency department visits. Patients with acute appendicitis are also likely to delay their visit to the health care center. Which can lead to complications including perforated appendicitis. A non-significant increase in the number of perforated appendicitis cases during pandemic period.
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Affiliation(s)
- Morteza Azadbakht
- Fellowship of Advanced Laparoscopic and Bariatric Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saleh Azadbakht
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- Corresponding author. Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Samira Daniali
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Dehghani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Parental attitudes towards choosing between operative and nonoperative management of pediatric acute appendicitis. J Pediatr Surg 2022; 57:1592-1598. [PMID: 34872734 DOI: 10.1016/j.jpedsurg.2021.10.053] [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: 04/27/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Making healthcare decisions for children can be challenging for parents or guardians. We aimed to characterize the decision-making preferences and stress of parents or guardians who were offered both appendectomy or nonoperative management (NOM) for children with acute appendicitis. METHODS Criteria was developed for offering operative or NOM for patients. At the time of decision, parents or guardians completed a survey assessing their understanding of treatment options, stress and preferences in being given the choice. An outpatient follow-up survey was later administered to evaluate post-decision satisfaction. RESULTS A total of 45 respondents were included in the study. More than 95% endorsed understanding of the risks/benefits of the options and felt supported and satisfied with their decision. Half felt the process was more than minimally stressful, 77% felt the decision was easy to make, 89% liked being asked and 95% preferred to make the decision themselves with varying degrees of input from their physician. Of the 62% of parents or guardians who completed the follow-up survey, >90% were satisfied with their decision and one respondent regretted their choice. DISCUSSION When offered the choice between operative and NOM of acute appendicitis, half of parents or guardians felt greater than minimal stress. The majority endorsed adequate understanding of the options, felt it was an easy decision, and maintained the desire to be the primary decision maker for their child. Our study provides preliminary data on parental or guardian attitudes towards shared decision-making in the surgical setting. Follow-up studies should focus on identifying predictors for those who feel increased stress and difficulty with decision-making. LEVEL OF EVIDENCE III.
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Sheen J, Bowen J, Whitmore H, Bowling K. Hyponatremia as a Marker of Complicated Appendicitis: A Retrospective Analysis. Cureus 2022; 14:e26672. [PMID: 35949749 PMCID: PMC9357972 DOI: 10.7759/cureus.26672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study is to investigate the potential role of hyponatremia as a biochemical predictor of complicated appendicitis.
The effective employment of biochemical markers to identify early and predict progression to complicated appendicitis would be beneficial in triaging those most requiring urgent appendicectomy. A marker of interest and subject of recent study in the literature is sodium. Methods and Materials This study was designed as a single-center, retrospective analysis of all appendicectomies performed between January 1, 2018 and March 10, 2021. Patients were categorized into pediatric and adult groups and subdivided into uncomplicated or complicated appendicitis. We utilized the Chi-square test and crude odds ratio (OR) rates to assess significance of serum sodium level values. Results In total, 890 patients underwent appendicectomy (181 pediatric, 709 adult cases). Within the pediatric group, 10 uncomplicated cases and 16 complicated cases were found to be hyponatremic. The result for hyponatremia as a diagnostic marker for complicated cases in this group was not significant at p<0.05, with a Chi-square test result of 1.6067 and p-value 0.204963 (OR 1.7538, 95% confidence interval (CI) 0.7312-4.2070). Adults displaying hyponatremia comprised four uncomplicated and 34 complicated cases, with calculated OR 7.915 (95% CI 2.7656-22.6521). Chi-square test result was 20.1687 with a p-value of <0.00001 and, thus, statistically significant. Conclusion Our findings suggest that hyponatremia can be employed as an indicator of complicated appendicitis in an adult population. This correlates with the findings of a recent systematic review of this topic and implicates this as a subject worthy of further study.
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Davari FV, Hashem Zadeh A. A rare case of appendiceal tip complete attachment to a sigmoid diverticulum: An appendiceal phlegmon case report. Int J Surg Case Rep 2022; 97:107379. [PMID: 35841756 PMCID: PMC9403015 DOI: 10.1016/j.ijscr.2022.107379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Appendiceal phlegmon is defined as an inflammatory mass, consisting of the inflamed appendix, enclosed by adjacent viscera and the greater omentum in 2 % to 10 % of patients with acute appendicitis. CASE PRESENTATION A 24-year-old female presented to the hospital with chief complaints of fever, nausea, vomiting, and pain over the right lower quadrant of the abdomen for two days. In the local examination, tenderness and rebound tenderness were detected. Ultrasonography and abdominal CT scan indicated appendiceal phlegmon. After seven weeks of receiving a course of antibiotics with complete resolution of her symptoms, she underwent elective laparoscopic appendectomy. During surgery, the appendiceal tip was completely attached and fused to a sigmoid diverticulum, which has not been reported elsewhere. The appendix was completely removed, and the patient was discharged from the hospital in a good general condition after two days. DISCUSSION Acute appendicitis can cause serious complications, such as ruptured appendix, abscess, or phlegmon. In most cases, inflammation and infection resolve by antibiotic administration. In some cases perforation of the inflamed appendix and local abscess or diffuse peritonitis formation, which requires immediate percutaneous drainage or surgery as indicated. Theoretically, the inflamed appendix can cause adhesive damage to the adjacent organs; however, there is no particular report on this type of damage. CONCLUSION This rare case suggests that during phlegmon formation and related inflammation, other complications such as fistula formation, are theoretically expected.
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Affiliation(s)
- Farzad Vaghef Davari
- Surgery Fellowship of Surgical Oncology, Tehran University of Medical Sciences, Iran
| | - Arezou Hashem Zadeh
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author at: Imam Khomeini Complex Hospital, Tohid squre, Tehran Postal code: 1419733141, Iran.
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20
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Mougeot JLC, Beckman MF, Bahrani Mougeot F, Horton JM. Cutaneous Microbiome Profiles Following Chlorhexidine Treatment in a 72-Hour Daily Follow-Up Paired Design: a Pilot Study. Microbiol Spectr 2022; 10:e0175321. [PMID: 35467392 PMCID: PMC9248901 DOI: 10.1128/spectrum.01753-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/18/2022] [Indexed: 01/04/2023] Open
Abstract
Venous catheter-related bloodstream infections represent a significant problem in the United States. Our objective was to determine daily changes in skin microbiome profiles up to 72h postchlorhexidine treatment. Left and right forearm skin swab samples were obtained from 10 healthy volunteers over 72h at 24h intervals. Dorsal surface of left arm was treated with chlorohexidine gluconate (CHG) at initial time point (T = 0), while the right arm remained untreated (control). Swab samples were obtained shortly before (T = 0) and after CHG treatment (T = 24-48-72h). Bacterial DNA extraction, 16S rRNA gene V1-V3 sequencing and taxonomic annotation were performed using ZymoBIOMICS pipeline. PERMANOVA, linear discriminant and bacterial interaction network analyses were performed. A total of 13 total phyla, 273 genera, and 950 total species were detected across all time points, CHG-treated or CHG-untreated. Most abundant species included Cutibacterium acnes, Staphylococcus epidermidis, and Rothia Mucilaginosa. Low biomass-related inconsistent taxa detection was observed. PERMANOVA suggested a marginal difference between CHG-treated and CHG-untreated microbiome profiles (Genera: P(perm) = 0.0531; Species: P(perm) = 0.0450). Bacterial interaction network guided PERMANOVA analyses detected a microbiome change over time, suggesting a consistent CHG treatment-specific change. LEfSe identified Finegoldia magna, Bacillus pumilus, Bacillus thermoamylovorans as the only distinctive species. These species were more abundant and/or present post-CHG treatment in the CHG-treated group. These findings suggest that the skin microbiome was not significantly different 24, 48, or 72h after CHG treatment. Previous culture-based studies have found similar results after 24h. Future studies will be needed to determine the mechanisms of bacterial regrowth after CHG treatment. IMPORTANCE Annually, over 80,000 central line infections occur in the United States. Understanding the pathogenesis of these infections is crucial. Chlorhexidine is the most commonly used skin preparation before line placement. We hypothesized that the use of chlorhexidine and dressings will alter the normal arm skin microbiome over a period of 72h. We used 16S-rRNA gene next generation sequencing (NGS) to determine the forearm skin microbiome of volunteers. The left arm was swabbed with chlorhexidine and the right arm served as control. The skin microbiome returned to normal after 24h. Our NGS results confirm findings of two previous culture-based studies. Relative abundance of Bacillus spp. in the chlorhexidine-treated samples was increased, consistent with one previous study. Based on the results of this pilot study, we will need to measure viable bacteria during a 24h time course following chlorhexidine treatment to understand the source of skin microbiome replenishment.
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Affiliation(s)
| | | | | | - James M. Horton
- Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
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Arakawa S, Kato H, Asano Y, Horiguchi A, Yamamoto M, Miura F, Okamoto K, Kimura Y, Sakaguchi T, Yoshida M. Emergency appendectomy versus elective appendectomy following conservative treatment for acute appendicitis: a multicenter retrospective clinical study by the Japanese Society for Abdominal Emergency Medicine. Surg Today 2022; 52:1607-1619. [PMID: 35695921 DOI: 10.1007/s00595-022-02526-3] [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: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To establish the best treatment strategy for acute appendicitis. METHODS We collected data on 2142 appendectomies performed in 2017 and compared the backgrounds and surgical outcomes of patients who underwent early surgery (ES) (< 48 h) with those managed with non-ES (> 48 h). We performed a risk factor analysis to predict postoperative complications and subgroup analysis to propose a standard treatment strategy. RESULTS The incidence of postoperative complications was significantly higher in the ES group than in the non-ES group, and significantly lower in the laparoscopic surgery group than in the laparotomy group. Surgical outcomes, including the incidence of postoperative complications, were comparable after acute surgery (< 12 h) and subacute surgery (12-48 h), following antibiotic treatment. The risk factors for postoperative complications in the ES group were a higher age, history of abdominal surgery, perforation, high C-reactive protein level, histological evidence of gangrenous or perforated appendicitis, a long operation time, and intraoperative complications. The risk factors for postoperative complications in the non-ES group were perforation and unsuccessful conservative treatment. CONCLUSIONS Non-early appendectomy is feasible for acute appendicitis but should be applied with care in patients with risk factors for postoperative complications or failure of pretreatment, including diabetes mellitus, abscess formation, and perforation.
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Affiliation(s)
- Satoshi Arakawa
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan.
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | | | - Fumihiko Miura
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata, Hospital, Kitakyushu, Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takanori Sakaguchi
- Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan
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22
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Jeddeloh K, Velji-Ibrahim J, Stock E, Bulander R, Rickard J, Harmon JV. Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis. Int J Surg Case Rep 2022; 95:107235. [PMID: 35636213 PMCID: PMC9157466 DOI: 10.1016/j.ijscr.2022.107235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Non-operative antibiotic therapy is now considered as an alternative to surgery for acute appendicitis (AA). This is in part due to the reported surgical complication rates. We report a patient who developed wound infection and port site hernia following a laparoscopic appendectomy, analyze our post-operative wound infection rates, and discuss the treatment options for AA globally. PRESENTATION OF CASE We report a 40-year-old woman who developed a wound infection and subsequent port site hernia following laparoscopic appendectomy (LA) and analyze surgical site infection (SSI) and readmission rates for patients who underwent LA at our medical center. Analysis of our surveillance data demonstrated that 15/865 (1.7%) patients developed SSIs and 7/15 (47%) of these patients had positive wound cultures. Patients who developed SSIs were more likely to be male (80% vs 20%; P = 0.03), be older (43.0 vs 34.0; P = 0.04), have higher surgical wound classification scores (66.7% vs 38.2%; P = 0.009), and have longer operative times (82 vs 62 min; P = 0.003). The overall readmission rate was 2.8%. DISCUSSION We report a lower SSI rate after LA than usually reported. Surgical site infection following LA is rare and may be challenging to diagnose early. Additional complications such as port-site hernia may also be encountered in this setting. CONCLUSION This data should inform both physicians and surgeons who must consider the expected complication rates associated with surgery for AA globally.
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Affiliation(s)
- Katie Jeddeloh
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States
| | - Jena Velji-Ibrahim
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States
| | - Emily Stock
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States
| | - Robert Bulander
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - James V Harmon
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
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The Clinical Significance of Shock Index and GFR in the Differential Diagnosis of Perforated Appendicitis. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1090115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gao S, Guo X, Li L, Jing C, Ma Y. Risk factors for periappendiceal adhesions in acute appendicitis: a retrospective comparative study. BMC Surg 2022; 22:134. [PMID: 35392891 PMCID: PMC8991578 DOI: 10.1186/s12893-022-01579-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Acute appendicitis usually requires immediate surgical treatment, but appendectomies were difficult for some patients with severe periappendiceal adhesions. We investigated risk factors of intraoperative adhesions to help surgeons make better treatment plans for appendicitis. METHODS We retrospectively analyzed 186 cases diagnosed with acute appendicitis and underwent surgery in Shandong Provincial Hospital affiliated to Shandong First Medical University between January 2018 and December 2019. According to the degree of intraoperative adhesions, they were divided into mild, moderate and severe groups. Then, we analyzed a number of preoperative factors contributed to adhesions, suppuration and perforation during appendectomy in 186 patients. RESULTS Contrast to the moderate group (MoG) and the mild group (MiG), the severe degree of adhesions group (SG) had a higher intraoperative perforation and suppuration rate, a greater likelihood of conversion to open and more postoperative complications. Multivariable logistic regression analysis showed that recurrent appendicitis and high neutrophil percentage were independently associated with periappendiceal adhesions. The preoperative ultrasonography (US) revealed periappendiceal fluid and high neutrophil percentage were independently associated with appendix suppuration. A high preoperative neutrophil percentage was independently associated with appendix perforation. CONCLUSIONS Recurrent appendicitis and preoperative high neutrophil percentage were risk factors of periappendiceal adhesions; preoperative US revealed periappendiceal fluid and high neutrophil percentage were risk factors of appendix suppuration; and a high preoperative neutrophil percentage was a risk factor of appendix perforation.
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Affiliation(s)
- Shenshuo Gao
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
| | - Xiaobo Guo
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Leping Li
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Changqing Jing
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Yan Ma
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
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Shen Z, Sun P, Jiang M, Zhen Z, Liu J, Ye M, Huang W. Endoscopic retrograde appendicitis therapy versus laparoscopic appendectomy versus open appendectomy for acute appendicitis: a pilot study. BMC Gastroenterol 2022; 22:63. [PMID: 35152882 PMCID: PMC8842886 DOI: 10.1186/s12876-022-02139-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/03/2022] [Indexed: 12/28/2022] Open
Abstract
Background An increasing number of studies have shown the merits of endoscopic retrograde appendicitis therapy (ERAT) in diagnosing and treating acute uncomplicated appendicitis. However, no related prospective controlled studies have been reported yet. Our aim is to assess the feasibility and safety of ERAT in the treatment of acute uncomplicated appendicitis. Methods In this open-label, randomized trial, participants were randomly allocated to the ERAT group, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. The primary outcome was the clinical success rate of the treatment. Intention-to-treat analysis was used in the study. Results The study comprised of 99 patients, with 33 participants in each group. The clinical success rate was 87.88% (29/33), 96.97% (32/33) and 100% (33/33) in the ERAT, LA and OA group, respectively. In the ERAT group, 4 patients failed ERAT due to difficult cannulation. In LA group, 1 patient failed because of abdominal adhesion. There were no significant differences among the three treatment groups regarding the clinical success rate (P = 0.123). The median duration of follow-up was 22 months. There were no significant differences (P = 0.693) among the three groups in terms of adverse events and the final crossover rate of ERAT to surgery was 21.21% (7/33). Conclusion ERAT can serve as an alternative and efficient method to treat acute uncomplicated appendicitis. Trial registration The study is registered with the WHO Primary Registry-Chinese Clinical Trial Registry (ChiCTR1900025812).
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Sekiguchi N, Matsuyama J, Koh M, Iede K, Ueda M, Tsuda Y, Nakashima S, Tanida T, Ikenaga M, Yamada T. Examination of factors related to pathological severity and microperforation in patients undergoing surgery for acute appendicitis. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Naoko Sekiguchi
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Jin Matsuyama
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Masahiro Koh
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Kiyotsugu Iede
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Masami Ueda
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Yujiro Tsuda
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Shinsuke Nakashima
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Tsukasa Tanida
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
| | - Terumasa Yamada
- Department of Gastroenterological surgery, Higashiosaka city medical center Osaka Japan
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Shahid MH, Khan FI, Askri ZA, Asad A, Saeed R, Talib TB, Khan AZ, Fatima T, Afzal MF. Two-Year Experiences of 500 Appendectomies in Lahore General Hospital, Lahore. Cureus 2022; 14:e21303. [PMID: 35186565 PMCID: PMC8849461 DOI: 10.7759/cureus.21303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Acute appendicitis is a leading cause of abdominal conditions in emergency departments. Evidence from research studies has indicated the efficacies of surgical procedures involving appendectomies. However, in Pakistan, there is a paucity of information regarding the epidemiology, clinical presentations, and surgical management of acute appendicitis. Objective This paper aims to report the epidemiologic data and findings of surgical management of acute appendicitis in Lahore General Hospital (LGH). The data was based on our two-year experiences of appendectomies in the hospital. Materials and methodology Data were collected retrospectively. The patients underwent appendectomies performed by the team of surgeons of Surgical Unit 1 of LGH in the Accident and Emergency (A&E) Department from July 2019 to October 2021. Results The total number of patients was 506, and the mean age was 26.8. Males (67.29%) and young adults aged 18-34 years were at higher risk of appendicitis. Compared to other surgical procedures performed, open appendectomy and laparoscopic appendectomy operative times were significantly shorter. Histopathology of all the cases showed acute inflammation of the appendix. Discussion Similar to findings from other research studies, the operative time of open appendectomies was shorter (70.6 minutes) in the hospital than the operative time of laparoscopic appendectomies (77 minutes). However, the overall operative times were longer than the operative times reported in some other research studies. Also, contrary to other research findings, open appendectomy (1.22 days) was associated with a longer length of hospital stay than laparoscopic appendectomy (≈1 day). Simple acute appendicitis was the most predominant operation findings (289, 57.1%). Conclusion Compared to other hospitals, the shorter hospital stays/recovery time indicated the high surgical skill of performing open and laparoscopic appendectomies in Lahore General Hospital, Lahore, Pakistan.
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Chen Y, Ren F, Xiao D, Guan AH, Zhu LD, Ma XP, Wang ZY. Prediction nomogram for evaluating the probability of postoperative fever in children with acute appendicitis. Front Pediatr 2022; 10:982614. [PMID: 36081635 PMCID: PMC9445266 DOI: 10.3389/fped.2022.982614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study was to establish a predictive model of postoperative fever in children with acute appendicitis through retrospective analysis, and the prediction ability of the model is demonstrated by model evaluation and external validation. METHODS Medical records information on children undergoing surgery for acute appendicitis within 2 years were retrospectively collected, prospective collection was performed for external validation in the next 3 months. The patients were divided into two groups according to whether the postoperative body temperature exceeded 38.5°C. Multivariate logistic regression analysis was used to determine independent risk factors and develop regression equations and nomogram. ROC curve, calibration curve and decision curve were made for model evaluation. Finally, the clinical implication of the prediction model was clarified by associating postoperative fever with prognosis. RESULTS High risk factors of postoperative fever included in the prediction model were onset time (X1), preoperative temperature (X2), leukocyte count (X3), C-reactive protein (X4) and operation time (X5). The regression equation is logit (P) = 0.005X1+0.166X2+0.056X3+0.004X4+0.005X5-9.042. ROC curve showed that the area under the curve (AUC) of the training set was 0.660 (0.621, 0.699), and the AUC of the verification set was 0.712 (0.639, 0.784). The calibration curve suggested that the prediction probability was close to the actual probability. Decision curve analysis (DCA) showed that patients could benefit from clinician's judgment. Furthermore, prognostic analysis showed children presenting with postoperative fever had the more duration of postoperative fever, hospitalization stays and cost, except for rehospitalization. CONCLUSION All the results revealed that the model had good predictive ability. Pediatricians can calculate the probability of postoperative fever and make timely interventions to reduce pain for children and parents.
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Affiliation(s)
- Yang Chen
- Shenzhen Children's Hospital, Shenzhen, China.,College of Medicine, Shantou University, Shantou, China
| | - Feng Ren
- Shenzhen Children's Hospital, Shenzhen, China
| | - Dong Xiao
- Shenzhen Children's Hospital, Shenzhen, China
| | - Ai-Hui Guan
- Shenzhen Children's Hospital, Shenzhen, China.,College of Medicine, Shantou University, Shantou, China
| | - Le-Dao Zhu
- Shenzhen Children's Hospital, Shenzhen, China
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Di Girolamo N, Petrini D, Szabo Z, Volait-Rosset L, Oglesbee BL, Nardini G, Possenti M, Gerosa S, Rota S, Huynh M, Vitolo D, Devescovi E, Nicoletti A, Selleri P, Guillier D, Reese D, Nicolier A, Reyes-Gomez E, Matteucci G, Reavill DR, Binanti D. Clinical, surgical, and pathological findings in client-owned rabbits with histologically confirmed appendicitis: 19 cases (2015-2019). J Am Vet Med Assoc 2022; 260:82-93. [PMID: 34843442 DOI: 10.2460/javma.20.08.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report clinical, surgical, and pathological findings in client-owned rabbits with histologically confirmed appendicitis. ANIMALS 19 rabbits. PROCEDURES Medical records for client-owned rabbits that had a histologic diagnosis of appendicitis were reviewed. RESULTS Median age of the rabbits at presentation was 24.0 months (range, 4 to 84 months). Seventeen cases occurred during the summer and fall seasons. Decreased appetite (17/19 rabbits), abnormal rectal temperature (hyperthermia, 9/16 rabbits; hypothermia, 4/16 rabbits), hypocalcemia (8/11 rabbits), and hypoglycemia (7/15 rabbits) were common signs. Abdominal ultrasonography and CT findings were suggestive of appendicitis in 6 of 8 rabbits and in 1 of 2 rabbits, respectively. Of the 6 rabbits that received medical treatment, 3 died at 48 hours, 1 died at 24 hours after hospitalization, and 1 died at 10 days after presentation; 1 rabbit was alive at 1,030 days after presentation. Of the 8 rabbits that underwent appendectomy, 3 died before discharge from the hospital and 1 died 113 days after surgery; 4 rabbits were alive at 315, 334, 1,433, and 1,473 days after presentation. The remaining 5 rabbits either died or were euthanized before treatment could be instituted. In each of the 19 rabbits, the appendix had evidence of severe inflammation with mucosal ulceration, heterophilic inflammation, and necrotic debris. CLINICAL RELEVANCE For rabbits with decreased appetite and an apparently painful abdomen, hyperthermia, hypocalcemia, or hypoglycemia, appendicitis should be considered as a differential diagnosis. Further comparisons of medical and surgical treatments are required to establish treatment recommendations for rabbits with appendicitis.
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Affiliation(s)
- Nicola Di Girolamo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK
| | | | - Zoltan Szabo
- Tai Wai Small Animal & Exotic Hospital, Tai Wai, Shatin, Sha Tin, Hong Kong
| | - Laetitia Volait-Rosset
- Exotic Animal Medicine and Surgery Unit, Alfort National Veterinary School, University of East Paris, Maisons-Alfort, France
| | | | | | - Marzia Possenti
- L'Arca Ambulatorio Veterinario Associato, Cassano d'Adda, Italy
| | | | | | - Minh Huynh
- Exotic Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France
| | | | | | | | | | - David Guillier
- Exotic Animal Medicine and Surgery Unit, Alfort National Veterinary School, University of East Paris, Maisons-Alfort, France
| | - David Reese
- VetCT Consultants in Telemedicine, Fremantle, WA, Australia
| | | | - Edouard Reyes-Gomez
- Unité d'Histologie et d'Anatomie Pathologique, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | | | | | - Diana Binanti
- AbLab Veterinary Diagnostic Laboratory, Sarzana, Italy
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Korsch LA, Michael Boemers T, Zimmermann P, Stenzel M, Wendenburg W. Delayed Detection of a Carcinoid Tumor after Conservative Therapy for Appendicitis in a 13-Year-Old Boy and a 17-Year-Old Girl. European J Pediatr Surg Rep 2021; 9:e61-e64. [PMID: 34777940 PMCID: PMC8580733 DOI: 10.1055/s-0041-1728723] [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: 07/02/2019] [Accepted: 03/06/2021] [Indexed: 11/14/2022] Open
Abstract
Acute appendicitis is common in children and adolescents. Recently, conservative antibiotic treatment is regarded to be a safe approach to treat uncomplicated appendicitis. It is already established as initial treatment in cases of perforated appendicitis with perityphlitic abscess, commonly followed by interval appendectomy. We report on a 13-year-old boy with uncomplicated appendicitis and a 17-year-old girl with complicated, perforated appendicitis and perityphlitic abscess in whom initially successful antibiotic treatment led to a delay in detection of a carcinoid tumor (neuroendocrine tumor, NET) of the appendix. NET of the appendix, with an incidence of 0.03 to 0.8% in the pediatric population undergoing appendectomy for acute appendicitis, are usually incidental findings after appendectomy with no secure method for detection prior to surgery. Raising concern about this rare but severe disease, we recommend information of patients and their parents about the potential risk of belated diagnosis before opting for conservative their treatment of acute appendicitis. Furthermore, patients successfully treated conservatively require a close follow-up by ultrasound. In presence of any conspicuous finding, especially on imaging, appendectomy should be considered.
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Affiliation(s)
- Leonie Annina Korsch
- Department of Pediatric Surgery and Urology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
| | - Thomas Michael Boemers
- Department of Pediatric Surgery and Urology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
| | - Peter Zimmermann
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Martin Stenzel
- Department of Pediatric Radiology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
| | - Wera Wendenburg
- Department of Pediatric Surgery and Urology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
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31
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Mosuka EM, Thilakarathne KN, Mansuri NM, Mann NK, Rizwan S, Mohamed AE, Elshafey AE, Khadka A, Mohammed L. A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children. Cureus 2021; 13:e18901. [PMID: 34692267 PMCID: PMC8528224 DOI: 10.7759/cureus.18901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/07/2023] Open
Abstract
More than a century after its introduction, appendectomy has remained the gold standard treatment for acute appendicitis. In adults with acute uncomplicated appendicitis, nonoperative management (NOM) has been shown to be a viable treatment option. To date, there has been relatively limited data on the nonoperative management of acute appendicitis in the pediatric population. The primary objective of this study was to systematically review the available literature in the pediatric population and compare the efficacy and recurrence between initial nonoperative treatment strategy and appendectomy in children with uncomplicated appendicitis. In July 2021, we conducted systematic searches of the PubMed and Google Scholar databases. We only included full-text comparative original studies published within the last decade, and we excluded articles that solely examined NOM without comparing it to appendectomy. Two writers worked independently on the data collection and analysis. It was found that NOM had a high initial success rate and a low rate of recurrent appendicitis. After months of follow-up, the vast majority of patients with uncomplicated acute appendicitis who received initial nonoperative treatment did not require surgical intervention. Furthermore, the rate of complication was comparable in both treatment groups, and NOM did not appear to be associated with an increased risk of complications. The most significant drawback stemmed from the fact that the included articles in this study had a wide range of study designs and inclusion criteria. According to current evidence, NOM is feasible and cost-effective. Antibiotic therapy can be given safely in a small subset of individuals with uncomplicated appendicitis. To optimize outcomes, physicians should evaluate the clinical presentation and the patient's desire when selecting those to be managed nonoperatively. Again, more research, preferably large randomized trials, is required to compare the long-term clinical efficacy of NOM with appendicectomy. Finally, additional research is required to establish the characteristics of patients who are the best candidates for nonoperative treatment.
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Affiliation(s)
- Emmanuel Mudika Mosuka
- Medicine, Faculty of Health Sciences, University of Buea, Buea, CMR
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Medical Documentation, Boston Children's Hospital, Boston, USA
| | | | - Naushad M Mansuri
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Neelam K Mann
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Shariqa Rizwan
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Afrah E Mohamed
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ahmed E Elshafey
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Akanchha Khadka
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Medicine, Nepal Medical College, Kathmandu, NPL
| | - Lubna Mohammed
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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32
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Composite Criteria for Non-Operative Management of Acute Non-Complicated Appendicitis Result in Low Failure Rates. World J Surg 2021; 46:69-75. [PMID: 34570268 DOI: 10.1007/s00268-021-06330-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study is to investigate the outcomes of conservative management of non-complicated acute appendicitis (AA) using our unique institutional protocol, and to compare between these and the outcomes of operative management. METHODS Patients admitted to our institution between March 2016 and October 2019 with non-complicated AA were grouped according to their initial management: non-operative versus surgical. Our unique protocol for non-operative management includes: pain < 3 days; afebrile upon admission; non-gravid; WBC <15,000 (× 109/L); CRP < 5 mg/dl; appendix diameter < 1 cm; no appendicolith on imaging; no prior episode of AA; no history of Inflammatory Bowel Disease; no evidence of peritonitis on physical examination. The primary outcome measured was failure of non-surgical management during the index admission. Secondary outcomes included recurrence rate, readmissions, complications, length of antibiotic treatment and length of stay (LOS). RESULTS A total of 695 patients were included, 436 in the operative group and 259 in the non-surgical treatment group. The mean follow-up time was 1004.9 ± 205.7 days. Patients initially treated conservatively rarely required surgery during their index admission (6.9%). Recurrence rate was 19.1% after a mean follow up of 33.4 months. The overall failure rate of conservative management was documented in 20.8% of the patients. The complication rate was higher in those treated with upfront surgery (1.6% vs. 0.4%, p < 0.001). The overall LOS was not statistically different between the groups. CONCLUSIONS Our composite protocol for non-surgical management of non-complicated AA results in a low failure rate. A well calculated patient treatment allocation in non-complicated AA can advocate for wide-spread use of the conservative approach.
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Affiliation(s)
- David A Talan
- From the Department of Emergency Medicine, UCLA Ronald Reagan Medical Center, and the David Geffen School of Medicine at UCLA - both in Los Angeles (D.A.T.); and the Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy (S.D.S.)
| | - Salomone Di Saverio
- From the Department of Emergency Medicine, UCLA Ronald Reagan Medical Center, and the David Geffen School of Medicine at UCLA - both in Los Angeles (D.A.T.); and the Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy (S.D.S.)
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The effect of the Covid-19 outbreak on the management of acute appendicitis: A retrospective comparative cohort study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.960850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Leary DP, Walsh SM, Bolger J, Baban C, Humphreys H, O'Grady S, Hegarty A, Lee AM, Sheehan M, Alderson J, Dunne R, Morrin MM, Lee MJ, Power C, McNamara D, McCawley N, Robb W, Burke J, Sorensen J, Hill AD. A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial. Ann Surg 2021; 274:240-247. [PMID: 33534226 DOI: 10.1097/sla.0000000000004785] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis. SUMMARY BACKGROUND DATA Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life. METHODS Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy. RESULTS One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001). CONCLUSIONS Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.
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Affiliation(s)
- D Peter O'Leary
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Siun M Walsh
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jarlath Bolger
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chwanrow Baban
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sorcha O'Grady
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife M Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sheehan
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jack Alderson
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth Dunne
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martina M Morrin
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Power
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah McNamara
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh McCawley
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Will Robb
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Burke
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Arnold D Hill
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
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Fujiwara K, Abe A, Masatsugu T, Hirano T, Hiraka K, Sada M. Usefulness of several factors and clinical scoring models in preoperative diagnosis of complicated appendicitis. PLoS One 2021; 16:e0255253. [PMID: 34314464 PMCID: PMC8315522 DOI: 10.1371/journal.pone.0255253] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background The preoperative distinction between uncomplicated and complicated appendicitis is important to determine the appropriate treatments, such as antibiotics, surgery, or interval appendectomy. Computed tomography (CT) plays an important role; however, combining clinical and imaging factors may make preoperative evaluation more reliable. This study evaluated and analyzed cases and the usefulness of several preoperative factors and clinical scoring models to detect complicated appendicitis. Methods A total of 203 patients preoperatively diagnosed with acute appendicitis at our facility were included. Complicated appendicitis was defined as appendicitis with gangrene, perforated appendix, and/or abscess formation. Preoperative factors were collected from published clinical scoring models; patient information, symptoms, signs, results of laboratory tests, and findings of CT. Factors were analyzed using a chi-squared test and the Mann-Whitney U test. Results The preoperative factors were compared between 151 uncomplicated and 52 complicated appendicitis patients. The significant factors were age ≥40, duration of symptoms >24 hours, body temperature ≥37.3°C, high levels of CRP, findings in CT scan (appendix diameter ≥10 mm, stranding of the adjacent fat, presence of fluid collection, and suspicion of abscess or perforation). We also evaluated the usefulness of clinical scoring models for the detection of complicated appendicitis and found the Appendicitis Inflammatory Response score and two prediction models (Atema score and Imaoka score) showed significance (p < 0.05). High serum CRP level was significantly associated with complicated appendicitis (p < 0.001), and the predicted existence rates of complicated appendicitis were 52.7% for serum CRP level ≥50mg/L, 74.4% for ≥100mg/L, and 82.6% for ≥150mg/L. Conclusion The results demonstrated several preoperative factors and clinical scoring models to increase suspicion of complicated appendicitis. Specifically, high serum levels of CRP may be a useful factor in predicting complicated appendicitis prior to surgery when supported by clinical findings and imaging; however, further research is needed.
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Affiliation(s)
- Kenji Fujiwara
- Department of Surgery, Sada Hospital, Fukuoka, Japan
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Abe
- Department of Surgery, Sada Hospital, Fukuoka, Japan
| | | | | | | | - Masayuki Sada
- Department of Surgery, Sada Hospital, Fukuoka, Japan
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Ando T, Oka T, Oshima G, Handa K, Maeda S, Yuasa Y, Aiko S. Fecalith in the Proximal Area of the Appendix is a Predictor of Failure of Nonoperative Treatment for Complicated Appendicitis in Adults. J Surg Res 2021; 267:477-484. [PMID: 34246841 DOI: 10.1016/j.jss.2021.06.015] [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: 06/12/2020] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The management of complicated appendicitis remains controversial, since this disease has various clinical presentations and is associated with high rates of adverse events. Although initial nonoperative treatment is generally employed for complicated appendicitis, its clinical presentation and the predictors of nonoperative treatment failure are unclear. METHODS Patients diagnosed with complicated appendicitis in our hospital between April 2015 and March 2020 were enrolled. In total, 113 patients were classified into three categories: emergency appendectomy, failure of nonoperative treatment and successful nonoperative treatment. The primary outcome was the rate of failure of nonoperative treatment, as assessed by logistic regression analysis. The secondary outcomes were the operative procedures and postoperative courses of the three groups. RESULTS Of 113 patients, 45 (40%) underwent emergency appendectomy, 25 (22%) failed nonoperative treatment, and 43 (38%) had successful nonoperative treatment. Among these successful cases, 38 patients (88%) underwent interval appendectomy. In multivariate analyses, the presence of a fecalith in the proximal area of the appendix was an independent risk factor for failure of nonoperative treatment (odds ratio, 20.5; 95% confidence interval, 4.37-95.7, P < 0.001). Postoperative outcomes were more unfavorable in cases of failed nonoperative treatment than in cases of emergency and interval appendectomy. CONCLUSIONS The presence of a fecalith in the proximal area of the appendix is an independent predictor for failure of nonoperative treatment for complicated appendicitis in adults. Patients with this risk factor should be considered candidates for surgical treatment.
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Affiliation(s)
- Tomofumi Ando
- Department of Surgery, Eiju General Hospital, Tokyo, Japan.
| | - Taishu Oka
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Go Oshima
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Kan Handa
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Shingo Maeda
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Yuji Yuasa
- Department of Radiology, Eiju General Hospital, Tokyo, Japan
| | - Satoshi Aiko
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
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Bowen JM, Sheen JRC, Whitmore H, Wright C, Bowling K. Acute appendicitis in the COVID-19 era: A complicated situation? Ann Med Surg (Lond) 2021; 67:102536. [PMID: 34230852 PMCID: PMC8252704 DOI: 10.1016/j.amsu.2021.102536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/29/2022] Open
Abstract
Acute appendicitis is the most common intra-abdominal surgical emergency in the world. Null hypothesis of no difference in the number of cases of complicated appendicitis. What impact did the government's ‘Stay at Home’ message have? Increasing body of evidence to support non-operative treatment in certain cases. A significantly higher rate of complicated cases found in the COVID era.
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Affiliation(s)
- Joel M Bowen
- Specialty Trainee Department of Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Jonathon R C Sheen
- Specialty Trainee Department of Trauma & Orthopaedics, Torbay and South Devon NHS Foundation Trust, UK
| | - Helen Whitmore
- Specialty Trainee Department of Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Chloe Wright
- Trust Doctor Department of General Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Kirk Bowling
- Consultant Department of Upper G.I. Surgery, Torbay and South Devon NHS Foundation Trust, UK
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Pringle HCM, Donigiewicz U, Bennett MR, Walker E, Fowler GE, Narang S, Ball S, Bethune RM. Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital. BMC Surg 2021; 21:242. [PMID: 33980191 PMCID: PMC8114653 DOI: 10.1186/s12893-021-01231-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges' advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. METHODS This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. RESULTS There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative. CONCLUSION During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.
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Affiliation(s)
| | | | - Melissa-Rose Bennett
- Royal Devon & Exeter Hospital, Exeter, EX2 5DW Devon UK
- University of Exeter Medical School, St. Luke’s Campus, Heavitree Road, Exeter, EX1 2LU Devon UK
| | | | | | - Sunil Narang
- Royal Devon & Exeter Hospital, Exeter, EX2 5DW Devon UK
| | - Susan Ball
- NIHR Applied Research Collaboration, South West Peninsula (PenARC), University of Exeter Medical School, Exeter, EX1 2LU Devon UK
| | - Robert M. Bethune
- Royal Devon & Exeter Hospital, Exeter, EX2 5DW Devon UK
- University of Exeter Medical School, St. Luke’s Campus, Heavitree Road, Exeter, EX1 2LU Devon UK
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Castoldi L, Solbiati M, Costantino G, Casiraghi E. Variations in volume of emergency surgeries and emergency department access at a third level hospital in Milan, Lombardy, during the COVID-19 outbreak. BMC Emerg Med 2021; 21:59. [PMID: 33971826 PMCID: PMC8107771 DOI: 10.1186/s12873-021-00445-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND During the recent outbreak of COVID-19 (coronavirus disease 2019), Lombardy was the most affected region in Italy, with 87,000 patients and 15,876 deaths up to May 26, 2020. Since February 22, 2020, well before the Government declared a state of emergency, there was a huge reduction in the number of emergency surgeries performed at hospitals in Lombardy. A general decrease in attendance at emergency departments (EDs) was also observed. The aim of our study is to report the experience of the ED of a third-level hospital in downtown Milan, Lombardy, and provide possible explanations for the observed phenomena. METHODS This retrospective, observational study assessed the volume of emergency surgeries and attendance at an ED during the course of the pandemic, i.e. immediately before, during and after a progressive community lockdown in response to the COVID-19 pandemic. These data were compared with data from the same time periods in 2019. The results are presented as means, standard error (SE), and 95% studentized confidence intervals (CI). The Wilcoxon rank signed test at a 0.05 significance level was used to assess differences in per-day ED access distributions. RESULTS Compared to 2019, a significant overall drop in emergency surgeries (60%, p < 0.002) and in ED admittance (66%, p ≅ 0) was observed in 2020. In particular, there were significant decreases in medical (40%), surgical (74%), specialist (ophthalmology, otolaryngology, traumatology, and urology) (92%), and psychiatric (60%) cases. ED admittance due to domestic violence (59%) and individuals who left the ED without being seen (76%) also decreased. Conversely, the number of deaths increased by 196%. CONCLUSIONS During the COVID-19 outbreak the volume of urgent surgeries and patients accessing our ED dropped. Currently, it is not known if mortality of people who did not seek care increased during the pandemic. Further studies are needed to understand if such reductions during the COVID-19 pandemic will result in a rebound of patients left untreated or in unwanted consequences for population health.
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Affiliation(s)
- Laura Castoldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOSD Chirurgia d'Urgenza,, Milano, Italy.
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Elena Casiraghi
- Anacleto Lab, Computer Science Department, Università degli Studi di Milano, Milan, Italy
- MIPS Lab, Computer Science Department, Università degli Studi di Milano, Milan, Italy
- CINI-AIIS, Italian National Laboratory in Artificial Intelligence and Intelligent Systems, University of Modena and Reggio Emilia, Modena, Italy
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Stöß* C, Nitsche* U, Neumann PA, Kehl V, Wilhelm D, Busse R, Friess H, Nimptsch U. Acute Appendicitis: Trends in Surgical Treatment—A Population-Based Study of Over 800 000 Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:244-249. [PMID: 34114553 PMCID: PMC8283679 DOI: 10.3238/arztebl.m2021.0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/17/2020] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendectomy is the gold standard for treatment of acute appendicitis. However, recent studies favor primary antibiotic therapy. The aim of this observational study was to explore changes in the numbers of operations for acute appendicitis in the period 2010-2017, paying special attention to disease severity. METHODS Data from diagnosis-related group statistics were used to analyze the trends, mortality, and complication rates in the surgical treatment of appendicitis in Germany between 2010 and 2017. All cases of appendectomy after a diagnosis of appendicitis were included. RESULTS Altogether, 865 688 inpatient cases were analyzed. The number of appendectomies went down by 9,8%, from 113 614 in 2010 to 102 464 in 2017, while the incidence fell from 139/100 000 in 2010 to 123/100 000 in 2017 (standardized by age group). This decrease is due to the lower number of operations for uncomplicated appendicitis (79 906 in 2017 versus 93 135 in 2010). Hospital mortality decreased both in patients who underwent surgical treatment of complicated appendicitis (0.62% in 2010 versus 0.42% in 2017) and in those with a complicated clinical course (5.4% in 2010 versus 3.4% in 2017). CONCLUSION Decisions on the treatment of acute appendicitis in German hospitals follow the current trend towards non-surgical management in selected patients. At the same time, the care of acute appendicitis has improved with regard to overall hospital morbidity and hospital mortality.
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Affiliation(s)
- Christian Stöß*
- *Joint first authors
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich
| | - Ulrich Nitsche*
- *Joint first authors
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich
| | | | - Victoria Kehl
- Münchner Studienzentrum, Klinikum rechts der Isar, School of Medicine,Technical University of Munich
| | - Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich
| | - Reinhard Busse
- Department of Health Care Management, Institute of Technology and Management, Technische Universität Berlin
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich
| | - Ulrike Nimptsch
- Department of Health Care Management, Institute of Technology and Management, Technische Universität Berlin
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Naya I, Adachi K, Takeuchi K, Ariyama Y, Hosaka A, Imamura K, Morita Y, Matsubara S, Lefor AK, Horie H. Clinical predictors of gangrenous appendicitis: elevated total bilirubin level and computed tomography scan findings. Acute Med Surg 2021; 8:e620. [PMID: 33815809 PMCID: PMC8013822 DOI: 10.1002/ams2.620] [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: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/29/2022] Open
Abstract
Aim Patients with gangrenous appendicitis usually require emergency surgery. Preoperative diagnosis of gangrenous appendicitis is clinically important but not always straightforward. We undertook this study to identify preoperative predictors of gangrenous appendicitis. Methods This was a single‐center case–control study. We identified 162 patients who underwent appendectomy between September 2011 and August 2014 after the diagnosis of acute appendicitis was established. We identified laboratory parameters and computed tomography (CT) scan findings predictive of histologically or surgically diagnosed gangrenous appendicitis by univariable and multivariable analyses. Results Of 146 study patients, gangrenous appendicitis was confirmed in 102. Univariable analysis showed that two laboratory factors (C‐reactive protein []and total bilirubin [T‐Bil]) and three CT scan findings were significant predictors for gangrenous appendicitis. Multivariable analysis showed that T‐Bil and two CT scan findings (appendicolith and fat stranding around the appendix) were independent predictors. The combination of “T‐Bil ≥ 1.0 mg/dL or appendicolith” was able to predict gangrenous appendicitis with a sensitivity of 90.5%, positive predictive value of 80.4%, and accuracy of 77.8%. The combination of “T‐Bil ≥ 1.0 mg/dL or fat stranding around the appendix” was able to predict gangrenous appendicitis with a sensitivity of 98.9%, positive predictive value of 76.4%, and accuracy of 71.9%. Conclusion These combinations of laboratory and CT scan findings could be valuable as predictors of gangrenous appendicitis.
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Affiliation(s)
- Itsuki Naya
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Kensuke Adachi
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan.,Department of Surgery Tokyo Metropolitan Bokutoh Hospital Bokutoh Hospital Tokyo Japan
| | - Koichi Takeuchi
- Department of Welfare and Medical Intelligence Chiba University Hospital Chiba Japan
| | - Yuno Ariyama
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Akihiro Hosaka
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Kazuhiro Imamura
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Yasuhiro Morita
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology Jichi Medial University Tochigi Japan
| | | | - Hisanaga Horie
- Department of Surgery Jichi Medial University Tochigi Japan
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Vatele J, Gentile S, Thomson V, Devictor B, Cloux M, Girouin N, Bratan F, Bergerot JF, Seux M, Banaste N, Tazarourte K, Gorincour G. Teleradiology as a relevant indicator of the impact of COVID-19 pandemic management on emergency room activities: a nationwide worrisome survey. Insights Imaging 2021; 12:30. [PMID: 33660203 PMCID: PMC7927778 DOI: 10.1186/s13244-021-00964-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate the impact of COVID-19's lockdown on radiological examinations in emergency services. METHODS Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5-8 and then 12-15). We included CT scans or MRIs performed for strokes, multiple traumas (Body-CT), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest. RESULTS Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020. From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre's number of examinations, gender distribution and patient ages were unchanged. In 2020, examinations significantly decreased: suspected strokes decreased by 36% (1052 vs 675, p < 0.001), Body-CT by 62% (349 vs 134, p < 0.001), CTr by 52% (1853 vs 895, p < 0.001) and for ANTAP, appendicitis decreased by 38% (45 vs 90, not statistically significant (NS)) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS). The number of examinations per centre decreased by 13% (185.5 vs 162.5, p < 0.001), whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p < 0.001). CONCLUSION Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care.
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Affiliation(s)
- Jordan Vatele
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - Stéphanie Gentile
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de recherche sur les Services de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Vivien Thomson
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France
| | - Bénédicte Devictor
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de recherche sur les Services de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | | | - Nicolas Girouin
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
- Norimagerie, Caluire et Cuire, France
| | - Flavie Bratan
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
- Department of Diagnostic and Interventional Imaging, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Jean-François Bergerot
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
- Ramsay Générale de Santé, Clinique Convert, Bourg-en-Bresse, France
| | - Mylène Seux
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
| | - Nathan Banaste
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France
- Department of Radiology, Hopital Nord-Ouest, Villefranche-sur-Saône, France
| | - Karim Tazarourte
- Emergency Department, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- EA 7425 HESPER, Université Lyon 1, Lyon, France
| | - Guillaume Gorincour
- Imadis Teleradiology, Lyon, Bordeaux, Marseille, France.
- ELSAN, Clinique Bouchard, Marseille, France.
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Chronological Changes in Appendiceal Pathology Among Patients Who Underwent Appendectomy for Suspected Acute Appendicitis. World J Surg 2021; 44:2965-2973. [PMID: 32322937 DOI: 10.1007/s00268-020-05509-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Given recent advances in imaging and the development of diagnostic parameters, the rate of unnecessary appendectomy (i.e., negative appendectomy) has been decreasing. However, the incidence of acute appendicitis (AA) in elderly patients is rising due to the aging of society. We aimed to identify chronological changes in demographics and appendiceal pathology among patients who underwent appendectomy for suspected AA. METHODS Data from 881 patients who underwent appendectomy for suspected AA between January 2006 and December 2017 were analyzed. The final diagnosis was based on intraoperative findings, pathological reports, and clinical course. Negative appendectomy was defined as the absence of appendiceal diseases including inflammation, fibrosis, and neoplasm. We compared demographics and appendiceal pathology between early (2006-2011) and late study phases (2012-2017). RESULTS The mean age of patients with pathologically proven AA (n = 761) was significantly greater in the late phase than in the early phase (38.6 ± 19.8 years vs. 44.0 ± 20.3 years, p = 0.0002), and the ratio of patients with AA aged ≧ 75 years was also increased (from 5.6 to 8.6%, p = 0.1120). The incidences of complicated appendicitis (defined as perforated or gangrenous appendicitis) and appendiceal diverticulitis (AD) were increased in the late phase compared to those in the early phase (61.3% vs. 77.2% and 3.7% vs. 6.6%, respectively). The negative appendectomy rate was significantly reduced in the late phase compared to that in the early phase (10.0% vs. 2.5%, p < 0.0001). CONCLUSIONS During a 12-year period, the mean age of patients with AA and the incidences of complicated appendicitis and AD increased, whereas the negative appendectomy rate decreased.
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Wichmann D, Schweizer U, Wulff D, Thiel K, Beltzer C, Königsrainer A, Archid R. Incidence of Perforated Appendicitis during the COVID-19 Pandemic: Lessons to Be Considered in the Second Wave. J Gastrointest Surg 2021; 25:2404-2406. [PMID: 33555522 PMCID: PMC7869768 DOI: 10.1007/s11605-021-04915-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/10/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Ulrich Schweizer
- Department of General, Visceral and Transplantation Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Daniel Wulff
- Department of General, Visceral and Transplantation Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplantation Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Christian Beltzer
- Department of General, Visceral and Thoracic-Surgery, German Armed Forced Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Rami Archid
- Department of General, Visceral and Transplantation Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Alejo G, Ruiz M, Hernandez-Ochoa A, Ortiz C, Huerta S. Differences in treatment strategies in the management of acute appendicitis in a county hospital in Guatemala and an academic teaching institution in the United States. Trop Doct 2020; 51:158-162. [PMID: 33356919 DOI: 10.1177/0049475520981231] [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] [Indexed: 01/01/2023]
Abstract
Laparoscopy and antibiotic-first (NOM) strategies have been introduced in the management of acute appendicitis in industrialised countries. Data regarding the feasibility of these strategies in low-income nations are sparse. A retrospective analysis of adult patients undergoing appendicectomy at a county non-teaching hospital in San Benito, Guatemala (Hospital Nacional (HNSB)) was compared to an academic, teaching institution in Dallas, USA (Veterans Medical Centre). Most patients at the VA (92%) underwent computed tomography prior to being operated upon while none did so at HNSB. Whilst all patients at HNSB underwent an open approach, 95% of VA patients underwent a laparoscopic appendicectomy with a 4.7% conversion rate. General anaesthesia was universally used at Veterans Medical Centre, whilst spinal anaesthesia was utilised in 88% of cases at HNSB. NOM of acute appendicitis was undertaken only rarely at the Veterans Medical Centre and never at HNSB, where it was not thought expedient.
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Affiliation(s)
- Gabriela Alejo
- BS, Medical Student, Department of Surgery, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Maria Ruiz
- BD, Medical Student, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Anny Hernandez-Ochoa
- MD, Chief of Surgery, Department of Surgery, Hospital Nacional in San Benito, Guatemala
| | - Cesar Ortiz
- MD, Hospital Director, Hospital Nacional in San Benito, Guatemala
| | - Sergio Huerta
- MD, FACS, Professor, Department of Surgery, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, USA
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Kabir SMU, Bucholc M, Walker CA, Sogaolu OO, Zeeshan S, Sugrue M. Quality Outcomes in Appendicitis Care: Identifying Opportunities to Improve Care. Life (Basel) 2020; 10:life10120358. [PMID: 33352906 PMCID: PMC7767194 DOI: 10.3390/life10120358] [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: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention, but the variability of diagnosis and management continue to challenge the surgeons. Aim: This study assessed patients undergoing appendectomy to identify opportunities to improve diagnostic accuracy and outcomes. METHODS An ethically approved retrospective cohort study was undertaken between March 2016 and March 2017 at a single university hospital of all consecutive adult and paediatric patients undergoing appendectomy. Demographic data including age, gender, co-morbidities, presentation and triage timings along with investigation, imaging and operative data were analysed. Appendicitis was defined as acute based on histology coupled with intraoperative grading with the American Association for the Surgery of Trauma (AAST) grades. Complications using the Clavien-Dindo classification along with 30-day re-admission rates and the negative appendectomy rates (NAR) were recorded and categorised greater and less than 25%. The use of scoring systems was assessed, and retrospective scoring performed to compare the Alvarado, Adult Appendicitis Score (AAS) and the Appendicitis Inflammatory Response (AIR) score. Results: A total of 201 patients were studied, 115 male and 86 females, of which 136/201 (67.6%) were adults and 65/201 (32.3%) paediatric. Of the adult group, 83 were male and 53 were female, and of the paediatric group, 32 were male and 33 were female. Median age was 20 years (range: 5 years to 81 years) and no patient below the age of 5 years had an appendectomy during our study period. All patients were admitted via the emergency department and median time from triage to surgical review was 2 h and 38 min, (range: 10 min to 26 h and 10 min). Median time from emergency department review to surgical review, 55 min (range: 5 min to 6 h and 43 min). Median time to operating theatre was 21 h from admission (range: 45 min to 140 h and 30 min). Out of the total patients, 173 (86.1%) underwent laparoscopic approach, 28 (13.9%) had an open approach and 12 (6.9%) of the 173 were converted to open. Acute appendicitis occurred in 166/201 (82.6%). There was no significant association between grade of appendicitis and surgeons' categorical NAR rate (p = 0.07). Imaging was performed in 118/201 (58.7%); abdominal ultrasound (US) in 53 (26.4%), abdominal computed tomography (CT) in 59 (29.2%) and both US and CT in 6 (3%). The best cut-off point was 4 (sensitivity 84.3% and specificity of 65.7%) for AIR score, 9 (sensitivity of 74.7% and specificity of 68.6%) for AAS, and 7 (sensitivity of 77.7% and specificity of 71.4%) for the Alvarado score. Twenty-four (11.9%) were re-admitted, due to pain in 16 (58.3%), collections in 3 (25%), 1 (4.2%) wound abscess, 1 (4.2%) stump appendicitis, 1 (4.2%) small bowel obstruction and 1 (4.2%) fresh rectal bleeding. CT guided drainage was performed in 2 (8.3%). One patient had release of wound collection under general anaesthetic whereas another patient had laparoscopic drain placement. A laparotomy was undertaken in 3 (12.5%) patients with division of adhesions in 1, the appendicular stump removed in 1 and 1 had multiple collections drained. CONCLUSION The negative appendectomy and re-admission rates were unacceptably high and need to be reduced. Minimising surgical variance with use of scoring systems and introduction of pathways may be a strategy to reduce NAR. New systems of feedback need to be introduced to improve outcomes.
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Affiliation(s)
- Syed Mohammad Umar Kabir
- Donegal Clinical Research Academy and Department of Surgery Letterkenny University Hospital, Letterkeny, Co. F92 AE81 Donegal, Ireland; (S.M.U.K.); (O.O.S.); (S.Z.)
| | - Magda Bucholc
- Intelligent Systems Research Centre, University of Ulster, Magee Campus, Londonderry BT48 7JL, UK;
| | - Carol-Ann Walker
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, X728 HG Letterkenny, Ireland;
| | - Opeyemi O. Sogaolu
- Donegal Clinical Research Academy and Department of Surgery Letterkenny University Hospital, Letterkeny, Co. F92 AE81 Donegal, Ireland; (S.M.U.K.); (O.O.S.); (S.Z.)
| | - Saqib Zeeshan
- Donegal Clinical Research Academy and Department of Surgery Letterkenny University Hospital, Letterkeny, Co. F92 AE81 Donegal, Ireland; (S.M.U.K.); (O.O.S.); (S.Z.)
| | - Michael Sugrue
- Donegal Clinical Research Academy and Department of Surgery Letterkenny University Hospital, Letterkeny, Co. F92 AE81 Donegal, Ireland; (S.M.U.K.); (O.O.S.); (S.Z.)
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, X728 HG Letterkenny, Ireland;
- Correspondence: ; Tel.: +353-74-918-8823; Fax: +353-74-918-8816
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Vinck EE, Villarreal RA, Luna-Jaspe C, Cabrera LF, Peterson TF, Bernal F, Roa CL. Low intra-operative diagnostic accuracy does not affect postoperative treatment of acute appendicitis. Acta Chir Belg 2020; 120:390-395. [PMID: 31307280 DOI: 10.1080/00015458.2019.1642578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The intra-operative classification of appendicitis defines postoperative treatment. The correct designation can influence patient recovery, complications and hospital costs. Recent research has shown that intra-operative classification criteria varies among surgeons, and is not always the same as the pathologist's report. Classification accuracy can lower costs by preventing unnecessary treatment or sub-optimal interventions. METHODS During a period of 4 months, N = 133 appendix specimens were received and evaluated by the pathology department of a single teaching hospital. Five surgeons extracted the specimens and one experienced pathologist drew the histopathology reports. A comparison between the surgeons' classifications and the pathologist's was made. Classification accuracy was determined and statistical analyses was performed using chi-square, and p values were obtained. A p < 0.05 was considered significant. RESULTS A total of N = 133 specimens were obtained, 127 belonged to patients following emergency surgery due to acute abdominal pain; the other six were from elective hemi-colectomies for right colonic adenocarcinomas, and were not included. Of the 127 specimens analyzed, 14 (11%) were negative, 21 (16.5%) were edematous, 81 (63.7%) were phlegmonous and 11 (8.6%) were gangrenous. A total of 18 (14%) perforated appendices were also reported. Surgical accuracy was 60.6% (N = 67) with a statistically significant p < 0.001. Only five patients with incorrect intraoperative classifications received unnecessary or lacked treatment. CONCLUSIONS An overall accuracy of 60.6% is seen when the surgical classification is compared to the pathological classification. Although the surgeons' accuracy is low when comparing intra-operative versus histopathological classification, this variation in designation does not affect postoperative treatment significantly.
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Affiliation(s)
- Eric E. Vinck
- Department of Surgery, El Bosque University, Associated with Dr. Horacio Oduber Hospitaal, Oranjestad, Aruba
| | - Ricardo A. Villarreal
- Department of Surgery, El Bosque University, Los Cobos Medical Center, Bogotá, Colombia
| | - Carlos Luna-Jaspe
- Department of Surgery, El Bosque University, Los Cobos Medical Center, Bogotá, Colombia
| | - Luis F. Cabrera
- Department of Surgery, El Bosque University, Los Cobos Medical Center, Bogotá, Colombia
| | - Tim F. Peterson
- Department of Surgery, Universitair Ziekenhuis Brussel, Jette, Belgie, Dr. Horacio Oduber Hospitaal, Oranjestad, Aruba
| | - Felipe Bernal
- Department of Surgery, El Bosque University, Los Cobos Medical Center, Bogotá, Colombia
| | - Carmen L. Roa
- Department of Clinical Pathology, Universidad El Bosque, Bogotá, Colombia
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Reinisch A, Reichert M, Hecker A, Padberg W, Ulrich F, Liese J. Nonoperative Antibiotic Treatment of Appendicitis in Adults: A Survey among Clinically Active Surgeons. Visc Med 2020; 36:494-500. [PMID: 33447606 PMCID: PMC7768103 DOI: 10.1159/000506058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As a result of well-publicized studies, the nonsurgical antibiotic therapy of uncomplicated acute appendicitis has been propagated since 2006. A final assessment regarding efficiency and long-term results is not possible; however, nonoperative therapy of acute appendicitis is actually being discussed more diversely and receives a lot of attention. It is still unknown how far this therapy has found its way into everyday clinical care. METHODS An online questionnaire was sent to 1,400 randomly selected specialists for general/visceral surgery in Germany. Representativeness was achieved by a preselection according to the geographical origin and the care level of the hospitals. RESULTS 14% of surgeons stated that they methodically treat appendicitis conservatively. 38.1% do so in exceptional cases, while 48.8% reject this therapy. For methodically use, sonography or computed tomography is demanded beforehand. Nonoperative therapy is performed more often in metropolitan areas and maximum-care/university hospitals. Patients' request for antibiotic therapy is an important factor for conservative treatment. The main argument against this therapy is "medical doubts." 26% of the surgeons would treat their own appendicitis conservatively. There are distinct associations between the application of conservative therapy, satisfaction with it, and expectations about future development. The response rate was 19.9%. CONCLUSION The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.
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Affiliation(s)
- Alexander Reinisch
- Department of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar, Wetzlar, Germany
| | - Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Frank Ulrich
- Department of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar, Wetzlar, Germany
| | - Juliane Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
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