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Shen L, Zhang L, Shi H. Outcomes of Daytime and Night-Time Appendectomies: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2024; 34:541-549. [PMID: 39183519 DOI: 10.1097/sle.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Acute appendicitis is a common surgical emergency characterized by appendix inflammation. Surgery remains the gold standard for treatment with laparoscopy gaining in popularity. However, the optimal timing for appendectomy remains unclear. We are not aware of studies evaluating potential differences in clinical outcomes among appendectomies performed during the daytime and at night. METHODS We followed the PRISMA guidelines and searched the ScienceDirect, Medline, and Google Scholar databases for studies published in English before June 2023. We included prospective and retrospective studies reporting appendectomy outcomes. We categorized the appendectomy procedure times as daytime or night-time based on each study's definitions. We extracted baseline characteristics and outcomes and assessed the quality of the studies included using the Newcastle-Ottawa Scale. We calculated pooled risk ratios (RRs) and weighted mean differences (WMDs) using random-effects models; and, we assessed heterogeneity using the I2 statistic. RESULTS We analyzed data from 12 studies for systematic review ( n =19,183) including daytime ( n =11,839) and night-time ( n =7344) appendectomies. For the meta-analysis, we included 9 studies, that evaluated outcomes such as mortality (pooled RR, 0.44; 95% CI, 0.09-2.01; I2 =43.7%; P =0.11), hospital stay (WMD, -0.02; 95% CI, -0.24 to 0.20; I2 =93.3%; P <0.001), and complications (pooled RR, 0.96; 95% CI, 0.64-1.45; I2 =65.1%; P =0.02). We found similar mortality rates, hospital stay lengths, and complications for the appendectomies, regardless of the time of day of the operation. The baseline characteristics of the patients were also similar, except for the duration of symptoms and the presence of an appendiceal abscess. CONCLUSION Our results showed that the timing of an appendectomy (daytime vs. night-time) does not significantly affect its outcomes. Surgeon availability or fatigue, and patient severity may not significantly impact the operation results. Standardized protocols and perioperative care ensure consistent outcomes.
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Affiliation(s)
- Lifang Shen
- Department of Surgery, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou City, Zhejiang Province, China
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Han H, Letourneau ID, Abate YH, Abdelmasseh M, Abu-Gharbieh E, Adane TD, Ahinkorah BO, Ahmad A, Ahmadi A, Ahmed A, Alhalaiqa FN, Al-Sabah SK, Al-Worafi YM, Amu H, Andrei CL, Anoushiravani A, Arabloo J, Aravkin AY, Ashraf T, Azadnajafabad S, Baghcheghi N, Bagherieh S, Bantie BB, Bardhan M, Basile G, Bayleyegn NS, Behnoush AH, Bekele A, Bhojaraja VS, Bijani A, Biondi A, Burkart K, Chu DT, Chukwu IS, Cruz-Martins N, Dai X, Demessa BH, Dhali A, Diaz D, Do TC, Dodangeh M, Dongarwar D, Dsouza HL, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Fagbamigbe AF, Fakhradiyev IR, Ferrara P, Fetensa G, Fischer F, Gebrehiwot M, Getachew M, Golechha M, Gupta VK, Habib JR, Hadi NR, Haep N, Haile TG, Hamilton EB, Hasan I, Hasani H, Hassanzadeh S, Haubold J, Hay SI, Hayat K, Ilesanmi OS, Inamdar S, Iwu CCD, Iyasu AN, Jayarajah U, Jayaram S, Jokar M, Jomehzadeh N, Joseph A, Joseph N, Joshua CE, Kabir A, Kandel H, Kauppila JH, Kemp Bohan PM, Khajuria H, Khan M, Khatatbeh H, Kim MS, Kisa A, Kompani F, Koohestani HR, Kumar R, Le TTT, Lee M, Lee SW, Li MC, Lim SS, Lo CH, Lunevicius R, Malhotra K, Maugeri A, Mediratta RP, Meretoja TJ, Mestrovic T, Mirza-Aghazadeh-Attari M, Mohamed NS, Mokdad AH, Monasta L, Moni MA, Moradi M, Mougin V, Mukoro GD, Murillo-Zamora E, Murray CJL, Naimzada MD, Najmuldeen HHR, Natto ZS, Negoi I, Nguyen HQ, Nikolouzakis TK, Olufadewa II, Padubidri JR, Pandey A, Parikh RR, Pham HT, Pollok RCG, Rahimi M, Rahimi-Movaghar V, Rahman M, Rahmani S, Rashidi MM, Rawaf S, Rickard J, Rouientan H, Roy S, Saddik BA, Saeed U, Saleh MA, Salehi S, Samy AM, Sanabria J, Sankararaman S, Schumacher AE, Senthilkumaran S, Shah PA, Shool S, Sibhat MM, Sidamo NB, Singh JA, Socea B, Solomon Y, Sreeram S, Tabatabaei SM, Tan KK, Tavangar SM, Tefera YM, Thomas NK, Ticoalu JHV, Tsegay GM, Tsegaye D, Ullah S, Usman AN, Valizadeh R, Veroux M, Verras GI, Vos T, Wang M, Wang S, Wickramasinghe DP, Yahya G, Zare I, Zarrintan A, Zhang ZJ, Dirac MA. Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. Lancet Gastroenterol Hepatol 2024; 9:825-858. [PMID: 39032499 PMCID: PMC11306195 DOI: 10.1016/s2468-1253(24)00157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021. METHODS Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs). FINDINGS In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates. INTERPRETATION Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions. FUNDING Bill and Melinda Gates Foundation.
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Laudon AD, Beaulieu-Jones BR, Gitonga B, Yang FF, Chen E, Flum DR, Lerner K, Evans HL, Thompson L, Azar FK, Charboneau A, Simianu VV, Sanchez SE, Drake FT. Power Has Pitfalls: (In)accuracy of Administrative Data for Nonoperative Management of Appendicitis. J Surg Res 2024; 302:428-436. [PMID: 39153365 DOI: 10.1016/j.jss.2024.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Nonoperative management (NOM) of uncomplicated appendicitis is increasingly common. Effectiveness of NOM has been studied by identifying patients via International Classification of Diseases (ICD) 9/ICD-10 codes for uncomplicated appendicitis and no code for appendectomy. We sought to assess the accuracy of such administrative definitions. METHODS We retrospectively identified patients with ICD-9/ICD-10 codes for appendicitis at five sites across the United States. Initial management plan and clinical severity were recorded by trained abstractors. We identified a gold standard cohort of patients with surgeon-diagnosed uncomplicated appendicitis and planned NOM. We defined two administrative cohorts with ICD-9/ICD-10 codes for uncomplicated appendicitis and either no surgery during initial admission (definition #1) or no surgery on day 0-1 of admission (definition #2). We compared each definition to the gold standard. RESULTS Among 1224 patients with uncomplicated appendicitis, 72 (5.9%) underwent planned NOM. NOM patients were older (median [Q1-Q3] of 37 [27-56] versus 32 [25-44] y) and less frequently male (51.4% versus 54.9%), White (54.1% versus 67.6%), and privately insured (38.9% versus 50.2%) than patients managed operatively. Definition #1 had sensitivity of 0.81 and positive predictive value of 0.87 for NOM of uncomplicated appendicitis. Definition #2 had sensitivity of 0.83 and positive predictive value of 0.72. The gold standard cohort had a true failure/recurrence rate of 23.6%, compared with apparent rates of 25.4% and 39.8%, respectively. CONCLUSIONS Administrative definitions are prone to misclassification in identifying planned NOM of uncomplicated appendicitis. This likely impacts outcomes in studies using administrative databases. Investigators should disclose how misclassification may affect results and select an administrative definition that optimally balances sensitivity and specificity for their research question.
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Affiliation(s)
- Aksel D Laudon
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Baraka Gitonga
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Frank F Yang
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth Chen
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Dave R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Kasey Lerner
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Heather L Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lauren Thompson
- Department of Surgery, Florida Atlantic University Schmidt College of Medicine, Boca Raton, Florida
| | - Faris K Azar
- Department of Surgery, Saint Mary's Medical Center, West Palm Beach, Florida
| | - Alex Charboneau
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Sabrina E Sanchez
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - F Thurston Drake
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Zhou S, Cheng Y, Cheng N, Gong J, Tu B. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev 2024; 5:CD011670. [PMID: 38695830 PMCID: PMC11064883 DOI: 10.1002/14651858.cd011670.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2017. Acute appendicitis (inflammation of the appendix) can be simple or complicated. Appendiceal phlegmon and appendiceal abscess are examples of complicated appendicitis. Appendiceal phlegmon is a diffuse inflammation in the bottom right of the appendix, while appendiceal abscess is a discrete inflamed mass in the abdomen that contains pus. Appendiceal phlegmon and abscess account for 2% to 10% of acute appendicitis. People with appendiceal phlegmon or abscess usually need an appendicectomy to relieve their symptoms (e.g. abdominal pain, loss of appetite, nausea, and vomiting) and avoid complications (e.g. peritonitis (infection of abdominal lining)). Surgery for people with appendiceal phlegmon or abscess may be early (immediately after hospital admission or within a few days of admission), or delayed (several weeks later in a subsequent hospital admission). The optimal timing of appendicectomy for appendiceal phlegmon or abscess is debated. OBJECTIVES To assess the effects of early appendicectomy compared to delayed appendicectomy on overall morbidity and mortality in people with appendiceal phlegmon or abscess. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases, and five trials registers on 11 June 2023, together with reference checking to identify additional studies. SELECTION CRITERIA We included all individual and cluster-randomised controlled trials (RCTs), irrespective of language, publication status, or age of participants, comparing early versus delayed appendicectomy in people with appendiceal phlegmon or abscess. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included eight RCTs that randomised 828 participants to early or delayed appendicectomy for appendiceal phlegmon (7 trials) or appendiceal abscess (1 trial). The studies were conducted in the USA, India, Nepal, and Pakistan. All RCTs were at high risk of bias because of lack of blinding and lack of published protocols. They were also unclear about methods of randomisation and length of follow-up. 1. Early versus delayed open or laparoscopic appendicectomy for appendiceal phlegmon We included seven trials involving 788 paediatric and adult participants with appendiceal phlegmon: 394 of the participants were randomised to the early appendicectomy group (open or laparoscopic appendicectomy as soon as the appendiceal mass resolved within the same admission), and 394 were randomised to the delayed appendicectomy group (initial conservative treatment followed by delayed open or laparoscopic appendicectomy several weeks later). There was no mortality in either group. The evidence is very uncertain about the effect of early appendicectomy on overall morbidity (risk ratio (RR) 0.74, 95% confidence interval (CI) 0.19 to 2.86; 3 trials, 146 participants; very low-certainty evidence), the proportion of participants who developed wound infections (RR 0.99, 95% CI 0.48 to 2.02; 7 trials, 788 participants), and the proportion of participants who developed faecal fistulas (RR 1.75, 95% CI 0.36 to 8.49; 5 trials, 388 participants). Early appendicectomy may reduce the abdominal abscess rate (RR 0.26, 95% CI 0.08 to 0.80; 4 trials, 626 participants; very low-certainty evidence), reduce the total length of hospital stay by about two days (mean difference (MD) -2.02 days, 95% CI -3.13 to -0.91; 5 trials, 680 participants), and increase the time away from normal activities by about five days (MD 5.00 days; 95% CI 1.52 to 8.48; 1 trial, 40 participants), but the evidence is very uncertain. 2. Early versus delayed laparoscopic appendicectomy for appendiceal abscess We included one trial involving 40 paediatric participants with appendiceal abscess: 20 were randomised to the early appendicectomy group (emergent laparoscopic appendicectomy), and 20 were randomised to the delayed appendicectomy group (initial conservative treatment followed by delayed laparoscopic appendicectomy 10 weeks later). There was no mortality in either group. The trial did not report on overall morbidity, various complications, or time away from normal activities. The evidence is very uncertain about the effect of early appendicectomy on the total length of hospital stay (MD -0.20 days, 95% CI -3.54 to 3.14; very low-certainty evidence). AUTHORS' CONCLUSIONS For the comparison of early versus delayed open or laparoscopic appendicectomy for paediatric and adult participants with appendiceal phlegmon, very low-certainty evidence suggests that early appendicectomy may reduce the abdominal abscess rate. The evidence is very uncertain whether early appendicectomy prevents overall morbidity or other complications. Early appendicectomy may reduce the total length of hospital stay and increase the time away from normal activities, but the evidence is very uncertain. For the comparison of early versus delayed laparoscopic appendicectomy for paediatric participants with appendiceal abscess, data are sparse, and we cannot rule out significant benefits or harms of early versus delayed appendicectomy. Further trials on this topic are urgently needed and should specify a set of criteria for use of antibiotics, percutaneous drainage of the appendiceal abscess prior to surgery, and resolution of the appendiceal phlegmon or abscess. Future trials should include outcomes such as time away from normal activities and length of hospital stay.
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Affiliation(s)
- Shiyi Zhou
- Department of Pharmacy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bing Tu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Zheng X, He X. Analysis of risk factors for complicated appendicitis during pregnancy and evaluation of clinical prediction model: A prospective cohort study. Surgeon 2023; 21:361-368. [PMID: 37210282 DOI: 10.1016/j.surge.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To investigate the risk factors and the value of clinical prediction model for complicated appendicitis (CA) during pregnancy. METHODS Prospective analysis of pregnant patients who underwent appendectomy at a single tertiary care center between February 2020 and February 2023 and who ultimately had pathologically confirmed acute appendicitis (AA). According to intraoperative conditions and postoperative pathology, they were divided into the CA group and the uncomplicated appendicitis (UA) group. The two groups of patients were then compared in terms of demographic characteristics, disease features, ancillary tests and predictive models of acute appendicitis. RESULTS A total of 90 patients with AA in pregnancy were included, 21 of whom had CA in pregnancy and 69 had UA in pregnancy. Multivariate regression analysis showed that gestational week, neutrophil ratio and C-reactive protein (CRP) were independent risk factors for CA during pregnancy. Relative to the first trimester, the third trimesters had an increased risk of complicated appendicitis (OR = 12.48, 95% CI: 1.56-99.57, P = 0.017). Neutrophil ratio ≥85.30% (OR = 24.54, 95% CI: 2.59-232.72, P = 0.005) and CRP ≥34.26 mg/L (OR = 7.86, 95% CI: 2.18-28.38, P = 0.002) had a significantly increased risk of CA. The AIR and AAS score models were statistically different between the two groups, but with a lower sensitivity of 52.38% and 42.86%, respectively. CONCLUSION The third trimesters, neutrophil ratio ≥85.30% and CRP ≥34.26 mg/L may be key predictors of CA in pregnancy. The current scoring model is inadequate to identify complex appendicitis in pregnancy and further research is needed.
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Affiliation(s)
- Xiaosong Zheng
- Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojun He
- Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Elliott BM, Bissett IP, Harmston C. The impact of delay and prehospital factors on acute appendicitis severity in New Zealand children: a national prospective cohort study. ANZ J Surg 2023; 93:1978-1986. [PMID: 37515345 DOI: 10.1111/ans.18615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Appendicitis is the most common reason children undergo acute general surgery but international, population-level disparities exist. This is hypothesised to be caused by preoperative delay and differential access to surgical care. The impact of prehospital factors on paediatric appendicitis severity in New Zealand is unknown. METHODS A prospective, multicentre cohort study with nested parental questionnaire was conducted by a national trainee-led collaborative group. Across 14 participating hospitals, 264 patients aged ≤16 years admitted between January and June 2020 with suspected appendicitis were screened. The primary outcome was the effect of prehospital factors on the American Association for the Surgery of Trauma (AAST) anatomical severity grade. RESULTS Overall, 182 children had confirmed appendicitis with a median age of 11.6. The rate of complicated appendicitis rate was 38.5% but was significantly higher in rural (44.1%) and Māori children (54.8%). Complicated appendicitis was associated with increased prehospital delay (47.8 h versus 20.1 h; P < 0.001), but not in-hospital delay (11.3 h versus 13.3 h; P = 0.96). Multivariate analysis revealed increased anatomical severity in rural (OR 4.33, 95% CI 1.78-7.25; P < 0.001), and Māori children (OR 2.39, 95% CI 1.24-5.75; P = 0.019), as well as in families relying on external travel sources or reporting unfamiliarity with appendicitis symptomology. CONCLUSION Prehospital delay and differential access to prehospital determinants of health are associated with increased severity of paediatric appendicitis. This manifested as increased severity of appendicitis in rural and Māori children. Understanding the pre-hospital factors that influence the timing of presentation can better inform health-system improvements.
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Affiliation(s)
- Brodie M Elliott
- Department of General Surgery, Whangarei Hospital, Northland, Whangarei, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Auckland Hospital, Auckland, New Zealand
| | - Christopher Harmston
- Department of General Surgery, Whangarei Hospital, Northland, Whangarei, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Zheng X, He X. Development of a nomogram for the prediction of complicated appendicitis during pregnancy. BMC Surg 2023; 23:188. [PMID: 37393302 DOI: 10.1186/s12893-023-02064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/31/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Complicated appendicitis during pregnancy directly affects the clinical prognosis of both mother and fetus. However, accurate identification of complicated appendicitis in pregnancy is fraught with various challenges. The purpose of this study was to identify the risk factors and to develop a useful nomogram to predict complicated appendicitis during pregnancy. METHODS This retrospective study involved pregnant women who underwent appendectomy at the Maternal and Child Health Hospital of Hubei Provincial from May 2016 to May 2022 and who ultimately had histopathological confirmed acute appendicitis. Univariate and multivariate logistic regression were applied to analyze clinical parameters and imaging features as a way to identify risk factors. Then, nomogram and scoring systems predicting complicated appendicitis in pregnancy were constructed and evaluated. Finally, the potential non-linear association between risk factors and complicated appendicitis was analyzed using restricted cubic splines. RESULTS Three indicators were finally identified for the construction of the nomogram: gestational weeks, C-reactive protein (CRP), and neutrophil percentage (NEUT%). To improve the clinical utility, the gestational weeks were divided into three periods (first trimesters, second trimesters, and third trimesters), while the optimal cut-offs for CRP level and NEUT% were found to be 34.82 mg/L and 85.35%, respectively. Multivariate regression analysis showed that third trimesters (P = 0.013, OR = 16.81), CRP level ≥ 34.82 mg/L (P = 0.007, OR = 6.24) and NEUT% ≥85.35% (P = 0.011, OR = 18.05) were independent risk factors for complicated appendicitis. The area under the ROC curve (AUC) of the nomogram predicting complicated appendicitis in pregnancy was 0.872 (95% CI: 0.803-0.942). In addition, the model was shown to have excellent predictive performance by plotting calibration plots, Decision Curve Analysis (DCA), and clinical impact curves. When the optimal cut-off point of the scoring system was set at 12, the corresponding AUC, sensitivity, specificity, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) values were AUC: 0.869(95% CI: 0.799-0.939),100%, 58.60%, 2.41, 0, 42%, and 100%, respectively. The restricted cubic splines revealed a linear relationship between these predictors and complicated appendicitis during pregnancy. CONCLUSIONS The nomogram utilizes a minimum number of variables to develop an optimal predictive model. Using this model, the risk of developing complicated appendicitis in individual patients can be determined so that reasonable treatment choices can be made.
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Affiliation(s)
- Xiaosong Zheng
- Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, NO.745 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, P.R. China
| | - Xiaojun He
- Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, NO.745 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, P.R. China.
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Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies. Heliyon 2022; 8:e11911. [PMID: 36478845 DOI: 10.1016/j.heliyon.2022.e11911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
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Duraiswamy S, Sanchez SE, Flum DR, Paasche-Orlow MK, Kenzik KM, Tseng JF, Drake FT. Caveat emptor: The accuracy of claims data in appendicitis research. Surgery 2022; 172:1050-1056. [PMID: 35985898 DOI: 10.1016/j.surg.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND International Classification of Disease, ninth/tenth revision codes are used to identify patients with appendicitis and classify severity of disease for research and hospital reimbursement. We sought to determine accuracy of International Classification of Disease, ninth/tenth revision codes in classifying appendicitis as uncomplicated versus complicated (defined as perforated, necrotic, or abscess) compared with the clinical gold standard: surgeon characterization of the appendix in the operative report. METHODS Retrospective review of operative reports and discharge International Classification of Disease, ninth/tenth revision codes for patients ≥18 years old who underwent noninterval, nonincidental appendectomy between January 2012 and December 2019 at a tertiary referral center. Sensitivity, specificity, and positive predictive value were calculated for International Classification of Disease, ninth/tenth revision codes to classify appendicitis accurately as complicated compared with surgeon description. ICD-9/10 codes and surgeon description were categorized into complicated/uncomplicated based on the American Association for the Surgery of Trauma grading system. RESULTS In the study, 1,495 patients with acute appendicitis underwent appendectomy. Per surgeon description, 200 (13%) were complicated and 1,295 (87%) uncomplicated. Compared with surgeon description, discharge International Classification of Disease, ninth/tenth revision codes did not accurately identify complicated appendicitis: sensitivity = 0.68, positive predictive value = 0.77. As a sensitivity analysis, the cohort was stratified by public versus private payers, and the results did not change. CONCLUSION International Classification of Disease, ninth/tenth revision codes do not accurately identify surgeon-described complicated appendicitis. Nearly one-third of the cases of complicated appendicitis were coded as uncomplicated. Such misclassification negatively impacts reimbursement for complicated appendicitis care and could lead to misleading results in research and quality improvement activities that rely on these codes.
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Affiliation(s)
- Swetha Duraiswamy
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA.
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - David R Flum
- Department of Surgery, University of Washington Medical Center, Seattle, WA
| | - Michael K Paasche-Orlow
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA
| | - Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Frederick Thurston Drake
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA. https://twitter.com/F_ThurstonDrake
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10
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Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis. Med Sci (Basel) 2022; 10:medsci10030036. [PMID: 35893118 PMCID: PMC9326721 DOI: 10.3390/medsci10030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052–1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646–0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.
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11
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Araim F, Shmelev A, Kowdley GC. Incidence of Complicated Appendicitis as a Metric of Health Care Delivery. Am Surg 2022; 88:597-607. [PMID: 33242987 DOI: 10.1177/0003134820953769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. MATERIALS AND METHODS All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. RESULTS A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P < .001), male gender (OR = 1.2), malnutrition (OR = 6.2), diabetes mellitus (OR = 2.1), chronic anemias (OR = 1.9), nonprivate insurances (OR 1.2-1.5), nonmetropolitan patient's residence (OR = 1.15), and Midwest region (OR = 1.2). Patient income and physician coverage were not significant factors after adjustment for all other covariates. Highest CAA fraction of 39.6% was noted in rural patients admitted to urban teaching facilities. DISCUSSION Although provider coverage at the state level may seem adequate and not related to increased CAA rates, the distance patients traveled for their definitive surgical care correlated with higher rates of CAA. Adjusting physician distribution into nonurban settings closer to patients could decrease rates of CAA by diminishing time to definitive care.
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Affiliation(s)
- Fawaz Araim
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA
| | - Artem Shmelev
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA
| | - Gopal C Kowdley
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA
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12
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Salim J, Agustina F, Maker JJR. Pre-Coronavirus Disease 2019 Pediatric Acute Appendicitis: Risk Factors Model and Diagnosis Modality in a Developing Low-Income Country. Pediatr Gastroenterol Hepatol Nutr 2022; 25:30-40. [PMID: 35087731 PMCID: PMC8762600 DOI: 10.5223/pghn.2022.25.1.30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. METHODS The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann-Whitney tests and logistic regression. RESULTS This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. CONCLUSION PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.
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Affiliation(s)
- Jonathan Salim
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | - Flora Agustina
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.,Pediatric Surgery Department, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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13
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Swift K, Thompson F, Roeder L, Choy KT, McDonald M, de Costa A. Appendicitis in Far North Queensland: a new take on an old story. ANZ J Surg 2021; 92:114-120. [PMID: 34931426 DOI: 10.1111/ans.17404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/18/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). METHODS Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012-2018. Population data for the same time period provided rates. RESULTS Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re-admission rate was 3.8% and all-cause mortality was 0.03%. CONCLUSION The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non-Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.
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Affiliation(s)
- Kate Swift
- Department of Surgery, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Fintan Thompson
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Luisa Roeder
- Technical University of Munich, Department of Sport and Health Sciences, Chair of Human Movement Science, Munich, Germany.,Faculty of Health, School of Exercise and Nutrition Sciences, Movement Neuroscience Program, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kay Tai Choy
- Department of Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Malcolm McDonald
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alan de Costa
- Department of Surgery, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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14
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Abstract
IMPORTANCE Acute appendicitis is the most common abdominal surgical emergency in the world, with an annual incidence of 96.5 to 100 cases per 100 000 adults. OBSERVATIONS The clinical diagnosis of acute appendicitis is based on history and physical, laboratory evaluation, and imaging. Classic symptoms of appendicitis include vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever. The diagnosis of acute appendicitis is made in approximately 90% of patients presenting with these symptoms. Laparoscopic appendectomy remains the most common treatment. However, increasing evidence suggests that broad-spectrum antibiotics, such as piperacillin-tazobactam monotherapy or combination therapy with either cephalosporins or fluroquinolones with metronidazole, successfully treats uncomplicated acute appendicitis in approximately 70% of patients. Specific imaging findings on computed tomography (CT), such as appendiceal dilatation (appendiceal diameter ≥7 mm), or presence of appendicoliths, defined as the conglomeration of feces in the appendiceal lumen, identify patients for whom an antibiotics-first management strategy is more likely to fail. CT findings of appendicolith, mass effect, and a dilated appendix greater than 13 mm are associated with higher risk of treatment failure (≈40%) of an antibiotics-first approach. Therefore, surgical management should be recommended in patients with CT findings of appendicolith, mass effect, or a dilated appendix who are fit for surgery, defined as having relatively low risk of adverse outcomes or postoperative mortality and morbidity. In patients without high-risk CT findings, either appendectomy or antibiotics can be considered as first-line therapy. In unfit patients without these high-risk CT findings, the antibiotics-first approach is recommended, and surgery may be considered if antibiotic treatment fails. In unfit patients with high-risk CT findings, perioperative risk assessment as well as patient preferences should be considered. CONCLUSIONS AND RELEVANCE Acute appendicitis affects 96.5 to 100 people per 100 000 adults per year worldwide. Appendectomy remains first-line therapy for acute appendicitis, but treatment with antibiotics rather than surgery is appropriate in selected patients with uncomplicated appendicitis.
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Affiliation(s)
- Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Erik Karl Paulson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Theodore N Pappas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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15
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Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312718. [PMID: 34886447 PMCID: PMC8656947 DOI: 10.3390/ijerph182312718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 12/29/2022]
Abstract
The incidence of acute appendicitis decreased in Western countries from 1930 to at least the early 1990s, when epidemiological data started becoming scarcer. This study aimed to assess the trend in annual hospitalizations for acute appendicitis in all people Spain for a 20-year period between 1998 and 2017. This observational study analyzing direct age-standardized hospital admission rates by gender and age group (0–14 years, 15–34 years, 35–44 years, 45–64 years, and ≥65 years). Joinpoint regression models were fitted to evaluate changes in trends. There were 789,533 emergency hospital admissions for acute appendicitis between 1998 and 2017: 58.9% in boys and men and 41.1% in girls and women. Overall, there was a significant increase in admissions for this cause from 1998 to 2009, with an annual percent change (APC) of 0.6%. Following the peak in 2009, admission rates decreased by around 1.0% annually until 2017. The length of hospital stay gradually decreased from 4.5 days in 1998 to 3.4 days in 2017. The trends in hospital admissions for acute appendicitis in Spain changed over the study period, decreasing from 2009, especially in people younger than 35 years.
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16
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Sisik A, Kudas I, Basak F, Hasbahceci M. Is the increased incidence of pathologically proven acute appendicitis more likely seen in elderly patients? A retrospective cohort study. Aging Male 2021; 24:1-7. [PMID: 33877020 DOI: 10.1080/13685538.2021.1911990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIM Although appendicitis is a disease of the young, it has been speculated that its incidence has increased among the elderly people. In this study, it was aimed to evaluate annual changes of appendicitis seen in older patients (≥60 years) throughout a 10-year period. METHODS All adult patients who were surgically treated for acute appendicitis were retrospectively analyzed with respect to pathological analysis, gender, age and proportion of the patients aged 60 or over in an annual base. Variability in the mean age and proportion of the older patients aged 60 or over throughout the study years were regarded as the main outcomes. RESULTS There were 3296 patients with a mean age of 30.42 ± 12 years. Distribution of gender was similar (p = 0.636). There was a significant positive correlation in the mean age of the patients throughout the study years (p = 0.043). Stratification by the age of 60 yielded a significant increase in percent of the older patients, from 0.93% at 2007 to 4.28% at 2016 (p = 0.019). CONCLUSIONS The mean age of the patients with acute appendicitis is going to increase. Therefore, it is expected that all surgeons are more likely to be confronted with elderly patients with appendicitis in the near-future.
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Affiliation(s)
- Abdullah Sisik
- Department of General Surgery, Adem Yavuz Str, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ilyas Kudas
- Department of General Surgery, Adem Yavuz Str, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Basak
- Department of General Surgery, Adem Yavuz Str, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Hasbahceci
- Department of General Surgery, Faculty of Medicine, Istinye University, Istanbul, Turkey
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17
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Cullison KM, Franck N. Clinical Decision Rules in the Evaluation and Management of Adult Gastrointestinal Emergencies. Emerg Med Clin North Am 2021; 39:719-732. [PMID: 34600633 DOI: 10.1016/j.emc.2021.07.001] [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: 12/29/2022]
Abstract
Although abdominal pain is a common chief complaint in the emergency department, only 1 in 6 patients with abdominal pain are diagnosed with a gastrointestinal (GI) emergency. These patients often undergo extensive testing as well as hospitalizations to rule out an acute GI emergency and there is evidence that not all patients benefit from such management. Several clinical decision rules (CDRs) have been developed for the diagnosis and management of patients with suspected acute appendicitis and upper GI bleeding to identify those patients who may safely forgo further testing or hospital admission. Further validation studies demonstrating the superiority of these CDRs over contemporary practice are needed.
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Affiliation(s)
- Kevin M Cullison
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 545 1st Avenue, New York, NY 10016, USA.
| | - Nathan Franck
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 545 1st Avenue, New York, NY 10016, USA
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18
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Li Z, Li Z, Zhao L, Cheng Y, Cheng N, Deng Y. Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2021; 8:CD010168. [PMID: 34402522 PMCID: PMC8407456 DOI: 10.1002/14651858.cd010168.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. MAIN RESULTS Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.
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Affiliation(s)
- Zhuyin Li
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Li
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Longshuan Zhao
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yilei Deng
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wickramasinghe DP, Xavier C, Samarasekera DN. The Worldwide Epidemiology of Acute Appendicitis: An Analysis of the Global Health Data Exchange Dataset. World J Surg 2021; 45:1999-2008. [PMID: 33755751 DOI: 10.1007/s00268-021-06077-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aims to describe the worldwide epidemiology and changing disease trends of acute appendicitis (AA). METHODS Epidemiological data on the incidence of AA and deaths were collected from the Global Health Data Exchange repository from 1990 to 2019. Data were stratified by age, sex and Socio-Demographic Index (SDI). RESULTS In 2019, there were an estimated 17.7 million cases (incidence 228/100,000) with over 33,400 deaths (0.43/100,000). Both the absolute number and the incidence had increased from 1990 to 2019 (+ 38.8% and + 11.4%, respectively). The number of deaths and deaths per 100,000 declined during this period (- 21.8% and - 46.2%, respectively). These trends were largely similar in all 5 SDI groups. There was a significant difference in the incidence of AA between the SDI groups, with low SDI group having the lowest and high SDI group having the highest. The high SDI group had the lowest mortality rate (Kruskall-Wallis test, p < 0.001). The peak incidence was in the 15-19-year age group. The mortality rate increased exponentially from the third decade of life. CONCLUSIONS The mortality rate of AA is declining worldwide, while the incidence is increasing. The peak incidence is in the 15-19-year group.
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Affiliation(s)
| | - Chrisjit Xavier
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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20
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Dima R, Wang Y, Zuccolo S, Palmer M, Cheong K. Pilot Study: Outcomes of the Full Abdominopelvic Ultrasound Protocol for Diagnosis of Acute Appendicitis in Children: A Retrospective Chart Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320917402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Sonographic evaluation for acute appendicitis in children often involves an exhaustive protocol, for which the therapeutic yield has not been formally evaluated. The purpose of the study was to pilot a retrospective chart review of children receiving an abdominopelvic sonogram upon presenting with suspected acute appendicitis. Methods: An annual retrospective chart review was designed to review abdominopelvic sonograms to rule out appendicitis and specifically performed at a Canadian children’s teaching hospital. Studies were excluded if the requisition stated multiple clinical concerns or if the patient was >18 years at the time of the sonogram. Results: Based on 230 patient cases reviewed, alternative diagnostic sonographic findings were found in 141 (61%) charts. Only 18 patient cases (8%) demonstrated both alternative sonographic findings as well as a change in management by the emergency room physician. Conclusion: Alternative diagnostic findings, based on a complete abdominopelvic sonogram, were common (61%) in this chart review but rarely changed patient management.
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Affiliation(s)
- Robert Dima
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario London, ON, Canada
- Department of Diagnostic Imaging, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Yongdong Wang
- Department of Diagnostic Imaging, McMaster University Medical Centre, Hamilton, ON, Canada
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sarah Zuccolo
- Department of Diagnostic Imaging, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Michelle Palmer
- Department of Diagnostic Imaging, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Kerry Cheong
- Department of Diagnostic Imaging, McMaster University Medical Centre, Hamilton, ON, Canada
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21
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De Alencastro L, Locatelli I, Clair C, Ebell MH, Senn N. Correlation of clinical decision-making with probability of disease: A web-based study among general practitioners. PLoS One 2020; 15:e0241210. [PMID: 33119623 PMCID: PMC7595298 DOI: 10.1371/journal.pone.0241210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/10/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Medical decision-making relies partly on the probability of disease. Current recommendations for the management of common diseases are based increasingly on scores that use arbitrary probability thresholds. OBJECTIVE To assess decision-making in pharyngitis and appendicitis using a set of clinical vignettes, and the extent to which management is congruent with the true probability of having the disease. DESIGN We developed twenty-four clinical vignettes with clinical presentations corresponding to specific probabilities of having disease defined by McIsaac (pharyngitis) or Alvarado (appendicitis) scores. Each participant answered four randomly selected web-based vignettes. PARTICIPANTS General practitioners (GP) working in primary care structures in Switzerland and the USA. MAIN MEASURES A comparison between the GP's management decision according to the true probability of having the disease and to the GP's estimated probability, investigating the GP's ability to estimate probability of disease. KEY RESULTS The mean age of the GPs was 48 years (SD 12) and 66% were men. The correlation between the GP's clinical management decision based on the vignette and the recommendations was stronger for appendicitis than pharyngitis (kw = 0.74, 95% CI 0.70-0.78 vs. kw = 0.66, 95% CI 0.62-0.71). On the other hand, the association between the clinical management decision and the probability of disease estimated by GPs was more congruent with recommendations for pharyngitis than appendicitis (kw = 0.70, 95% CI 0.66-0.73 vs. 0.61, 95% CI 0.56-0.66). Only a minority of GPs correctly estimated the probability of disease (29% for appendicitis and 39% for pharyngitis). CONCLUSIONS Despite the fact that general practitioners often misestimate the probability of disease, their management decisions are usually in line with recommendations. This means that they use other approaches, perhaps more subjective, to make decisions, such as clinical judgment or reasoning that integrate factors other than just the risk of the disease.
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Affiliation(s)
- Lionel De Alencastro
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- * E-mail:
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Mark H. Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Georgia, Athens, Georgia, United States of America
| | - Nicolas Senn
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
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Roth WH, Cai A, Zhang C, Chen ML, Merkler AE, Kamel H. Gastrointestinal Disorders and Risk of First-Ever Ischemic Stroke. Stroke 2020; 51:3577-3583. [PMID: 33040706 DOI: 10.1161/strokeaha.120.030643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies suggest that alteration of the normal gut microbiome contributes to atherosclerotic burden and cardiovascular disease. While many gastrointestinal diseases are known to cause disruption of the normal gut microbiome in humans, the clinical impact of gastrointestinal diseases on subsequent cerebrovascular disease remains unknown. We conducted an exploratory analysis evaluating the relationship between gastrointestinal diseases and ischemic stroke. METHODS We performed a retrospective cohort study using claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included only beneficiaries ≥66 years of age. We used previously validated diagnosis codes to ascertain our primary outcome of ischemic stroke. In an exploratory manner, we categorized gastrointestinal disorders by anatomic location, disease chronicity, and disease mechanism. We used Cox proportional hazards models to examine associations of gastrointestinal disorder categories and ischemic stroke with adjustment for demographics and established vascular risk factors. RESULTS Among a mean of 1 725 246 beneficiaries in each analysis, several categories of gastrointestinal disorders were associated with an increased risk of ischemic stroke after adjustment for established stroke risk factors. The most notable positive associations included disorders of the stomach (hazard ratio, 1.17 [95% CI, 1.15-1.19]) and functional (1.16 [95% CI, 1.15-1.17]), inflammatory (1.13 [95% CI, 1.12-1.15]), and infectious gastrointestinal disorders (1.13 [95% CI, 1.12-1.15]). In contrast, we found no associations with stroke for diseases of the anus and rectum (0.97 [95% CI, 0.94-1.00]) or neoplastic gastrointestinal disorders (0.97 [95% CI, 0.94-1.00]). CONCLUSIONS In exploratory analyses, several categories of gastrointestinal disorders were associated with an increased risk of future ischemic stroke after adjustment for demographics and established stroke risk factors.
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Affiliation(s)
- William H Roth
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (W.H.R., A.C., C.Z., M.L.C., A.E.M., H.K.).,Division of Neurocritical Care, Department of Neurology, University of Florida Medicine, Gainesville (W.H.R.)
| | - Anna Cai
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (W.H.R., A.C., C.Z., M.L.C., A.E.M., H.K.)
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (W.H.R., A.C., C.Z., M.L.C., A.E.M., H.K.)
| | - Monica L Chen
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (W.H.R., A.C., C.Z., M.L.C., A.E.M., H.K.)
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (W.H.R., A.C., C.Z., M.L.C., A.E.M., H.K.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (W.H.R., A.C., C.Z., M.L.C., A.E.M., H.K.)
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23
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Costa A. Appendix redux: a stone unturned. ANZ J Surg 2020; 90:1867-1870. [DOI: 10.1111/ans.16018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Alan Costa
- James Cook University Medical School, Cairns Clinical School Cairns Queensland Australia
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24
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Kakar M, Delorme M, Broks R, Asare L, Butnere M, Reinis A, Engelis A, Kroica J, Saxena A, Petersons A. Determining acute complicated and uncomplicated appendicitis using serum and urine biomarkers: interleukin-6 and neutrophil gelatinase-associated lipocalin. Pediatr Surg Int 2020; 36:629-636. [PMID: 32219562 DOI: 10.1007/s00383-020-04650-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The study aim is to determine whether serum and urine interleukin-6 (IL-6) and neutrophil gelatinase-associated lipocalin (NGAL) can be included in the early diagnostic algorithm for pediatric appendicitis. METHODS Prospective single-center cohort study included 92 children divided into control, acute complicated appendicitis (AcA) and acute uncomplicated appendicitis (AnA) groups. Serum and urine samples were assayed for IL-6 and NGAL preoperatively, and on the second and fifth postoperative days. Intraoperative and bacteriological findings divided the appendicitis patients. RESULTS Average serum biomarker levels were higher in appendicitis patients versus the control, and the following values were produced via receiver operating characteristic (ROC) analysis. NGAL and IL-6 cutoff values were 113.95 ng/ml and 24.64 pg/ml, respectively, NGAL had 68.3% sensitivity and 65.5% specificity, while IL-6 had 72.6% and 86.2%. Comparing AcA and AnA, IL-6 was the only biomarker of significance yielding 77.4% sensitivity and 58.1% specificity with a 26.43 pg/ml cutoff value. Urine biomarkers were non-specific in differentiation appendicitis severity and ultimately, between infectious and non-infectious disease. CONCLUSION Although NGAL provided measurable useful diagnostic information in evaluating children for appendicitis, its values were not sufficient for appendicitis severity. Serum IL-6 remains a strong biomarker for suspected acute appendicitis and has promising results predicting its severity.
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Affiliation(s)
- Mohit Kakar
- Department of Pediatric Surgery, Children's Clinical University Hospital, Vienibas gatve, 45, Riga, 1004, Latvia. .,Department of Pediatric Surgery, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia.
| | - Mathilde Delorme
- Faculty of Medicine, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia
| | - Renars Broks
- Department of Biology and Microbiology, Riga Stradins University, Dzirciema iela, 16, Riga, 1007, Latvia
| | - Lasma Asare
- Department of Statistics, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia
| | - Marisa Butnere
- Department of Pediatric Surgery, Children's Clinical University Hospital, Vienibas gatve, 45, Riga, 1004, Latvia.,Department of Pediatric Surgery, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradins University, Dzirciema iela, 16, Riga, 1007, Latvia
| | - Arnis Engelis
- Department of Pediatric Surgery, Children's Clinical University Hospital, Vienibas gatve, 45, Riga, 1004, Latvia.,Department of Pediatric Surgery, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia
| | - Juta Kroica
- Department of Biology and Microbiology, Riga Stradins University, Dzirciema iela, 16, Riga, 1007, Latvia
| | - Amulya Saxena
- Department of Pediatric Surgery, Imperial College London, Chelsea Children's Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Aigars Petersons
- Department of Pediatric Surgery, Children's Clinical University Hospital, Vienibas gatve, 45, Riga, 1004, Latvia.,Department of Pediatric Surgery, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia
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25
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Ball CG, Murphy P, Verhoeff K, Albusadi O, Patterson M, Widder S, Hameed SM, Parry N, Vogt K, Kortbeek JB, MacLean AR, Engels PT, Rice T, Nenshi R, Khwaja K, Minor S. A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform? Can J Surg 2020; 63:E150-E154. [PMID: 32216251 DOI: 10.1503/cjs.019118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Methods In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged. Readmissions during the 30-day window were also captured. Preoperative, intraoperative and postoperative variables were tracked. Standard statistical methodology was employed. Results A total of 601 ACS/EGS patients were followed for up to 30 inpatient or readmission days after their index emergent operation. Fifty-one percent of patients were female, and the median age was 51 years. They frequently had substantial medical comorbidities (42%) and morbid obesity (15%). The majority of procedures were minimally invasive (66% laparoscopic). Median length of stay was 3.3 days and the early readmission (< 30 d) rate was 6%. Six percent of patients were admitted to the critical care unit. The overall complication and mortality rates were 34% and 2%, respectively. Cholecystitis (31%), appendicitis (21%), bowel obstruction (18%), incarcerated hernia (12%), gastrointestinal hemorrhage (7%) and soft tissue infections (7%) were the most common diagnoses. The morbidity and mortality rates for open surgical procedures were 73% and 5%, respectively. Conclusion Nontrauma ACS/EGS procedures are associated with a high postoperative morbidity rate. This study will serve as a prospective benchmark for postoperative complications among ACS/EGS patients and subsequent quality improvement across Canada.
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Affiliation(s)
- Chad G. Ball
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Patrick Murphy
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Kevin Verhoeff
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Omar Albusadi
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Matthew Patterson
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Sandy Widder
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - S. Morad Hameed
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Neil Parry
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Kelly Vogt
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - John B. Kortbeek
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Anthony R. MacLean
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Paul T. Engels
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Timothy Rice
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Rahima Nenshi
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Kosar Khwaja
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Samuel Minor
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
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26
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Sarker SK. Legal & ethical dilemmas in incidental findings during surgery: Review article. Int J Surg 2020; 75:107-113. [DOI: 10.1016/j.ijsu.2020.01.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022]
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Eurboonyanun K, Rungwiriyawanich P, Chamadol N, Promsorn J, Eurboonyanun C, Srimunta P. Accuracy of Nonenhanced CT vs Contrast-Enhanced CT for Diagnosis of Acute Appendicitis in Adults. Curr Probl Diagn Radiol 2020; 50:315-320. [PMID: 32037023 DOI: 10.1067/j.cpradiol.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute appendicitis is one of the most common causes of acute abdominal pain requiring emergency intervention. It is often difficult for the clinician to make an accurate diagnosis due to nonspecific and overlapping clinical symptoms. Computed tomography (CT) has become the imaging modality of choice for the evaluation of suspected acute appendicitis. The main purpose of our study was to compare nonenhanced CT (NECT) with contrast-enhanced CT (CECT) for the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 140 patients were enrolled in the study. Two abdominal radiologists-masked to both the clinical information and the final diagnosis-retrospectively reviewed the computed tomographic findings and made an imaging diagnosis based on (1) NECT only, (2) CECT only, and (3) both NECT and CECT. With the final diagnosis as the reference standard, the accuracy of each CT technique was estimated. RESULTS The respective sensitivity, specificity, and accuracy for NECT, CECT, and NECT + CECT for the diagnosis of acute appendicitis were 80.7%, 86.7%, and 84.3%; 86.0%, 81.9%, and 83.6%; and, 87.7%, 80.7%, and 83.6%. There was no significant difference in the diagnosis of acute appendicitis among the 3 techniques. In order to make a correct diagnosis, the presence of at least 3 imaging findings for NECT or at least 4 for CECT had the best diagnostic accuracy. We also found that 9.25 mm was the optimal cut-off threshold for the detection of patients with acute appendicitis. CONCLUSION Our study allowed direct comparison between NECT, CECT, and NECT + CECT combined. There was no difference in the ability of each CT technique for diagnosing patients with acute appendicitis. For a patient whom iodinated contrast media is contraindicated or a patient who has an increased risk of severe adverse reaction, we would encourage the use of NECT because it provides comparable diagnostic accuracy without further exposing such patient to the contrast media.
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Affiliation(s)
- Kulyada Eurboonyanun
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | | | - Nittaya Chamadol
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Julaluck Promsorn
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chalerm Eurboonyanun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piyachat Srimunta
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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28
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Sepas HN, Negahi A, Mousavie SH, Nasiri M. Evaluation of the Potential Association of Platelet Levels, Mean Platelet Volume and Platelet Distribution Width with Acute Appendicitis. Open Access Maced J Med Sci 2019; 7:2271-2276. [PMID: 31592065 PMCID: PMC6765097 DOI: 10.3889/oamjms.2019.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: The occurrence and early management of acute appendicitis among children are especially important due to the difficult diagnosis and nonspecific symptoms of the disease. Diagnosis of appendicitis in children is very difficult due to similarity of its symptoms to other diseases, and also its self-limiting nature Platelet indexes such as mean platelet volume (MPV) and platelet distribution width (PDW) have been suggested as a biomarker of inflammation. AIM: Therefore, we examined the association of MPV and PDW with acute appendicitis in children. METHODS: This cross-sectional study was conducted on 464 patients with suspected acute appendicitis under the age of 18 years referred to the specialised hospitals of the ten studied provinces between October 2014 and October 2015. All data obtained regarding patient’s lab tests, i.e. platelet count, MPV and PDW and also radiological studies and surgical reports were gathered in datasheets and analysed to evaluate the potential association of platelet levels, mean platelet volume (MPV) and platelet distribution width (PDW) with acute appendicitis RESULTS: Our results showed that the MPV was significantly higher in acute appendicitis in comparison to perforated appendicitis as well as acute gangrenous appendicitis. PDW was significantly higher in acute appendicitis in comparison to perforated appendicitis and acute gangrenous appendicitis. The current project indicated that PDW < 10.05 had a sensitivity of 35% and specificity of 75%, platelet count < 229500 had a sensitivity of 24% and specificity of 75% and MPV < 8.95 had a sensitivity of 70% and specificity of 71%. CONCLUSION: Our study suggested that platelet indexes such as MPV and PDW could significantly correlate with acute appendicitis in pediatric patients. Hence, we believe that both MPV and PDW could use as a simple and low-cost lab test for diagnosing acute appendicitis. Also, this study revealed that the MPV lower than 8.95 could be a novel index for diagnosing acute appendicitis with sensitivity of 70% and specificity of 71%.
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Affiliation(s)
- Hossein Najd Sepas
- Department of Vascular Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Negahi
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Seyed Hamzeh Mousavie
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Nasiri
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
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29
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Gomes CA, Abu-Zidan FM, Sartelli M, Coccolini F, Ansaloni L, Baiocchi GL, Kluger Y, Di Saverio S, Catena F. Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study. World J Surg 2019; 42:3903-3910. [PMID: 30006833 DOI: 10.1007/s00268-018-4736-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Our aim is to compare the management approaches and clinical outcomes of acute appendicitis according to annual Gross National Income per Capita (GNI/Capita) of countries. METHODS Consecutive patients who were diagnosed to have acute appendicitis from 116 centers of 44 countries were prospectively studied over a 6-month period (April-September 2016). Studied variables included demography, Alvarado score, comorbidities, radiological and surgical management, histopathology, and clinical outcome. Data were divided into three groups depending on the GNI/Capita. RESULTS A total of 4271 patients having a mean (SD) age of 33.4 (17.3) years were studied. Fifty-five percent were males. Two hundred and eighty patients were from lower-middle-income (LMI) countries, 1756 were from upper-middle-income (UMI) countries, and 2235 were from high-income (HI) countries. Patients in LMI countries were significantly younger (p < 0.0001) and included more males (p < 0.0001). CT scan was done in less than 8% of cases in LMI countries, 23% in UMI countries, and 38% in HI countries. Laparoscopy was performed in 73% of the cases in the HI countries, while open appendectomy was done in more than 60% of cases in both LMI and UMI countries (p < 0.0001). The longest mean hospital stay was in the UMI group (4.84 days). There was no significant difference in the complication or death rates between the three groups. The overall death rate was 3 per 1000 patients. CONCLUSIONS There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis that is related to country income. A global effort is needed to address this variation. Individual socioeconomic status could be more important than global country socioeconomic status in predicting clinical outcome.
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Affiliation(s)
- Carlos Augusto Gomes
- Surgery Department, Faculdade de Ciências Médicas e da Saúde Juiz de Fora (SUPREMA), Hospital Universitário Therezinha de Jesus, Juiz de Fora, Brazil
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Salomone Di Saverio
- Department of Surgery, Addenbrookes Hospital Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Fausto Catena
- Department of General Surgery, Maggiore Hospital, Parma, Italy.,Department of Surgery, "Infermi" Hospital, Rimini, Italy
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30
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Tarulli M, Rezende-Neto J, Vlachou PA. Focused CT for the evaluation of suspected appendicitis. Abdom Radiol (NY) 2019; 44:2081-2088. [PMID: 30796478 DOI: 10.1007/s00261-019-01942-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of focused appendiceal CT as a feasible alternative to the standard CT of the abdomen and pelvis (CT-AP) in patients with suspected acute appendicitis. METHODS Retrospective review of 200 adults with suspected acute appendicitis between January and October 2016 were included in this study. Each patient underwent CT-AP with oral and intravenous (IV) contrast. A subset of axial images starting at the top of L4 vertebral body to the roof of the acetabula were obtained from each study which served as the focused appendiceal CT. After review of the focused CTs, the non-focused CT-AP scans were reviewed, each patient acting as their own control. Images were assessed for ability to identify the appendix, assess for appendicitis, or identify alternative diagnoses that could account for the presenting symptoms. RESULTS Of 200 cases, the appendix was visualized in the focused CT in 191 patients. In nine studies, the appendix was not visualized in focused or standard CT-AP. Using focused CT, 42 cases were positive for acute appendicitis. This result was identical when reviewing standard CT-AP. Alternative diagnoses were present in 38 patients. Using focused CT, 14 of these were not fully covered but the readers were able to make the diagnoses confidently on the focused CTs. Only one patient had acute non-appendiceal pathology mostly outside of the field of view. CONCLUSIONS Focused appendiceal CT with IV and oral contrast in the setting of clinically suspected appendicitis is a suitable alternative to conventional CT-AP.
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Bos C, Doumouras AG, Akhtar-Danesh GG, Flageole H, Hong D. A population-based cohort examining factors affecting all-cause morbidity and cost after pediatric appendectomy: Does annual adult procedure volume matter? Am J Surg 2018; 218:619-623. [PMID: 30580933 DOI: 10.1016/j.amjsurg.2018.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/04/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to examine factors affecting morbidity and cost after pediatric appendectomy and particularly the role of adult surgical volume. MATERIALS AND METHODS This was population-based study including all pediatric patients who underwent appendectomy for appendicitis in Canada (excluding Quebec) from 2008 to 2015. All-cause morbidity was the main outcome of interest. Cost of the index admission (in 2014 Canadian dollars) was a secondary outcome. Hierarchal linear and logistic regressions were used to model the outcomes. RESULTS Overall, 41,512 patients were identified. After adjustment, younger patients (OR = 0.98/year, 95%CI 0.97-0.99, p < 0.001), patients with comorbidities (OR = 2.20, 95%CI 1.96-2.46, p < 0.001), and those with perforated appendicitis (OR = 5.95, 95%CI 5.44-6.50, p < 0.001) were more susceptible to morbidity. Annual pediatric appendectomy volume was a significant predictor of reduced morbidity (OR = 0.85/20 cases, 95%CI 0.76-0.93, p < 0.001) as was the use of laparoscopy (OR = 0.81, 95%CI 0.72-0.91, p = 0.001). Conversely, annual adult appendectomy volume conferred no benefit nor did pediatric surgery specialty training. CONCLUSION Outcomes after pediatric appendectomy are influenced by pediatric case volume, regardless of specialty training, but extra adult surgical volume confers no benefit.
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Affiliation(s)
- Cecily Bos
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Helene Flageole
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
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Siletz A, Grotts J, Lewis C, Tillou A, Cheaito A, Cryer H. Monitoring Complications of Medically Managed Acute Appendicitis. Am Surg 2018. [DOI: 10.1177/000313481808401030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nonoperative management of acute appendicitis is becoming widespread, but recurrence and the potential for a complicated course are important concerns. An admission report-based institutional database was created to monitor appendicitis treatment outcomes. Complications and complexity of surgery were recorded based on manual chart review. A cohort of patients spanning one year was analyzed. Initial management was operative in 181 (82%) and nonoperative in 39 (18%) cases. There were no differences in demographics, BMI, or Alvarado score. One operative patient and 17 non-operative patients required additional treatment for recurrence/nonresolution (0.6% vs 44%, P < 0.00001). Twenty-eight (15%) operative patients and 17 (44%) nonoperative patients had complications ( P = 0.0003). Thirty-six (19.9%) operations in the operative group and 8 (53.3%) in the non-operative group were classified as complex ( P = 0.007). Hospital stay was longer in the nonoperative group (one vs two days, P = 0.005). Two incidental malignancies in the operative group and one in the nonoperative group were identified. These results are consistent with prior studies showing that recurrence/nonresolution is common after nonoperative management. For patients with recurrence/nonresolution, surgery may be more complex.
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Affiliation(s)
- Anaar Siletz
- Departments of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jonathan Grotts
- Departments of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Catherine Lewis
- Departments of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Areti Tillou
- Departments of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ali Cheaito
- Departments of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Henry Cryer
- Departments of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Schneuer FJ, Adams SE, Bentley JP, Holland AJ, Huckel Schneider C, White L, Nassar N. A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children. Med J Aust 2018; 209:80-85. [PMID: 29976133 DOI: 10.5694/mja17.00541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children. DESIGN Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013. MAIN OUTCOME MEASURES Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital. RESULTS Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mostly symptomatic re-admissions or emergency department presentations) than open appendicectomy (7.4% v 5.8%), but with a reduced risk of post-operative intestinal obstruction (adjusted odds ratio [aOR], 0.59; 95% CI, 0.36-0.97). For cases of complicated appendicitis, the risk of wound infections was lower for laparoscopic appendicectomy (aOR, 0.67; 95% CI, 0.50-0.90), but not the risks of intestinal obstruction (aOR, 0.97; 95% CI, 0.62-1.52) or intra-abdominal abscess (aOR, 1.06; 95% CI, 0.72-1.55). CONCLUSION Post-appendicectomy outcomes were similar for most age groups and hospital types. Children with uncomplicated appendicitis have lower risk of post-operative bowel obstruction after laparoscopic appendicectomy than after open appendicectomy, but may be discharged before their post-operative symptoms have adequately resolved.
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Affiliation(s)
| | | | - Jason P Bentley
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | | | | | | | - Natasha Nassar
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
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Reinisch A, Heil J, Woeste G, Bechstein W, Liese J. The meteorological influence on seasonal alterations in the course of acute appendicitis. J Surg Res 2017; 217:137-143. [PMID: 28599958 DOI: 10.1016/j.jss.2017.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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