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Fransvea P, Chiarello MM, Fico V, Cariati M, Brisinda G. Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis. World J Clin Cases 2024; 12:6580-6586. [DOI: 10.12998/wjcc.v12.i33.6580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 09/27/2024] Open
Abstract
In developed countries, the average life expectancy has been increasing and is now well over 80 years. Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups. Acute appendicitis is one of the most common surgical diseases, with a lifetime risk of 8%. A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups (> 80 years). Among patients > 50-year-old who present to the emergency department for acute abdominal pain, 15% have acute appendicitis. In these patients, emergency surgery for acute appendicitis is challenging, and some important aspects must be considered. In the elderly, surgical treatment outcomes are influenced by sarcopenia. Sarcopenia must be considered a precursor of frailty, a risk factor for physical function decline. Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity. Aside from morbidity and mortality, the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance. Therefore, prediction of function decline is critical. In emergency surgery, preoperative interventions are difficult to implement because of the narrow time window before surgery. In this editorial, we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.
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Affiliation(s)
- Pietro Fransvea
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | | | - Valeria Fico
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | - Maria Cariati
- Department of Surgery, Provincial Health Authority, Crotone 88900, Italy
| | - Giuseppe Brisinda
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
- Translational Medicine and Surgery, Catholic School of Medicine, Roma 00168, Italy
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Shahba L, Kuhestani Parizi M, Shafie M. Comparison of Clinical and Laboratory Manifestations Between Acute Appendicitis and Mesenteric Lymphadenitis in Children. Cureus 2024; 16:e62437. [PMID: 39011220 PMCID: PMC11248513 DOI: 10.7759/cureus.62437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Acute appendicitis is a major cause of emergency surgery in children and adolescents. Mesenteric lymphadenitis is also one of the most common differential diagnoses in children with acute appendicitis, and despite its high prevalence, few clinical studies have examined its features. The clinical signs of mesenteric lymphadenitis in children are very similar to those of acute appendicitis. The aim of this study was to determine the clinical manifestations of acute appendicitis and mesenteric lymphadenitis in children. METHODS In this cross-sectional study, patients less than 15 years old admitted to the pediatric emergency center of Afzalipour Hospital in Kerman from 2018 to 2021 were studied, and those who had a final diagnosis of appendicitis, mesenteric lymphadenitis, or appendectomy were included in the study by census. Data collection from the records of these patients included age, sex, clinical signs, duration of emergency until diagnosis, fever, number of times of vomiting, leukocytosis, lymphocyte, neutrophil count, neutrophil-to-lymphocyte ratio, sonographic findings, and pathology findings. SPSS software and descriptive and analytical statistics were used to analyze the data. RESULTS The results showed that unlike sex (p=0.11), there was a significant difference between the two groups in terms of age (p<0.001). Nausea, vomiting, anorexia, pain shift, and leukocytosis were more common in the acute appendicitis group than in the mesenteric lymphadenitis group, with a significant difference between the two groups (p<0.001). There was a significant difference between the two groups in terms of neutrophil percentage and neutrophil-to-lymphocyte ratio (p<0.001). CONCLUSION The present study was conducted with the aim of assisting medical professionals due to the possibility of misdiagnosing mesenteric lymphadenitis with acute appendicitis. Differentiation of these two diseases is facilitated by the significant differences in their clinical signs and test results. These results can be a useful guide for physicians to better diagnose the diseases.
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Affiliation(s)
- Ladan Shahba
- Surgery Department, Kerman Medical University, Kerman, IRN
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Patel A, Zhang M, Liao G, Karkache W, Montroy J, Fergusson DA, Khadaroo RG, Tran DTT, McIsaac DI, Lalu MM. A Systematic Review and Meta-Analysis Examining the Impact of Age on Perioperative Inflammatory Biomarkers. Anesth Analg 2021; 134:751-764. [PMID: 34962902 DOI: 10.1213/ane.0000000000005832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dysregulation of immune responses to surgical stress in older patients and those with frailty may manifest as differences in inflammatory biomarkers. We conducted a systematic review and meta-analysis to examine differences in perioperative inflammatory biomarkers between older and younger patients, and between patients with and without frailty. METHODS MEDLINE, Embase, Cochrane, and CINAHL databases were searched (Inception to June 23, 2020). Observational or experimental studies reporting the perioperative level or activity of biomarkers in surgical patients stratified by age or frailty status were included. The primary outcome was inflammatory biomarkers (grouped by window of ascertainment: pre-op; post-op: <12 hours, 12-24 hours, 1-3 days, 3 days to 1 week, and >1 week). Quality assessment was conducted using the Newcastle-Ottawa Scale. Inverse-variance, random-effects meta-analysis was conducted. RESULTS Forty-five studies (4263 patients) were included in the review, of which 36 were pooled for meta-analysis (28 noncardiac and 8 cardiac studies). Two studies investigated frailty as the exposure, while the remaining investigated age. In noncardiac studies, older patients had higher preoperative levels of interleukin (IL)-6 and C-reactive protein (CRP), lower preoperative levels of lymphocytes, and higher postoperative levels of IL-6 (<12 hours) and CRP (12-24 hours) than younger patients. In cardiac studies, older patients had higher preoperative levels of IL-6 and CRP and higher postoperative levels of IL-6 (<12 hours and >1 week). CONCLUSIONS Our findings demonstrate a paucity of frailty-specific studies; however, the presence of age-associated differences in the perioperative inflammatory response is consistent with age-associated states of chronic systemic inflammation and immunosenescence. Additional studies assessing frailty-specific changes in the systemic biologic response to surgery may inform the development of targeted interventions.
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Affiliation(s)
- Abhilasha Patel
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - MengQi Zhang
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Liao
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wassim Karkache
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Dean A Fergusson
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program.,Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rachel G Khadaroo
- Department of Surgery and Critical Care Medicine, University of Alberta, Walter C Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Diem T T Tran
- Clinical Epidemiology Program.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program.,Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics (Basel) 2021; 6:geriatrics6030093. [PMID: 34562994 PMCID: PMC8482159 DOI: 10.3390/geriatrics6030093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
With increased life expectancy and the growing total population of elderly patients, there has been rise in the number of cases of acute appendicitis in elderly people. Although acute appendicitis is not the most typical pathological condition in the elderly, it is not uncommon. Most of these patients require surgical treatment, and as with any acute surgical pathology in advanced age, treatment possibilities are affected by comorbidities, overall health status, and an increased risk of complications. In this literature review we discuss differences in acute appendicitis in the elderly population, with a focus on clinical signs, diagnostics, pathogenesis, treatment, and results.
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Téoule P, Laffolie JD, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:764-774. [PMID: 33533331 DOI: 10.3238/arztebl.2020.0764] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/05/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute appendicitis is the most common cause of the acute abdomen, with an incidence of 1 per 1000 persons per year. It is one of the main differential diagnoses of unclear abdominal conditions. METHODS This review is based on pertinent publications that were retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS In addition to the medical history, physical examination and laboratory tests, abdominal ultrasonography should be performed to establish the diagnosis (and sometimes computed tomography [CT] or magnetic resonance imaging [MRI], if ultrasonography is insufficient). Before any treatment is provided, appendicitis is classified as either uncomplicated or complicated. In both types of appendicitis, the decision to treat surgically or conservatively must be based on the overall clinical picture and the patient's risk factors. Appendectomy is the treatment of choice for acute appendicitis in all age groups. In Germany, appendectomy is mainly performed laparoscopically in patients with low morbidity. Uncomplicated appendicitis can, alternatively, be treated conservatively under certain circumstances. A meta-analysis of five randomized, controlled trials has revealed that ca. 37% of adult patients treated conservatively undergo appendectomy within one year. Complicated appendicitis is a serious disease; it can also potentially be treated conservatively (with antibiotics, with or without placement of a drain) as an alternative to surgical treatment. CONCLUSION Conservative treatment is being performed more frequently, but the current state of the evidence does not justify a change of the standard therapy from surgery to conservative treatment.
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Affiliation(s)
- Patrick Téoule
- Department of Surgery, Universitäts -medizin Mannheim, Medical Faculty Mannheim, Heidelberg UniversityDepartment of General Pediatrics and Neonatology, Pediatric Gastroenterology, University of Giessen, GermanyDepartment of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
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Andric M, Kalff JC, Schwenk W, Farkas S, Hartwig W, Türler A, Croner R. [Recommendations on treatment of acute appendicitis : Recommendations of an expert group based on the current literature]. Chirurg 2020; 91:700-711. [PMID: 32747976 DOI: 10.1007/s00104-020-01237-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis.
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Affiliation(s)
- M Andric
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - J C Kalff
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - W Schwenk
- Allgemein‑, Viszeral- und Gefäßchirurgie, Städtisches Klinikum Solingen, Solingen, Deutschland
| | - S Farkas
- Allgemein- und Viszeralchirurgie, St. Josefs-Hospital Wiesbaden, Wiesbaden, Deutschland
| | - W Hartwig
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - A Türler
- Allgemein- und Viszeralchirurgie, Johanniter Kliniken Bonn, Bonn, Deutschland
| | - R Croner
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Smith JW, Knight Davis J, Quatman-Yates CC, Waterman BL, Strassels SA, Wong JD, Heh VK, Baselice HE, Brock GN, Clark BC, Bridges JFP, Santry HP. Loss of Community-Dwelling Status Among Survivors of High-Acuity Emergency General Surgery Disease. J Am Geriatr Soc 2019; 67:2289-2297. [PMID: 31301180 DOI: 10.1111/jgs.16046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. DESIGN Retrospective analysis of claims data. SETTING US communities with Medicare beneficiaries. PARTICIPANTS Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra-abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319). MEASUREMENTS Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long-term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community-dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan-Meier plots, and χ2 tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community-dwelling status at 9 months. RESULTS A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in-hospital complications. Overall, 418 (14.3%) HA-EGS survivors died during the follow-up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA-EGS. CONCLUSION Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. Long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality-of-life burden of EGS survivorship prospectively. J Am Geriatr Soc 67:2289-2297, 2019.
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Affiliation(s)
- Jason W Smith
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | | | | | - Brittany L Waterman
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Scott A Strassels
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio
| | - Jen D Wong
- Department of Human Sciences, Ohio State University, Columbus, Ohio.,Office of Geriatrics and Inter-professional Aging Studies, Ohio State University, Columbus, Ohio
| | - Victor K Heh
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio
| | - Holly E Baselice
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio
| | - Guy N Brock
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, Ohio.,Department of Biomedical Sciences, Ohio University, Athens, Ohio.,Division of Geriatric Medicine, Ohio University, Athens, Ohio
| | - John F P Bridges
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Heena P Santry
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio
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