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Serrano E, Voldal EC, Machado-Aranda D, DeUgarte DA, Kao L, Drake T, Winchell R, Cuschieri J, Krishnadasan A, Talan DA, Siparsky N, Ayoung-Chee P, Self WH, McGonagill P, Mandell KA, Liang MK, Dodwad SJ, Thompson CM, Padilla RM, Fleischman R, Price TP, Jones A, Bernardi K, Garcia L, Evans HL, Sanchez SE, Odom S, Comstock BA, Heagerty PJ, Lawrence SO, Monsell SE, Fannon EE, Kessler LG, Flum DR, Davidson GH. Trial Participation and Outcomes Among English-Speaking and Spanish-Speaking Patients With Appendicitis Randomized to Antibiotics: A Secondary Analysis of the CODA Randomized Clinical Trial. JAMA Surg 2023; 158:901-908. [PMID: 37379001 PMCID: PMC10308294 DOI: 10.1001/jamasurg.2023.2277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 06/29/2023]
Abstract
Importance Spanish-speaking participants are underrepresented in clinical trials, limiting study generalizability and contributing to ongoing health inequity. The Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial intentionally included Spanish-speaking participants. Objective To describe trial participation and compare clinical and patient-reported outcomes among Spanish-speaking and English-speaking participants with acute appendicitis randomized to antibiotics. Design, Setting, and Participants This study is a secondary analysis of the CODA trial, a pragmatic randomized trial comparing antibiotic therapy with appendectomy in adult patients with imaging-confirmed appendicitis enrolled at 25 centers across the US from May 1, 2016, to February 28, 2020. The trial was conducted in English and Spanish. All 776 participants randomized to antibiotics are included in this analysis. The data were analyzed from November 15, 2021, through August 24, 2022. Intervention Randomization to a 10-day course of antibiotics or appendectomy. Main Outcomes and Measures Trial participation, European Quality of Life-5 Dimensions (EQ-5D) questionnaire scores (higher scores indicating a better health status), rate of appendectomy, treatment satisfaction, decisional regret, and days of work missed. Outcomes are also reported for a subset of participants that were recruited from the 5 sites with a large proportion of Spanish-speaking participants. Results Among eligible patients 476 of 1050 Spanish speakers (45%) and 1076 of 3982 of English speakers (27%) consented, comprising the 1552 participants who underwent 1:1 randomization (mean age, 38.0 years; 976 male [63%]). Of the 776 participants randomized to antibiotics, 238 were Spanish speaking (31%). Among Spanish speakers randomized to antibiotics, the rate of appendectomy was 22% (95% CI, 17%-28%) at 30 days and 45% (95% CI, 38%-52%) at 1 year, while in English speakers, these rates were 20% (95% CI, 16%-23%) at 30 days and 42% (95% CI 38%-47%) at 1 year. Mean EQ-5D scores were 0.93 (95% CI, 0.92-0.95) among Spanish speakers and 0.92 (95% CI, 0.91-0.93) among English speakers. Symptom resolution at 30 days was reported by 68% (95% CI, 61%-74%) of Spanish speakers and 69% (95% CI, 64%-73%) of English speakers. Spanish speakers missed 6.69 (95% CI, 5.51-7.87) days of work on average, while English speakers missed 3.76 (95% CI, 3.20-4.32) days. Presentation to the emergency department or urgent care, hospitalization, treatment dissatisfaction, and decisional regret were low for both groups. Conclusions and Relevance A high proportion of Spanish speakers participated in the CODA trial. Clinical and most patient-reported outcomes were similar for English- and Spanish-speaking participants treated with antibiotics. Spanish speakers reported more days of missed work. Trial Registration ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
- Elina Serrano
- University of Washington, Seattle
- Fred Hutch Cancer Center, Seattle, Washington
| | - Emily C. Voldal
- University of Washington, Seattle
- Fred Hutch Cancer Center, Seattle, Washington
| | | | | | - Lillian Kao
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | | | | | - Joseph Cuschieri
- Harborview Medical Center, UW Medicine, Seattle, Washington
- University of California, San Francisco, San Francisco
| | | | - David A. Talan
- Olive View–UCLA Medical Center, Los Angeles, California
- Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | - Patricia Ayoung-Chee
- Bellevue Hospital Center, NYU School of Medicine, New York, New York
- Tisch Hospital, NYU Langone Medical Center, New York, New York
- Morehouse School of Medicine, Atlanta GA
| | - Wesley H. Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Mike K. Liang
- Lyndon B. Johnson General Hospital, University of Texas, Houston
- University of Houston, HCA Healthcare, Kingwood, Kingwood, Texas
| | - Shan-Jahan Dodwad
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | - Callie M. Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee
- University of Utah, Salt Lake City
| | | | | | | | - Alan Jones
- The University of Mississippi Medical Center, Jackson
| | - Karla Bernardi
- Lyndon B. Johnson General Hospital, University of Texas, Houston
| | - Luis Garcia
- University of Iowa Hospitals and Clinics, Iowa City
| | - Heather L. Evans
- Harborview Medical Center, UW Medicine, Seattle, Washington
- The Medical University of South Carolina, Charleston
| | | | - Stephen Odom
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Park KB, Hong J, Moon JY, Jung J, Seo HS. Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003-2017. J Korean Med Sci 2022; 37:e27. [PMID: 35075826 PMCID: PMC8787806 DOI: 10.3346/jkms.2022.37.e27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Advances in medicine and changes in the medical environment can affect the diagnosis and treatment of diseases. The main purpose of the present study was to investigate whether the difference in accessibility to diagnosis and treatment facilities influenced the occurrence of appendectomy in Korea. METHODS We collected data on 183,531 appendectomy patients between 2003 and 2017 using the National Health Insurance Services claims. Retrospective analysis of relationship between the age-standardized rate (ASR) of appendectomy and clinical variables affecting medical accessibility was performed. Pearson's correlation analyses were used. RESULTS The incidence of appendectomy decreased from 30,164 cases in 2003 to 7,355 cases in 2017. The rate of computerized tomography (CT) scans for diagnosis of appendicitis increased from 4.73% in 2003 to 86.96% in 2017. The ASR of appendectomy in uncomplicated and complicated appendicitis decreased from 48.71 in 2005 to 13.40 in 2010 and 8.37 in 2005 to 2.96 in 2009, respectively. The ASR of appendectomy was higher in the high-income group. The proportion and ASR of appendectomy in older age group increased steadily with years. The total admission days continued to decrease from 6.02 days in 2003 to 4.96 days in 2017. CONCLUSION The incidence of appendectomy was seemingly associated with the rate of CT scan. In particular, the incidence of appendectomy in uncomplicated appendicitis was markedly reduced. Through enhanced accessibility to CT scans, accurate diagnosis and treatment of appendicitis can be facilitated.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jinwook Hong
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jong Youn Moon
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Center for Public Healthcare, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Departement of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Departement of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
| | - Ho Seok Seo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
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Davidson GH, Flum DR, Monsell SE, Kao LS, Voldal EC, Heagerty PJ, Fannon E, Lavallee DC, Bizzell B, Lawrence SO, Comstock BA, Krishnadasan A, Winchell RJ, Self WH, Thompson CM, Farjah F, Park PK, Alam HB, Saltzman D, Moran GJ, Kaji AH, DeUgarte DA, Salzberg M, Ferrigno L, Mandell KA, Price TP, Siparsky N, Glaser J, Ayoung-Chee P, Chiang W, Victory J, Chung B, Carter DW, Kutcher ME, Jones A, Holihan J, Liang MK, Faine BA, Cuschieri J, Evans HL, Johnson J, Patton JH, Coleman N, Fischkoff K, Drake FT, Sanchez SE, Parsons C, Odom SR, Kessler LG, Talan DA. Antibiotics versus Appendectomy for Acute Appendicitis - Longer-Term Outcomes. N Engl J Med 2021; 385:2395-2397. [PMID: 34694761 DOI: 10.1056/nejmc2116018] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Giana H Davidson
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - David R Flum
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Sarah E Monsell
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Lillian S Kao
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Emily C Voldal
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Patrick J Heagerty
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Erin Fannon
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Danielle C Lavallee
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Bonnie Bizzell
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Sarah O Lawrence
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Bryan A Comstock
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Anusha Krishnadasan
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Robert J Winchell
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Wesley H Self
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Callie M Thompson
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Farhood Farjah
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Pauline K Park
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Hasan B Alam
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Darin Saltzman
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Gregory J Moran
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Amy H Kaji
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Daniel A DeUgarte
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Matthew Salzberg
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Lisa Ferrigno
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Katherine A Mandell
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Thea P Price
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Nicole Siparsky
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Jacob Glaser
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Patricia Ayoung-Chee
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - William Chiang
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Jesse Victory
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Bruce Chung
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Damien W Carter
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Matthew E Kutcher
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Alan Jones
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Julie Holihan
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Mike K Liang
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Brett A Faine
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Joseph Cuschieri
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Heather L Evans
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Jeffrey Johnson
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Joe H Patton
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Natasha Coleman
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Katherine Fischkoff
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - F Thurston Drake
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Sabrina E Sanchez
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Charles Parsons
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Stephen R Odom
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - Larry G Kessler
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
| | - David A Talan
- From University of Washington Medical Center-UW Medicine (G.H.D., D.R.F., E.F., D.C.L., B.B., S.O.L., F.F., L.G.K.), University of Washington (S.E.M., E.C.V., P.J.H., B.A.C.), Swedish Medical Center (K.A.M.), and Harborview Medical Center-UW Medicine (J.C., H.L.E.), Seattle, and Providence Regional Medical Center, Everett (J.G.) - all in Washington; McGovern Medical School, University of Texas Health Science Center (L.S.K.), Lyndon B. Johnson General Hospital, University of Texas (J.H., M.K.L.), and HCA Healthcare Kingwood, University of Houston (M.K.L.) - all in Houston; BC Academic Science Health Network, Vancouver, BC, Canada (D.C.L.); Olive View-UCLA Medical Center (A.K., D.S., G.J.M., D.A.T.), Harbor-UCLA Medical Center (A.H.K., D.A.D.), and UCLA Ronald Reagan Medical Center (D.A.T.), Los Angeles, and the University of California, San Francisco (J.C.) - all in California; Weill Cornell Medical Center (R.J.W.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C., J.V.), Bellevue Hospital Center, NYU School of Medicine (W.C.), and Columbia University Medical Center (N.C., K.F.) - all in New York; Vanderbilt University Medical Center, Nashville (W.H.S., C.M.T.); University of Utah, Salt Lake City (C.M.T.); University of Michigan Medical Center, Ann Arbor (P.K.P., H.B.A.), and Henry Ford Health System, Detroit (J.J., J.H.P.) - both in Michigan; UCHealth, University of Colorado Hospital, Denver (M.S., L.F.); Rush University Medical Center, Chicago (T.P.P., N.S.); Morehouse School of Medicine, Atlanta (P.A.-C.); Maine Medical Center, Portland (B.C., D.W.C.); University of Mississippi Medical Center, Jackson (M.E.K., A.J.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F.); Medical University of South Carolina, Charleston (H.L.E.); and Boston University Medical Center (F.T.D., S.E.S.) and Beth Israel Deaconess Medical Center (C.P., S.R.O.) - both in Boston
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Kim MJ, Choi WH, Cheong JC, Choi SY, Kim JW, Park JH. Delta neutrophil index and symptomatic time are effective factors for predicting perforated appendicitis. Medicine (Baltimore) 2021; 100:e25935. [PMID: 34011068 PMCID: PMC8137091 DOI: 10.1097/md.0000000000025935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/16/2021] [Indexed: 01/05/2023] Open
Abstract
Appendicitis is a common intra-abdominal inflammatory disease, and morbidity increases with age when perforation occurs. Because, not all patients require emergency surgery, there have been numerous studies on factors for predicting perforated appendicitis. In this study, we aimed to confirm whether the delta neutrophil index (DNI) and the time from symptom onset to surgery are effective predictors for perforated appendicitis in different age groups.This was a retrospective study conducted on 542 appendicitis patients who underwent surgery at Kangdong Sacred Heart Hospital. The simple group consisted of 431 subjects, and the perforation group consisted of 111 subjects.Multiple logistic regression analyses demonstrated that age, neutrophil percentage, DNI, C-reactive protein (CRP), and symptomatic time were significant predictors of perforation. Analysis of the receiver-operating characteristic curve showed that the DNI was the most reliable predictive value. In the analyses according to age, the perforation rate was higher in the >65-year-age group; these patients also had a higher DNI, CRP, and symptomatic time. In the DNI analysis using receiver operating characteristic (ROC) analysis, the area under the curve was higher in the >65-year-age group than in other age groups. In addition, the cutoff values have been determined and perforation occurred significantly in the group with a DNI value of 2.1 or higher and a symptomatic time of 33 hours or longer.DNI is effective in predicting perforation in patients with appendicitis compared with other inflammatory factors. Furthermore, the simultaneous measurement of symptomatic time and DNI is helpful in predicting perforation and determining whether emergency surgery is necessary.
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Affiliation(s)
- Min Jeong Kim
- Department of Surgery, Kangdong Sacred Heart Hospital
| | - Won Hyuk Choi
- Department of Surgery, Kangdong Sacred Heart Hospital
| | | | - Su Yun Choi
- Department of Surgery, Kangdong Sacred Heart Hospital
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jun Ho Park
- Department of Surgery, Kangdong Sacred Heart Hospital
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Akbulut S, Bahçe ZS, Öztaş T, Gümüş S, Söğütçü N, Sakarya H, Gök AFK, Yağmur Y. Assessment of demographic, clinical and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis. ULUS TRAVMA ACIL CER 2021; 27:315-324. [PMID: 33884602 DOI: 10.14744/tjtes.2020.73537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the clinical, biochemical, and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis (AAp). METHODS The demographic, biochemical and histopathological data of 8206 patients who underwent appendectomy for AAp between January 2006 and March 2014 were retrospectively analyzed in this study. Patients were compared regarding the following characteristics: disruption by season (autumn vs. winter vs. spring vs. summer), working days (weekdays vs. weekends), histopathological findings (AAp vs. normal appendix [NAp]) and histopathological subgroup (non-perforated AAp vs. perforated AAp vs. NAp). RESULTS Of the 8206 patients aged between 16 and 89 years, 4763 (58.0%) were male. Appendectomy distribution by season was as follows: autumn (n=1959; 23.9%), winter (n=2062; 25.1%), spring (n=2061; 25.1%) and summer (n=2124, 25.9%). NAp rates were higher in summer than those in other seasons. White blood cell (WBC) and neutrophil levels were significantly higher in autumn and winter compared with those in other seasons. In total, 6120 (74.6%) appendectomies occurred on weekdays and 2086 (25.4%) on weekends. WBC and neutrophil levels were significantly higher on weekends than those on weekdays. Appendectomy distribution by histopathological groups as follows: AAp (n=7414; 90.3%) and NAp (n=792; 9.7%). Appendectomy distribution by histopathological subgroups was as follows: non-perforated AAp (n=6966; 84.9%), perforated AAp (n=448; 5.5%), and NAp (n=792; 9.7%). WBC, neutrophil, and TBil levels in the non-perforated and perforated AAp groups were significantly higher than in the NAp group. While most of the patients with perforated AAp (62.1%) and non-perforated AAp (59.6%) were males, most of the patients with NAp (58.1%) were females. CONCLUSION This study suggests that a relationship exists between demographic features, histopathological findings of appendectomy specimens, seasons, days of the week, and working days in patients undergoing appendectomy.
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Affiliation(s)
- Sami Akbulut
- Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey
| | - Zeynep Sener Bahçe
- Department of General Surgery, Diyarbakır Training and Research Hospital, Diyarbakır-Turkey
| | - Tulin Öztaş
- Department of Pediatric Surgery, Diyarbakır Training and Research Hospital, Diyarbakır-Turkey
| | - Serdar Gümüş
- Department of General Surgery, Diyarbakır Training and Research Hospital, Diyarbakır-Turkey
| | - Nilgün Söğütçü
- Department of Pathology, Diyarbakir Training and Research Hospital, Diyarbakır-Turkey
| | - Hamdi Sakarya
- Department of General Surgery, Diyarbakır Training and Research Hospital, Diyarbakır-Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul-Turkey
| | - Yusuf Yağmur
- Department of General Surgery, Diyarbakır Training and Research Hospital, Diyarbakır-Turkey
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Aharoni M, Barash Y, Zager Y, Anteby R, Khalilieh S, Amiel I, Klang E, Goldes Y, Gutman M, Horesh N, Rosin D. Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience. Isr Med Assoc J 2021; 23:269-273. [PMID: 34024041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare. OBJECTIVES To evaluate the presentation and management of patients with acute appendicitis. METHODS A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared. RESULTS Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right lower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 ± 23 vs. 52 ± 26 minutes, P = 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P = 0.04). Length of stay (1.82 ± 2.04 vs. 2.74 ± 4.68, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar. CONCLUSIONS The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.
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Affiliation(s)
- Mor Aharoni
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saed Khalilieh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Omling E, Salö M, Saluja S, Bergbrant S, Olsson L, Björk J, Hagander L. A Nationwide Cohort Study of Outcome after Pediatric Appendicitis. Eur J Pediatr Surg 2021; 31:191-198. [PMID: 32590867 PMCID: PMC10499502 DOI: 10.1055/s-0040-1712508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/16/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. MATERIALS AND METHODS A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. RESULTS Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18-3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08-5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61-5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62-0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11-0.63], p = 0.002). CONCLUSION Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.
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Affiliation(s)
- Erik Omling
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Salö
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Saurabh Saluja
- Department of Surgery, Weill Cornell Medicine, New York, New York, United States
| | - Sanna Bergbrant
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Louise Olsson
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Björk
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Skåne, Sweden
| | - Lars Hagander
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
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Williams BM, Purcell LN, Varela C, Gallaher J, Charles A. Appendicitis Mortality in a Resource-Limited Setting: Issues of Access and Failure to Rescue. J Surg Res 2021; 259:320-325. [PMID: 33129505 PMCID: PMC7897218 DOI: 10.1016/j.jss.2020.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Appendicitis is one of the most common emergency surgery conditions worldwide, and the incidence is increasing in low- and middle-income countries. Disparities in access to care can lead to disproportionate morbidity and mortality in resource-limited settings; however, outcomes following an appendectomy in low- and middle-income countries remain poorly described. Therefore, we aimed to describe the characteristics and outcomes of patients with appendicitis presenting to a tertiary care center in Malawi. METHODS We conducted a retrospective analysis of the Kamuzu Central Hospital (KCH) Acute Care Surgery database from 2013 to 2020. We included all patients ≥13 years with a postoperative diagnosis of acute appendicitis. We performed bivariate analysis by mortality, followed by a modified Poisson regression analysis to determine predictors of mortality. RESULTS We treated 214 adults at KCH for acute appendicitis. The majority experienced prehospital delays to care, presenting at least 1 week from symptom onset (n = 99, 46.3%). Twenty (9.4%) patients had appendiceal perforation. Mortality was 5.6%. The presence of a postoperative complication the only statistically significant predictor of mortality (RR 5.1 [CI 1.13-23.03], P = 0.04) when adjusting for age, shock, transferring, and time to presentation. CONCLUSIONS Delay to intervention due to inadequate access to care predisposes our population for worse postoperative outcomes. The increased risk of mortality associated with resultant surgical complications suggests that failure to rescue is a significant contributor to appendicitis-related deaths at KCH. Improvement in barriers to diagnosis and management of complications is necessary to reduce further preventable deaths from this disease.
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Affiliation(s)
- Brittney M Williams
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Laura N Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Pérez-Soto RH, Ponce de León-Ballesteros G, Álvarez-Bautista F, Trolle-Silva AM, Medina-Franco H. Thrombocytosis and Hyponatremia as Predictors of Complicated Acute Appendicitis: Predictors of Appendicitis. J Surg Res 2021; 261:369-375. [PMID: 33493889 DOI: 10.1016/j.jss.2020.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple serologic markers have been studied to predict complicated acute appendicitis (CAA) (C-reactive protein and procalcitonin); these increase health care costs and are not always available in medical centers in Mexico. There is a need for low-cost serologic markers to predict CAA and guide the preoperative management of patients. Our objective was to analyze the predictive value of hyponatremia and thrombocytosis for complicated acute appendicitis. METHODS We analyzed 274 patients with AA surgically treated and divided them into two groups: the CAA group and the uncomplicated AA group. We compared the serum values of sodium and platelet blood counts on presentation in the emergency room between the two groups and the proportion of patients with hyponatremia and/or thrombocytosis. Receiver operating characteristic analysis was performed for the two biochemical markers. Sensitivity, specificity, and positive and negative predictive values were calculated for complicated appendicitis in the presence of hyponatremia and thrombocytosis. RESULTS We found 87 patients with CAA and 187 with uncomplicated acute appendicitis. Patients with CAA presented with lower serum sodium values and higher platelet counts than uncomplicated patients. Hyponatremia was found in 54.8% of complicated patients and 29.2% in the uncomplicated group. Thrombocytosis was present in 11.6% of the complicated group and 3.2% in uncomplicated patients. We found a specificity and positive predictive value of 100% for complicated appendicitis in patients with hyponatremia and thrombocytosis. CONCLUSIONS In patients with abdominal pain and suspected acute appendicitis, the presence of hyponatremia and thrombocytosis is a strong predictive tool for the complicated disease. This is the first study to analyze the association between thrombocytosis and complicated appendicitis.
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Affiliation(s)
- Rafael H Pérez-Soto
- General Surgeon, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
| | | | - Francisco Álvarez-Bautista
- General Surgeon, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Alicia Maybí Trolle-Silva
- Department of Anatomical Pathology at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Heriberto Medina-Franco
- Oncologic Surgery, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
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Zhang P, Zhang Q, Zhao H, Li Y. Factors affecting the length of hospital stay after laparoscopic appendectomy: A single center study. PLoS One 2020; 15:e0243575. [PMID: 33296384 PMCID: PMC7725291 DOI: 10.1371/journal.pone.0243575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022] Open
Abstract
AIM This study aimed to explore factors may affect the length of hospital stay after laparoscopic appendectomy. METHODS The data of 636 patients undergoing laparoscopic appendectomy between July 2016 and July 2019 in Beijing Tsinghua Changgung Hospital were retrospectively analyzed. The patients were divided into group A (hospital stay ≤3 days, 348 patients) and group B (hospital stay >3 days, 288 patients) according to their hospital stay.Sex, age, disease onset time(time from onset to admission), nausea, vomiting, diarrhea, peritonitis, comorbidities, and history of appendicitis; preoperative body temperature (T), white blood cell (WBC) count, percentage of neutrophilic granulocytes, and preoperative C-reactive protein (CRP) level; time from diagnosis to surgery. appendix diameter, appendicolith, and ascites in ultrasound or CT; surgical time(the surgery start time was the time of skin incision, and the end time was the time the anesthesia intubation was removed), intraoperative blood loss (the volume of blood infiltrating into a gauze was calculated by weighing the gauze infiltrated with water and calculating the volume of water), intraoperative adhesions or effusions, and stump closure methods, convert to open appendectomy, appendix pathology(perforated or gangrenous appendicitis were defined as complicated appendicitis and simple or suppurative appendicitis were defined as uncomplicated appendicitis) and antibiotic treatment schemes were analyzed. RESULTS Significant differences were detected between group A and group B in age (37.10 ± 13.52y vs 42.94 ± 15.57y, P<0.01), disease onset time (21.36 ± 16.56 h vs 32.52 ± 27.99 h, P <0.01), time from diagnosis to surgery (8.63 ± 7.29 h vs 10.70 ± 8.47 h, P<0.01); surgical time(64.09 ± 17.24 min vs 86.19 ± 39.96 min, P < 0.01); peritonitis(52.9% vs 74%, P < 0.01), comorbidities (12.4% vs 20.5%, P < 0.01), appendicolith (27.6% vs 41.7%, P < 0.01), ascites before the surgery(13.8% vs 22.9%, P < 0.01), intraoperative adhesions or effusions(56% vs 80.2%, P < 0.01); preoperative temperature (37.11 ± 0.64°C vs 37.54 ± 0.90°C, P < 0.01); preoperative WBC count (13.06 ± 3.39 × 109/L vs 14.21 ± 4.54 × 109/L, P = 0.04);preoperative CRP level(18.99 ± 31.72 mg/L vs 32.46 ± 46.68 mg/L, P < 0.01); appendix diameter(10.22 ± 2.59 mm vs 11.26 ± 3.23 mm, P < 0.01); intraoperative blood loss (9.36 ± 7.29 mL vs 13.74 ± 13.49 mL, P < 0.01); using Hem-o-lok for stump closure(30.7% vs 38.5%, P = 0.04); complicated appendicitis (9.5% vs 45.8%, P < 0.01); and using ertapenem for antibiotic treatment after the surgery(4.3% vs 21.5%, P < 0.01). Multivariate analysis demonstrated that age (OR = 1.021; 95%CI = 1.007-1.036), peritonitis (OR = 1.603; 95% CI = 1.062-2.419), preoperative WBC count (OR = 1.084; 95% CI = 1.025-1.046), preoperative CRP level (OR = 1.010; 95% CI = 1.005-1.015), time from diagnosis to surgery (OR = 1.043; 95% CI = 1.015-1.072), appendicolith (OR = 1.852; 95% CI = 1.222-2.807), complicated appendicitis (OR = 3.536; 95% CI = 2.132-5.863), surgical time (OR = 1.025; 95% CI = 1.016-1.034), use of Hem-o-lok for stump closure (OR = 1.894; 95% CI = 1.257-2.852), and use of ertapenem for antibiotic treatment (OR = 3.076; 95% CI = 1.483-6.378) were the risk factors for a prolonged hospital stay. CONCLUSIONS The patient with appendicitis was older and had peritonitis, higher preoperative WBC count or CRP level, longer time from diagnosis to surgery, appendicolith, and complicated appendicitis, predicting a prolonged hospital stay. Shorter surgical time and the use of silk ligation for stump closure and cephalosporins + metronidazole for antibiotic treatment might be better choices to obtain a shorter hospital stay.
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Affiliation(s)
- Peng Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qian Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hongwei Zhao
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuanxin Li
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- * E-mail:
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11
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Flum DR, Davidson GH, Monsell SE, Shapiro NI, Odom SR, Sanchez SE, Drake FT, Fischkoff K, Johnson J, Patton JH, Evans H, Cuschieri J, Sabbatini AK, Faine BA, Skeete DA, Liang MK, Sohn V, McGrane K, Kutcher ME, Chung B, Carter DW, Ayoung-Chee P, Chiang W, Rushing A, Steinberg S, Foster CS, Schaetzel SM, Price TP, Mandell KA, Ferrigno L, Salzberg M, DeUgarte DA, Kaji AH, Moran GJ, Saltzman D, Alam HB, Park PK, Kao LS, Thompson CM, Self WH, Yu JT, Wiebusch A, Winchell RJ, Clark S, Krishnadasan A, Fannon E, Lavallee DC, Comstock BA, Bizzell B, Heagerty PJ, Kessler LG, Talan DA. A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. N Engl J Med 2020; 383:1907-1919. [PMID: 33017106 DOI: 10.1056/nejmoa2014320] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis. METHODS We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith. RESULTS In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], -0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50). CONCLUSIONS For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith. (Funded by the Patient-Centered Outcomes Research Institute; CODA ClinicalTrials.gov number, NCT02800785.).
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Affiliation(s)
- David R Flum
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Giana H Davidson
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Sarah E Monsell
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Nathan I Shapiro
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Stephen R Odom
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Sabrina E Sanchez
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - F Thurston Drake
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Katherine Fischkoff
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Jeffrey Johnson
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Joe H Patton
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Heather Evans
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Joseph Cuschieri
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Amber K Sabbatini
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Brett A Faine
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Dionne A Skeete
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Mike K Liang
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Vance Sohn
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Karen McGrane
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Matthew E Kutcher
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Bruce Chung
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Damien W Carter
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Patricia Ayoung-Chee
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - William Chiang
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Amy Rushing
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Steven Steinberg
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Careen S Foster
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Shaina M Schaetzel
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Thea P Price
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Katherine A Mandell
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Lisa Ferrigno
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Matthew Salzberg
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Daniel A DeUgarte
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Amy H Kaji
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Gregory J Moran
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Darin Saltzman
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Hasan B Alam
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Pauline K Park
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Lillian S Kao
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Callie M Thompson
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Wesley H Self
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Julianna T Yu
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Abigail Wiebusch
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Robert J Winchell
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Sunday Clark
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Anusha Krishnadasan
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Erin Fannon
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Danielle C Lavallee
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Bryan A Comstock
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Bonnie Bizzell
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Patrick J Heagerty
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - Larry G Kessler
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
| | - David A Talan
- The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.)
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Bernard L, Chen I, Le T. Appendectomy at the time of ovarian cancer staging increases infectious complications: a National Surgical Quality Improvement Program (NSQIP) propensity score-stratified analysis. Int J Gynecol Cancer 2020; 30:1542-1547. [PMID: 32848024 DOI: 10.1136/ijgc-2020-001702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Despite evidence that routine elective appendectomy at the time of staging surgery for ovarian cancer is not warranted, it remains common practice in gynecology oncology. The objective of this study was to compare the surgical complication rates of women undergoing surgery for suspected early-stage ovarian malignancy with concurrent appendectomy to those who did not undergo appendectomy. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2010-2017 data were used to analyze the patient characteristics and outcomes of women undergoing staging surgeries for suspected early ovarian cancer. Women with pre-operative ascites, disseminated cancer, concurrent bowel surgery, or cytoreductive surgery were excluded. Multivariate logistic regression and propensity score stratification were used to assess 30-day post-operative outcomes. RESULTS Three hundred and fifty-one of 2100 women (16.7%) underwent concurrent appendectomy at time of surgery, and the post-operative infection rate was 7.8%. Women with concurrent appendectomy had twice the odds of post-operative infection (OR 2.03, 95% CI 1.26 to 3.27) after controlling for clinically important risk factors. The increased odds of infection remained significant after propensity score stratification (OR 2.04, 95% CI 1.27 to 3.3). No association was observed with length of hospital stay, readmission, return to the operating room, or post-operative death. CONCLUSIONS Appendectomy at time of surgery for suspected early-stage ovarian cancer is associated with significantly elevated odds of post-operative infection. Unless there is clinical suspicion for involvement, routine appendectomy should be abandoned in clinical practice.
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Affiliation(s)
- Laurence Bernard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tien Le
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
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Cai YL, Yang SS, Peng DZ, Jia QB, Li FY, Ye H, Cheng NS. Laparoscopic appendectomy is safe and feasible in pregnant women during second trimester: A retrospective study in a top-level Chinese center. Medicine (Baltimore) 2020; 99:e21801. [PMID: 32872081 PMCID: PMC7437783 DOI: 10.1097/md.0000000000021801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ± 4.3 vs 21.5 ± 2.9, P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ± 107 US$ vs 340 ± 115 US$, P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No "Yinao" was found in any of the patients in the LA group.In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.
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Cano-Valderrama O, Morales X, Ferrigni CJ, Martín-Antona E, Turrado V, García A, Cuñarro-López Y, Zarain-Obrador L, Duran-Poveda M, Balibrea JM, Torres AJ. Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study. Int J Surg 2020; 80:157-161. [PMID: 32679205 PMCID: PMC7361112 DOI: 10.1016/j.ijsu.2020.07.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
| | - Xavier Morales
- Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain
| | | | - Esteban Martín-Antona
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Victor Turrado
- Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain
| | | | | | | | | | - José M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain; Department of Surgery, Universidad Autónoma, Barcelona, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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Koç C, Akbulut S, Coşkun EI, Sarıcı B, Yılmaz S. Comparison of the demographic and clinical features of pregnant and non-pregnant patients undergoing appendectomy. ULUS TRAVMA ACIL CER 2020; 26:555-562. [PMID: 32589240 DOI: 10.14744/tjtes.2020.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features. RESULTS No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality. CONCLUSION Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.
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Affiliation(s)
- Cemalettin Koç
- Department of Surgery and Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya-Turkey
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya-Turkey
| | - Ebru Inci Coşkun
- Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, Malatya-Turkey
| | - Barış Sarıcı
- Department of Surgery and Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya-Turkey
| | - Sezai Yılmaz
- Department of Surgery and Liver Transplant Institute, İnönü University Faculty of Medicine, Malatya-Turkey
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Dotlacil V, Frybova B, Polívka N, Kardos D, Vajda P, Toczewski K, Pechanová R, Babala J, Rygl M, Patkowski D. Current management of pediatric appendicitis: A Central European survey. ADV CLIN EXP MED 2020; 29:745-750. [PMID: 32603558 DOI: 10.17219/acem/122176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Appendicitis is one of the most common diagnoses in pediatric populations. Although new recommendations for the treatment of pediatric appendicitis were published, management varies among different institutions. OBJECTIVES To determine current practices in 4 (n = 4) representative pediatric surgical departments in Central Europe. MATERIAL AND METHODS One department from each of the 4 countries was surveyed using an online questionnaire. Questions focused on preoperative, operative and postoperative practices in 2018, particularly those related to antibiotic (ATB) therapy and laparoscopy. RESULTS A total of 519 appendectomies were performed, among which 413 (79.6%) were laparoscopic appendectomies (LAs), with a conversion rate of 5.1%. Appendectomy, as an elective procedure, was performed in 43 (8.3%) patients. One-quarter (129 patients) had complex appendicitis and 72.3% of these were operated laparoscopically. In 3 departments, ATB prophylaxis was administered, based on the decisions of the operating surgeon. One department used standard ATB prophylaxis (metronidazole). Whenever phlegmonous appendicitis was detected, ATB were administered therapeutically in 2 departments. Two other departments administered ATB based on surgeon decision. The choice of ATB was not standardized. If complex appendicitis was detected, all sites administered ATB therapeutically. The type of ATB treatment was standardized in complex cases in 2 departments. Thirty-four complications (6.6%) at surgical sites were recorded - 4.1% (16/390) after uncomplicated and 14% (18/129) after complex appendicitis. Thirty-two occurred after acute surgeries and 26 of these followed laparoscopic procedures. Postoperatively, intra-abdominal abscesses occurred in 3.5% of laparoscopic and in 2.9% of open appendectomy (OA) cases. CONCLUSIONS This questionnaire study showed that treatment outcomes for appendicitis in children in Central Europe are comparable with data reported in the literature. Laparoscopic appendectomy is the predominant surgical method, but there is a little consensus for ATB treatment in the management of appendicitis at our 4 pediatric surgical departments.
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Affiliation(s)
- Vojtech Dotlacil
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Barbora Frybova
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Natalie Polívka
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Daniel Kardos
- Department of Pediatrics, Surgical Division, University of Pecs, Hungary
| | - Peter Vajda
- Department of Pediatrics, Surgical Division, University of Pecs, Hungary
| | - Krystian Toczewski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland
| | - Rebeka Pechanová
- Department of Pediatric Surgery, Comenius University in Bratislava, National Institute of Children's Diseases, Slovakia
| | - Jozef Babala
- Department of Pediatric Surgery, Comenius University in Bratislava, National Institute of Children's Diseases, Slovakia
| | - Michal Rygl
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland
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Kim SY, Lim H, Park B, Lim H, Kim M, Kong IG, Choi HG. Increased risk of gallstones after appendectomy: A longitudinal follow-up study using a national sample cohort. Medicine (Baltimore) 2020; 99:e20269. [PMID: 32443372 PMCID: PMC7253851 DOI: 10.1097/md.0000000000020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To evaluate the association between appendectomy and the occurrence of gallstones using a national sample cohort from Korea.The Korean National Health Insurance Service-National Sample Cohort was collected from 2002 to 2013. We extracted data for patients who had undergone appendectomy (n = 14,955) and a 1:4 matched control group (n = 59,820) and then analyzed the occurrence of gallstones. The patients were matched according to age, sex, income, region of residence, hypertension, diabetes mellitus, and history of dyslipidemia. Appendectomies were identified using operation codes (Q2860-Q2863) for appendicitis alone (International Classification of Disease-10: K35). Gallstones were diagnosed if the corresponding International Classification of Disease-10 code (K80) was reported ≥2 times. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using stratified Cox proportional hazard models, and 95% confidence intervals were calculated. Subgroup analyses were performed based on age, sex, and time period after appendectomy.The adjusted HR for gallstones was 1.78 (95% confidence interval = 1.51-2.09, P < .001) in the appendectomy group. Consistent HRs were found in the analyses of all the subgroups determined using age and sex, with the exception of men ≥60 years of age. The risk of gallstones was increased during the first year after appendectomy.The occurrence of gallstones was increased in the patients who had undergone appendectomy.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | | | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery
| | | | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | | | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery
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Hester CA, Pickett M, Abdelfattah KR, Cripps MW, Dultz LA, Dumas RP, Grant JL, Luk S, Minei J, Park C, Shoultz TH. Comparison of Appendectomy for Perforated Appendicitis With and Without Abscess: A National Surgical Quality Improvement Program Analysis. J Surg Res 2020; 251:159-167. [PMID: 32151825 DOI: 10.1016/j.jss.2019.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/15/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Outcomes of appendectomy stratified by type of complicated appendicitis (CA) features are poorly researched, and the evidence to guide operative versus nonoperative management for CA is lacking. This study aimed to determine laparoscopic-to-open conversion risk, postoperative abscess risk, unplanned readmission risk, and length of hospital stay (LOS) associated with appendectomy in patients with perforated appendicitis without abscess (PA) and perforated appendicitis with abscess (PAWA) compared with a control cohort of nonperforated appendicitis (NPA). METHODS The 2016-2017 National Surgical Quality Improvement Program Appendectomy-targeted database identified 12,537 (76.1%) patients with NPA, 2142 (13.0%) patients with PA, and 1799 (10.9%) patients with PAWA. Chi-squared analysis and analysis of variance were used to compare categorical and continuous variables. Binary logistic and linear regression models were used to compare risk-adjusted outcomes. RESULTS Compared with NPA, PA and PAWA had higher rates of conversion (0.8% versus 4.9% and 6.5%, respectively; P < 0.001), postoperative abscess requiring intervention (0.6% versus 4.8% and 7.0%, respectively; P < 0.001), readmission (2.8% versus 7.7% and 7.6%, respectively; P < 0.001), and longer median LOS (1 day versus 2 days and 2 days, respectively; P < 0.001). PA and PAWA were associated with increased odds of postoperative abscess (odds ratio [OR]: 7.18, 95% confidence interval [CI]: 5.2-9.8 and OR: 9.94, 95% CI: 7.3-13.5, respectively), readmission (OR: 2.70, 95% CI: 2.1-3.3 and OR: 2.66, 95% CI: 2.2-3.3, respectively), and conversion (OR: 5.51, 95% CI: 4.0-7.5 and OR: 7.43, 95% CI: 5.5-10.1, respectively). PA was associated with an increased LOS of 1.7 days and PAWA with 1.9 days of LOS (95% CI: 1.5-1.8 and 1.7-2.1, respectively). CONCLUSIONS Individual features of CA were independently associated with outcomes. Further research is needed to determine if surgical management is superior to nonoperative management for CA.
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Affiliation(s)
- Caitlin A Hester
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Maryanne Pickett
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Kareem R Abdelfattah
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Michael W Cripps
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Linda A Dultz
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Ryan P Dumas
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Jennifer L Grant
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Stephen Luk
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Joseph Minei
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Caroline Park
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Thomas H Shoultz
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas.
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RIFT Study Group on behalf of the West Midlands Research Collaborative. Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study. Lancet Child Adolesc Health 2020; 4:271-80. [PMID: 32200936 DOI: 10.1016/S2352-4642(20)30006-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. METHODS We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5-15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. FINDINGS 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82-0·86). Applying score cutoffs of 3 points or lower for children aged 5-10 years and girls aged 11-15 years, and 2 points or lower for boys aged 11-15 years, the failure rate was 3·3% (95% CI 2·0-5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4-47·2; 521 of 1176), and positive predictive value was 41·4% (38·5-44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4-77·4) was similar to that of ultrasound scan (75·0%, 65·3-83·1). INTERPRETATION The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. FUNDING None.
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Dworsky JQ, Childers CP, Copeland T, Maggard-Gibbons M, Tan HJ, Saliba D, Russell MM. Geriatric Events Among Older Adults Undergoing Nonelective Surgery Are Associated with Poor Outcomes. Am Surg 2019; 85:1089-1093. [PMID: 31657300 PMCID: PMC8019520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.
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Affiliation(s)
- Jill Q. Dworsky
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Christopher P. Childers
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Timothy Copeland
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | | | - Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Debra Saliba
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- UCLA/JH Borun Center for Gerontological Research, Los Angeles, CA
- RAND Corporation, Santa Monica, CA
| | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Abstract
The present study evaluated the association between appendectomy and rheumatoid arthritis (RA) using a national sample cohort of the Korean population. In this cohort study, the Korean National Health Insurance Service-National Sample Cohort of individuals ≥20 years old was collected from 2002 to 2013. A total of 14,995 appendectomy participants were 1:4 matched with 59,980 control subjects for age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the occurrence of RA in both the appendectomy and control groups. Appendectomies were identified using operation codes for appendicitis only. RA was defined by International Classification of Disease-10 codes (M05 or M06) and medication histories. Crude and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. Subgroup analyses were performed on groups stratified by age and sex. The adjusted HR for RA was 1.02 (95% confidence interval = 0.76-1.38) in the appendectomy group (P = .883). In all of the subgroup analyses according to age and sex, the adjusted HRs for RA were not higher in the appendectomy group than those in the control group. We could not identify any significant relationship between appendectomy and RA.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang
| | - Dong Jun Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang
| | - Sunmi Kim
- Department of Family Medicine, Kangwon National University College of Medicine, Chuncheon, Gangwon-do
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang
- Graduate School of Public Health, Seoul National University
| | - Il Gyu Kong
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang
- Department of Otorhinolaryngology-Head and Neck Surgery, National Medical Center, Seoul, Korea
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Wang V, Kriger D, Fanous E, Lee A, Zakhary B, Coimbra R, Depew AJ. Should All Complicated Appendicitis Be Treated the Same? The Answer Is No. Am Surg 2019; 85:1179-1183. [PMID: 31657320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.
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Abstract
The study aimed to expand previous data regarding an association between asthma and appendectomy in children compared with the population of all ages.The Korean Health Insurance Review and Assessment Service-National Sample Cohort from 2002 through 2013 was used. In all, 22,030 participants who underwent appendectomy were matched for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 88,120 participants who were included as a control group. In both the appendectomy and control groups, previous history of asthma was investigated. Appendectomy for appendicitis was identified based on a surgical code (International Classification of Disease-10 [ICD-10]: K35). Asthma was classified using an ICD-10 code (J45 and J46) and medication history. The crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of asthma for appendectomy were analyzed using conditional logistic regression analysis. Subgroup analyses were conducted according to age and sex.Approximately 15.2% (3358/22,030) of individuals in the appendectomy group and 13.3% (11,749/88,120) of those in the control group had asthma (P < .001). The appendectomy group demonstrated a higher adjusted odds of asthma than the control group (adjusted OR 1.18, 95% CI 1.13-1.23, P < .001). This result was consistent in the subgroups divided according to age and sex.The odds for asthma were higher in the appendectomy group than in the control group.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Dong Jun Oh
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul Hospital
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Dongtan
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
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Abstract
OBJECTIVE To explore geographic variations in Irish laparoscopic and open appendectomy procedures. DESIGN Analysis based on 2014-2017 administrative hospital data from public hospitals. SETTING Counties of Ireland. PARTICIPANTS Irish residents with hospital admissions for an appendectomy as the principal procedure. MAIN OUTCOME MEASURES Age and gender standardised laparoscopic and open appendectomy rates for 26 counties. Geographic variation measured with the extremal quotient (EQ), coefficient of variation (CV) and the systematic component of variation (SCV). RESULTS 23 684 appendectomies were included. 77.6% (n= 18,387) were performed laparoscopically. An EQ of 8.3 for laparoscopy and 10.0 for open appendectomy was determined. A high CV was demonstrated with a value of 36.7 and 80.8 for laparoscopic and open appendectomy, respectively. An SCV of 14.2 and 124.8 for laparoscopic and open appendectomy was observed. A wider variation was determined when children and adults were assessed separately. CONCLUSIONS The geographic distribution in rates of appendectomy varies considerably across Irish counties. Our data suggest that a patient's likelihood of undergoing a laparoscopic or open appendectomy is associated with their county of residence.
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Affiliation(s)
- Ola Ahmed
- General Surgery, Wexford General Hospital, Wexford, Ireland
| | - Ken Mealy
- General and Colorectal Surgery, Wexford General Hospital, Wexford, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Haijanen J, Sippola S, Tuominen R, Grönroos J, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Hurme S, Salminen P. Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial. PLoS One 2019; 14:e0220202. [PMID: 31344073 PMCID: PMC6657874 DOI: 10.1371/journal.pone.0220202] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy and safety of antibiotic treatment for uncomplicated acute appendicitis has been established at long-term follow-up with the majority of recurrences shown to occur within the first year. Overall costs of antibiotics are significantly lower compared with appendectomy at short-term follow-up, but long-term durability of these cost savings is unclear. The study objective was to compare the long-term overall costs of antibiotic therapy versus appendectomy in the treatment of uncomplicated acute appendicitis in the APPAC (APPendicitis ACuta) trial at 5 years. METHODS AND FINDINGS This multicentre, non-inferiority randomized clinical trial randomly assigned 530 adult patients with CT-confirmed uncomplicated acute appendicitis to appendectomy or antibiotic treatment at six Finnish hospitals. All major costs during the 5-year follow-up were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis. Between November 2009 and June 2012, 273 patients were randomized to appendectomy and 257 to antibiotics. The overall costs of appendectomy were 1.4 times higher (p<0.001) (€5716; 95% CI: €5510 to €5925) compared with antibiotic therapy (€4171; 95% CI: €3879 to €4463) resulting in cost savings of €1545 per patient (95% CI: €1193 to €1899; p<0.001) in the antibiotic group. At 5 years, the majority (61%, n = 156) of antibiotic group patients did not undergo appendectomy. CONCLUSIONS At 5-year follow-up antibiotic treatment resulted in significantly lower overall costs compared with appendectomy. As the majority of appendicitis recurrences occur within the first year after the initial antibiotic treatment, these results suggest that treating uncomplicated acute appendicitis with antibiotics instead of appendectomy results in lower overall costs even at longer-term follow-up.
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Affiliation(s)
- Jussi Haijanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Suvi Sippola
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Risto Tuominen
- Department of Public Health, University of Turku, Turku, Finland
- University of Namibia, Windhoek, Namibia
| | - Juha Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Hannu Paajanen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Pia Nordström
- Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - Markku Aarnio
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
- * E-mail:
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Seawell J, Sciarretta JD, Pahlkotter M, Muertos K, Onayemi A, Davis JM. The Understated Malignancy Potential of Nonoperative Acute Appendicitis. Am Surg 2019; 85:712-716. [PMID: 31405413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cancer of the appendix is rare and is most commonly found incidentally on pathology after an appendectomy for uncomplicated appendicitis (UA). The medical management alternative with antibiotics and observation remains an ongoing debate. The purpose of our study was to develop modern epidemiological data for adult patients completing an appendectomy for UA secondary to an appendiceal neoplasm (AN). ACS-NSQIP database was queried (2005-2016) to identify patients completing an appendectomy. Cohorts of patients who were diagnosed with UA and an AN were included in the study. Relevant perioperative clinical and outcomes data were collected. Type of AN, surgical procedure, and mortality were analyzed. A total of 239,615 UA patients were identified, of whom 2,773 (1.2%) met the inclusion criteria of AN. Patients with AN were predominantly white (79.5%), with a mean age of 54.5 ± 15.9 years, and 54.6 per cent were females. AN pathology findings included malignant neoplasm (64.5%), malignant carcinoid (17.3%), benign carcinoid (9.3%), and benign neoplasm (8.8%). The overall reported incidence was 1.2 per cent and the mortality rate was 0.7 per cent. Our study emphasizes surgical intervention in adult UA maintains a 1 per cent incidence of AN, and treatment with antibiotics alone will presumably lead to a delay in surgical treatment and progression of disease.
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Pogorelic Z, Buljubasic M, Susnjar T, Jukic M, Pericic TP, Juric I. Comparison of Open and Laparoscopic Appendectomy in Children: A 5-year Single Center Experience. Indian Pediatr 2019; 56:299-303. [PMID: 31064898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the outcomes of treatment in children with acute appendicitis between laparoscopic and open surgical approaches. DESIGN Retrospective study. SETTING Division of Pediatric Surgery at a tertiary-care hospital in Croatia between January 2012 to December 2016. PATIENTS 834 children [median (IQR) age 13 (11,15)] who underwent appendectomy; 301 in the laparoscopic group and 533 in the open group. MAIN OUTCOME MEASURES Postoperative complications, duration of hospitalization, re-operation, and the quantity of analgesics used. RESULTS The median length of hospital stay was 3 days in laparoscopic group compared to 6 days in open group (P<0.001). The amount of analgesics used was lower in patients with laparoscopic appendectomy compared to patients who underwent open procedure (P=0.042). Significantly higher number of wound infections was recorded in the open group (n=21; 3.9%) compared to laparoscopic group (n=3; 1%) (P=0.014). The frequency of re-operation in both groups was equal (1.3%). The median duration of surgery was shorter in the group of patients with laparoscopic appendectomy compared to the open approach (30 vs. 45 min; P<0.001). In five-year period, the proportion of laparoscopic appendectomies increased by 21.5%. CONCLUSIONS Laparoscopic appendectomy was safe and effective in children. Advantages of laparoscopic approach were shorter hospital stay, lower number of wound infections and lower usage of analgesics.
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Affiliation(s)
- Zenon Pogorelic
- Department of Pediatric Surgery, University Hospital of Split and University of Split, School of Medicine, Croatia. Correspondence to: Dr Zenon Pogorelic, Department of Pediatric Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia.
| | | | - Tomislav Susnjar
- Department of Pediatric Surgery, University Hospital of Split, Croatia
| | - Miro Jukic
- Department of Pediatric Surgery, University Hospital of Split, Croatia
| | - Tina Poklepovic Pericic
- Department of Research in Biomedicine and Health, University of Split, School of Medicine; Croatia
| | - Ivo Juric
- Department of Pediatric Surgery, University Hospital of Split and University of Split, School of Medicine, Croatia
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Lai SW, Lin CL. Patients with appendectomy are at increased risk of herpes zoster: real-world data in Taiwan. Intern Emerg Med 2019; 14:329-330. [PMID: 30565081 DOI: 10.1007/s11739-018-2010-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Family Medicine, China Medical University Hospital, No. 2, Yu-De Road, Taichung, 404, Taiwan.
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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Kulvatunyou N, Zimmerman SA, Joseph B, Friese RS, Gries L, O'Keeffe T, Stroster JA, Tang AL. Risk Factors for Perforated Appendicitis in the Acute Care Surgery Era-Minimizing the Patient's Delayed Presentation Factor. J Surg Res 2019; 238:113-118. [PMID: 30769247 DOI: 10.1016/j.jss.2019.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Numerous factors contribute to advanced disease or increased complications in patients with acute appendicitis (AA). This study aimed to identify risk factors associated with AA perforation, including the effect of system time (ST) delay, after controlling for patient time (PT) delay. In this study, PT was controlled (to less than or equal to 24 h) to better understand the effect of ST delay on AA perforation. METHODS Medical records of patients who underwent surgery for AA at a tertiary referral hospital from October 2009 through September 2013 were reviewed. Data collected included demographics, body mass index, presence of fecalith, PT (i.e., duration of time from symptom onset to arrival in emergency department), and ST (i.e., duration of time from arrival in emergency department to operating room). AA was classified as simple (acute, nonperforated) versus advanced (gangrenous, perforated). RESULTS Seven hundred forty-seven patients underwent surgery for AA. After excluding patients with PT > 24 h, 445 patients fit the study criteria, of which 358 patients with simple AA and 87 patients with advanced disease. Advanced appendicitis patients were older and had higher body mass index, longer PT, higher WBC, and higher incidence of fecaliths. Both groups had similar ST. Risk factors for advanced appendicitis after multiple regression analysis are age >50 y old, WBC >15,000, the presence of fecaliths, and PT delay >12 h. CONCLUSIONS Once PT delay was limited to ≤24 h, the ST delay of >12 h did not adversely affect the incidence of advanced AA. Age >50 y, WBC >15,000, PT delay >12 h, and the presence of fecaliths were identified as risk factors associated with advanced AA.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Steven A Zimmerman
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
| | - Bellal Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S Friese
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Lynn Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - John A Stroster
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
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Buitrago G, Junca E, Eslava-Schmalbach J, Caycedo R, Pinillos P, Leal LC. Clinical Outcomes and Healthcare Costs Associated with Laparoscopic Appendectomy in a Middle-Income Country with Universal Health Coverage. World J Surg 2019; 43:67-74. [PMID: 30145672 DOI: 10.1007/s00268-018-4777-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although many studies have compared outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA), some clinical and economic outcomes continue to be controversial, particularly in low-medium-income countries. We aimed at determining clinical and economic outcomes associated with LA versus OA in adult patients in Colombia. METHODS Retrospective, cohort study based on administrative healthcare records included all patients who underwent LA or OA in Colombia's contributory regime between July 1, 2013, and September 30, 2015. Outcomes were 30-day mortality rates, ICU admissions rates, length of stay (LOS), and hospital costs provided until discharge. Propensity score matching techniques were used to balance the baseline characteristics of patients (age, sex, comorbidities based on the Charlson index, insurer, and geographic location) and to estimate the average treatment effect (ATE) of LA as compared to OA over outcomes. RESULTS A total of 65,625 subjects were included, 92.9% underwent OA and 7.1% LA. For the entire population, 30-day mortality was 0.74 per 100 appendectomies (95% CI 0.67-0.81), the mean and median LOS were 3.83 days and 1 day, respectively, and the ICU admissions rate during the first 30 days was 7.92% (95% CI 7.71-8.12). The ATE shows an absolute difference in the mortality rate after 30 days of -0.35 per 100 appendectomies (p = 0.023), in favor of LA. No effects on ICU admissions or LOS were identified. LA was found to increase costs by 514.13 USD on average, with total costs of 772.78 USD for OA and 1286.91 USD for LA (p < 0.001). CONCLUSIONS In Colombia's contributory regime, LA is associated with lower 30-day mortality rate and higher hospital costs as compared to OA. No differences are found in ICU admissions or LOS.
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Affiliation(s)
- Giancarlo Buitrago
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia.
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
| | - Edgar Junca
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Javier Eslava-Schmalbach
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Ruben Caycedo
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Pilar Pinillos
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Luis Carlos Leal
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
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Reiter AJ, Schlottmann F, Kajombo C, Gallaher J, Charles AG. Surgical Outcomes of Acute Appendicitis in High- Middle- and Low-Income Countries. Am Surg 2019; 85:e97-e99. [PMID: 30819316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Kim SY, Kim HJ, Lim H, Lim MS, Kim M, Choi HG. Increased risk of appendectomy in patients with gastroesophageal reflux disease: A nested case-control study using a national sample cohort. Medicine (Baltimore) 2018; 97:e13700. [PMID: 30593140 PMCID: PMC6314750 DOI: 10.1097/md.0000000000013700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study is to confirm and complement previous data regarding an association between gastroesophageal reflux disease and appendectomy.The Korean National Health Insurance Service-National Sample Cohort includes data from people ≥ 20 years old collected from 2002 to 2013. A total of 13,484 participants who received an appendectomy were matched with 53,936 controls at a 1:4 ratio. We analyzed the previous histories of gastroesophageal reflux disease (GERD) in the appendectomy and control groups. Appendectomies were identified using operation codes (Q2860-Q2863) exclusive for appendicitis (International Classification of Disease-10 (ICD-10): K35). GERD was defined using the ICD-10 (K21), and patients who were treated ≥ 2 times and were prescribed a proton pump inhibitor (PPI) for ≥ 2 weeks were included. Crude (simple) and adjusted odds ratios (ORs) for GERD and appendectomy were analyzed using conditional logistic regression analyses.A higher GERD rate was detected in the appendectomy group (11.4% [1,713/15,062]) than in the control group (8.2% [4,947/60,248], P < .001). Adjusted ORs for GERD were 1.37 (95% confidence interval [CI] = 1.30-1.45) (P < .001). Subgroup analyses stratified according to age and sex revealed consistent findings. The adjusted OR for GERD in participants prescribed PPIs for ≥ 30 days was 1.31 (95% CI = 1.20-1.43), and the adjusted OR for GERD in participants prescribed PPIs for ≥ 60 days was 1.30 (95% CI = 1.15-1.48).The Odds for GERD were higher in the appendectomy group than in the control group.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine
| | - Hyun Lim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang
| | - Man Sup Lim
- Department of General Surgery, Hallym University College of Medicine, Chuncheon
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine
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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; 84:1684-1690. [PMID: 30747695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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 nonoperative 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 nonoperative 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
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Al-Khyatt W, Mytton J, Tan BHL, Aquina CT, Evison F, Fleming FJ, Pasquali S, Griffiths EA, Vohra RS. A Population-Based Cohort Study of Emergency Appendectomy Performed in England and New York State. World J Surg 2018; 41:1975-1984. [PMID: 28299474 DOI: 10.1007/s00268-017-3981-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND To compare selected outcomes (30-day reoperation and total length of hospital stay) following emergency appendectomy between populations from New York State and England. METHODS This retrospective cohort study used demographic and in-hospital outcome data from Hospital Episode Statistics (HES) and the New York Statewide Planning and Research Cooperative System (SPARCS) administrative databases for all patients aged 18+ years undergoing appendectomy between April 2009 and March 2014. Univariate and adjusted multivariable logistic regression were used to test significant factors. A one-to-one propensity score matched dataset was created to compare odd ratios (OR) of reoperations between the two populations. RESULTS A total of 188,418 patient records, 121,428 (64.4%) from England and 66,990 (35.6%) from NYS, were extracted. Appendectomy was completed laparoscopically in 77.7% of patients in New York State compared to 53.6% in England (P < 0.001). The median lengths of hospital stay for patients undergoing appendectomy were 3 (interquartile range, IQR 2-4) days versus 2 (IQR 1-3) days (P < 0.001) in England and New York State, respectively. All 30-day reoperation rates were higher in England compared to New York State (1.2 vs. 0.6%, P < 0.001), representing nearly a twofold higher risk of 30-day reoperation (OR 1.88, 95% CI 1.64-2.14, P < 0.001). As the proportion of appendectomy completed laparoscopically increased, there was a reduction in the reoperation rate in England (correlation coefficient -0.170, P = 0.036). CONCLUSIONS Reoperations and total length of hospital stay is significantly higher following appendectomy in England compared to New York State. Increasing the numbers of appendectomy completed laparoscopically may decrease length of stay and reoperations.
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Affiliation(s)
- Waleed Al-Khyatt
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Jemma Mytton
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Yardley Court, 11-13 Frederick Road, Edgbaston, Birmingham, B15 1JD, UK
| | - Benjamin H L Tan
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Christopher T Aquina
- Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14610, USA
| | - Felicity Evison
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Yardley Court, 11-13 Frederick Road, Edgbaston, Birmingham, B15 1JD, UK
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14610, USA
| | - Sandro Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ewen A Griffiths
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Ravinder S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
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Zouari M, Louati H, Abid I, Trabelsi F, Ben Dhaou M, Jallouli M, Mhiri R. Enterobius vermicularis: A Cause of Abdominal Pain Mimicking Acute Appendicitis in Children. A Retrospective Cohort Study. Arch Iran Med 2018; 21:67-72. [PMID: 29664657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Enterobius vermicularis (EV) is the most common helminthic infection in the world. This small parasite is predominant in the pediatric population. The presence of EV in the appendix can cause or mimick appendicitis. The aim of our study was to compare patients with EV infection and those without EV infection, and to identify predictive factors that may help the diagnosis of EV infection in patients presenting with right iliac fossa pain and avoid negative appendectomy. METHODS A retrospective analysis of all the appendices removed between January 2012 and December 2016 was conducted at the department of pediatric surgery, Hedi Chaker Hospital, Sfax, Tunisia. According to the final histopathological diagnosis, patients with EV infection were compared to those without EV infection. Data including age, sex, white blood cell (WBC) count, neutrophil count, eosinophil count, C-reactive protein, and ultrasound results for both groups were analyzed and compared. The study protocol was approved by the local hospital ethics committee. Statistical analysis was performed using IBM SPSS, version 20. Descriptive analysis in the form of mean and standard deviation was performed on demographic information. Differences between groups were assessed using the student t-test for continuous variables and the χ2 test and Fisher exact test where appropriate for categorical variables. RESULTS In total, 540 pediatric appendectomies were performed. Overall, 63.5% of patients were male and 36.5% were female. Mean age was 9.28 ± 2.77 years. 22.2% of procedures were completed laparoscopically, 76.5% were open and 1.3% were converted. The negative appendectomy rate was 11.1%. EV was present in 9.8% of cases. Comparison of clinical, biological, and ultrasound findings between two groups of patients with EV (EV+) and those without EV (EV-) shows a statistical significance for pruritus ani (P < 0.001), WBC count (P < 0.001), neutrophil count (P < 0.001), C-reactive protein (CRP) (P = 0.001), positive ultrasound (P < 0.001), perforation rate (P = 0.009), and negative appendectomy rate (P < 0.001). No significant difference between the two groups was seen when comparing gender (P = 0.271), vomiting (P = 0.130), eosinophil count (P = 0.915), and procedure (P = 0.536). CONCLUSION EV was seen in 9.8% of pediatric appendectomies in our study. Pruritus ani, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain.
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Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Hamid Louati
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Imen Abid
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Fatma Trabelsi
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Mohamed Jallouli
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
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RIFT Study Group On behalf of the West Midlands Research Collaborative. Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study. BMJ Open 2018; 8:e017574. [PMID: 29331965 DOI: 10.1136/bmjopen-2017-017574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy). The primary aim of this study is to determine the contemporary negative appendicectomy rate. The study's secondary aims are to determine the rate of laparoscopy for appendicitis and to validate the Appendicitis Inflammatory Response (AIR) and Alvarado prediction scores. METHODS AND ANALYSIS This multicentre, international prospective observational study will include all patients referred to surgical specialists with either RIF pain or suspected appendicitis. Consecutive patients presenting within 2-week long data collection periods will be included. Centres will be invited to participate in up to four data collection periods between February and August 2017. Data will be captured using a secure online data management system. A centre survey will profile local policy and service delivery for management of RIF pain. ETHICS AND DISSEMINATION Research ethics are not required for this study in the UK, as determined using the National Research Ethics Service decision tool. This study will be registered as a clinical audit in participating UK centres. National leads in countries outside the UK will oversee appropriate registration and study approval, which may include completing full ethical review. The study will be disseminated by trainee-led research collaboratives and through social media. Peer-reviewed publications will be published under corporate authorship including 'RIFT Study Group' and 'West Midlands Research Collaborative'.
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Gurien LA, Burford JM, Bonasso PC, Dassinger MS. Resource savings and outcomes associated with outpatient laparoscopic appendectomy for nonperforated appendicitis. J Pediatr Surg 2017; 52:1760-1763. [PMID: 28347529 DOI: 10.1016/j.jpedsurg.2017.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative admission for acute appendicitis utilizes health care system resources. We evaluated outcomes and hospital charges for children with nonperforated appendicitis who underwent outpatient laparoscopic appendectomy. METHODS A retrospective chart review was performed for patients ≤18years old who underwent laparoscopic appendectomy for acute appendicitis in 2015. Patients were categorized into discharge from postanesthesia care unit (PACU) (outpatient), admission for <24-h, and admission for >24-h. Continuous variables were compared using analysis of variance and categorical variables were compared using chi-square test, with p<0.05 considered significant. RESULTS Of the 171 patients identified, 63 (37%) were discharged from the PACU, 94 (55%) were admitted <24-h, and 14 (8%) were admitted >24-h. There were no differences in postoperative emergency department/clinic visits, complications, or readmissions. Hospital charges for admission <24-h and >24-h were $1007 and $2237 more per patient than the PACU-discharge group, respectively. Outpatient laparoscopic appendectomies became more common over time, occurring in only 20% of patients with acute appendicitis in the first quarter of the year versus 49% of patients in the last quarter. CONCLUSION Outpatient laparoscopic appendectomy for nonperforated appendicitis in children is a safe practice that decreases length of stay and hospital charges. Adoption of an outpatient strategy allows for better standardization of care and can lead to savings in health care resources. LEVEL OF EVIDENCE III (Treatment: retrospective comparative study).
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Affiliation(s)
- Lori A Gurien
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA; Department of Pediatric Surgery, Arkansas Children's Hospital Research Institute, 13 Children's Way, Little Rock, AR 72202, USA.
| | - Jeffrey M Burford
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA
| | - Patrick C Bonasso
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA; Department of Pediatric Surgery, Arkansas Children's Hospital Research Institute, 13 Children's Way, Little Rock, AR 72202, USA
| | - Melvin S Dassinger
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA
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Sarda S, Short HL, Hockenberry JM, McCarthy I, Raval MV. Regional variation in rates of pediatric perforated appendicitis. J Pediatr Surg 2017; 52:1488-1491. [PMID: 28259382 DOI: 10.1016/j.jpedsurg.2017.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND While trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown. METHODS A retrospective, cross-sectional analysis of the 2006-2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications. RESULTS National PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (p<0.001), where the increase in rates between 2009 and 2012 was only statistically significant in the Midwest [Odds Ratio (OR) 1.07; 95% Confidence Interval (95%CI) 1.03-1.12] and West (OR 1.10; 95% CI 1.07-1.14). The Northeast consistently experienced the lowest PA rates. The odds of PA were highest among uninsured patients (OR 1.35; 95% CI 1.31-1.29). The South had the highest proportion of uninsured children, and these patients had the highest odds of perforation (OR 1.57; 95% CI 1.21-2.02). CONCLUSIONS For children with appendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape. LEVELS OF EVIDENCE RATING Level III Treatment Study - Retrospective comparative study of appendicitis presentation in children by region of the country.
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Affiliation(s)
- Samir Sarda
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Heather L Short
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jason M Hockenberry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ian McCarthy
- Deparment of Economics, Emory University, Atlanta, GA, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Shaughnessy AF. Antibiotics May Equal Surgery for Children with Appendicitis. Am Fam Physician 2017; 95:737. [PMID: 28671432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Kurien M, Sanders DS, Ekbom A, Ciacci C, Ludvigsson JF. Increased rate of abdominal surgery both before and after diagnosis of celiac disease. Dig Liver Dis 2017; 49:147-151. [PMID: 27765577 DOI: 10.1016/j.dld.2016.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The detection of celiac disease (CD) is suboptimal. AIMS We hypothesized that misdiagnosis is leading to diagnostic delays, and examine this assertion by determining if patients have increased risk of abdominal surgery before CD diagnosis. METHODS Through biopsy reports from Sweden's 28 pathology departments we identified all individuals with CD (Marsh stage 3; n=29,096). Using hospital-based data on inpatient and outpatient surgery recorded in the Swedish Patient Register, we compared abdominal surgery (appendectomy, laparotomy, biliary tract surgery, and uterine surgery) with that in 144,522 controls matched for age, sex, county and calendar year. Conditional logistic regression estimated odds ratios (ORs). RESULTS 4064 (14.0%) individuals with CD and 15,760 (10.9%) controls had a record of earlier abdominal surgery (OR=1.36, 95% CI=1.31-1.42). Risk estimates were highest in the first year after surgery (OR=2.00; 95% CI=1.79-2.22). Appendectomy, laparotomy, biliary tract surgery, and uterine surgery were all associated with having a later CD diagnosis. Of note, abdominal surgery was also more common after CD diagnosis (hazard ratio=1.34; 95% CI=1.29-1.39). CONCLUSIONS There is an increased risk of abdominal surgery both before and after CD diagnosis. Surgical complications associated with CD may best explain these outcomes. Medical nihilism and lack of CD awareness may be contributing to outcomes.
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Affiliation(s)
- Matthew Kurien
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Anders Ekbom
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carolina Ciacci
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Shirah BH, Shirah HA, Alhaidari WA, Elraghi MA, Chughtai MA. The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate. Abdom Radiol (NY) 2017; 42:109-114. [PMID: 27503383 DOI: 10.1007/s00261-016-0862-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The diagnosis of acute appendicitis is mainly clinical and is correct in about 80% of patients, but 20-33% present with atypical findings, which resulted in a negative appendectomy rate of 20-30%. The graded compression ultrasound method in the diagnosis of acute appendicitis was reported with a sensitivity of 89%, and specificity of 95%. In this study, we aim to evaluate the graded compression ultrasonography in the diagnosis of acute appendicitis, its influence on the clinical judgment to operate, and its role in lowering the negative appendectomy rate. METHODS 1073 patients treated surgically for acute appendicitis between January 2005 and December 2014 were reviewed. Ultrasound findings, histopathological diagnosis, and positive or negative appendectomy rates were analyzed. RESULTS 647 (60.3%) patients were males and 426 (39.7%) females. The mean age was 26.5 years. Positive ultrasound findings were recorded in 892 (83.13%), while negative findings were recorded in 181 (16.87%). Positive appendectomy was recorded in 983 (91.6%), while negative appendectomy was recorded in 90 (8.4%). The sensitivity was 83%, specificity was 100%, and the rate of negative appendectomy was 8.39%. CONCLUSION Graded compression technique of ultrasound is a useful modality, in addition to the clinical judgment of the surgeon and clinical findings, in detecting true positive cases of acute appendicitis, and thus reducing the negative appendectomy rate. Values of 100% specificity, and 8.4% negative appendectomy rate, or better, could be achieved, when an experienced surgeon and a professional radiologist collaborate in the diagnosis of acute appendicitis.
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Affiliation(s)
- Bader Hamza Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, P.O.Box 65362, Jeddah, 21556, Saudi Arabia.
| | - Hamza Asaad Shirah
- Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia
| | - Wael Awad Alhaidari
- Department of Accidents and Emergency, Al Ansar General Hospital, Medina, Saudi Arabia
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42
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Kinderchirurgen fordern Nachbesserung der Studie. Kinderkrankenschwester 2016; 35:429. [PMID: 30387947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Lee J, Ko Y, Ahn S, Park JH, Kim HJ, Hwang SS, Lee KH. Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: A post-hoc analysis using propensity-score methods. J Clin Ultrasound 2016; 44:401-410. [PMID: 26990317 DOI: 10.1002/jcu.22351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/03/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To retrospectively compare ultrasound (US) and CT as the preoperative first-line imaging modality in terms of negative appendectomy rate (NAR) and appendiceal perforation rate (APR) in adolescents and adults with suspected appendicitis. METHODS We included 2,030 patients in 11 sites who underwent appendectomy following US (n = 102) or CT (n = 1,928). Propensity-score (PS) adjusted and matched comparisons were conducted. Matching was performed with 1:1 and 1:3 ratios. Secondary analyses were performed by adding appendiceal perforation to PS model. RESULTS The unadjusted NAR difference between the unmatched US and CT groups (8% [8/102] versus 3.8% [73/1,928]) was 4.1 percentage points (95% confidence interval, -1.2, -9.3; p = 0.133). The PS adjusted difference was 4.1 percentage points (-1.8, -10.0; p = 0.169). The differences after 1:1 (9% [8/94] versus 5% [5/94]) and 1:3 (9% [8/94] versus 3.0% [8/271]) matching were 3 (-4, -10, p = 0.39) and 5.6 (-0.4, -11.6, p = 0.069) percentage points, respectively. The unadjusted APR difference between the unmatched US and CT groups (22% [22/102] versus 23.8% [459/1,928]) was -2.2 percentage points (-10.4, -6.0; p = 0.59). The PS-adjusted difference was -5.2 percentage points (-13.3, -2.9; p = 0.21). The differences after 1:1 (19% [18/94] versus 24% [23/94]) and 1:3 (19% [18/94] versus 20.7% [56/271]) matching were -5 (-17, -6, p = 0.38) and -1.5 (-10.8, -7.8, p = 0.75) percentage points, respectively. CONCLUSIONS The use of US instead of CT may increase NAR but does not significantly affect APR. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:401-410, 2016.
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Affiliation(s)
- Jaebong Lee
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Yousun Ko
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Abegunde AT, Muhammad BH, Bhatti O, Ali T. Environmental risk factors for inflammatory bowel diseases: Evidence based literature review. World J Gastroenterol 2016; 22:6296-6317. [PMID: 27468219 PMCID: PMC4945988 DOI: 10.3748/wjg.v22.i27.6296] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/19/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: Advances in genetics and immunology have contributed to the current understanding of the pathogenesis of inflammatory bowel diseases (IBD).
METHODS: The current opinion on the pathogenesis of IBD suggests that genetically susceptible individuals develop intolerance to dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental insults. Environmental exposures are innumerable with varying effects during the life course of individuals with IBD. Studying the relationship between environmental factors and IBD may provide the missing link to increasing our understanding of the etiology and increased incidence of IBD in recent years with implications for prevention, diagnosis, and treatment. Environmental factors are heterogeneous and genetic predisposition, immune dysregulation, or dysbiosis do not lead to the development of IBD in isolation.
RESULTS: Current challenges in the study of environmental factors and IBD are how to effectively translate promising results from experimental studies to humans in order to develop models that incorporate the complex interactions between the environment, genetics, immunology, and gut microbiota, and limited high quality interventional studies assessing the effect of modifying environmental factors on the natural history and patient outcomes in IBD.
CONCLUSION: This article critically reviews the current evidence on environmental risk factors for IBD and proposes directions for future research.
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Epifanio M, Antonio de Medeiros Lima M, Corrêa P, Baldisserotto M. An Imaging Diagnostic Protocol in Children with Clinically Suspected Acute Appendicitis. Am Surg 2016; 82:390-396. [PMID: 27215717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of the present study is to evaluate a new diagnostic strategy using clinical findings followed by ultrasound (US) and, in selected cases, MRI. This study included 166 children presenting signs and symptoms suggesting acute appendicitis. Cases classified as suggesting appendicitis according to clinical exams had to be referred to surgery, whereas the other cases were discharged. Unclear cases were evaluated using US. If the US results were considered inconclusive, patients underwent MRI. Of the 166 patients, 78 (47%) had acute appendicitis and 88 (53%) had other diseases. The strategy under study had a sensitivity of 96 per cent, specificity of 100 per cent, positive predictive value of 100 per cent, negative predictive value of 97 per cent, and accuracy of 98 per cent. Eight patients remained undiagnosed and underwent MRI. After MRI two girls presented normal appendixes and were discharged. One girl had an enlarged appendix on MRI and appendicitis could have been confirmed by surgery. In the other five patients, no other sign of the disease was detected by MRI such as an inflammatory mass, free fluid or an abscess in the right iliac fossa. All of them were discharged after clinical observation. In the vast majority of cases the correct diagnosis was reached by clinical and US examinations. When clinical assessment and US findings were inconclusive, MRI was useful to detect normal and abnormal appendixes and valuable to rule out other abdominal pathologies that mimic appendicitis.
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Affiliation(s)
- Matias Epifanio
- School of Medicine and Graduate School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Yıldız I, Koca Y. Is There An Ideal Stump Closure Technique In Laparoscopic Appendectomy? Surg Technol Int 2016; 28:117-120. [PMID: 27121413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND There is no standard routine closure technique in the management of appendiceal stump. Therefore, the ideal method should be determined based on the condition of the radix of the appendix. AIM The aim of this study was to evaluate appendiceal stump closure methods in patients undergoing laparoscopic appendectomy due to acute appendicitis. MATERIALS AND METHODS The retrospective study included 196 patients who underwent laparoscopic appendectomy due to the diagnosis of acute appendicitis at Gazipasa State Hospital, Golhisar State Hospital, and Isparta State Hospital between 2009 and 2013. The methods performed for the closure of the appendiceal stump included stapler closure technique (Group I), ENDOLOOP® (Johnson & Johnson Inc., New Brunswick, New Jersey) technique (Group II), Hem-o-lok® (Teleflex®, Limerick, Pennsylvania) clip (Group III), and handmade endo-loop technique (Group IV). The groups were compared in terms of duration of surgery, length of hospital stay, postoperative pain, complication rates, and cost of treatment. RESULTS No significant difference was observed among the groups in terms of patient characteristics. In eight patients, laparoscopic appendectomy was converted to open surgery due to various reasons. Mean length of hospital stay was two days in all of the groups that underwent laparoscopic appendectomy. No significant difference was found among the groups in terms of duration of surgery, complications, and postoperative analgesic requirement, but a significant difference was observed in terms of the cost of treatment. CONCLUSIONS We suggest that the handmade endo-loop technique is a safe, applicable, and cost-effective method to be used in the closure of appendiceal stump.
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Affiliation(s)
- Ihsan Yıldız
- Department of General Surgery, Suleyman Demirel University Medical School, Isparta, Turkey
| | - Yavuz Koca
- Department of General Surgery, Suleyman Demirel University Medical School, Isparta, Turkey
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Assefa Z. MANAGEMENT OF INFLAMMATORY APPENDICEAL MASS IN ZEWDITU MEMORIAL HOSPITAL, ADDIS ABABA, ETHIOPIA. Ethiop Med J 2016; 54:57-62. [PMID: 27476224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Appendiceal mass is one of the complications of acute appendicitis. The management of patients with appendiceal mass is controversial and different treatment options have been suggested. OBJECTIVE The objective of this study was to assess the results of conservative management of patients with appendiceal mass followed by interval appendicecomy. METHODS The study was a retrospective analysis of 73 medical records of patients with appendiceal mass who were managed conservatively between March 2007 and February 2014. RESULTS Fifty patients were males and 23 patients were females making the male to female ratio of 2.2:1. The mean age was 29.6 ± 6.3 years (range 12-68 years). The maximum incidence was in the 3rd decade. Forty one (55.8%) of the patients presented one week or more after the onset of their illness. Abdominal pain, right lower quadrant (RLQ) direct and rebound tenderness were observed in all patients. Mass was detected in the RLQ in 84.9% of the patients. Sixty five patients (89%) responded to conservative treatment and these patients were discharged after a mean hospital stay of 6.5 1.5 days (range 3-12 days). Interval appendicectomy was done for 58 patients 8-16 weeks after successful conservative management. The mean hospital stay after interval appendicectomy was 3.5 ± 0.5 days with a range of 2-5 days. One patient (1.7%) had a wound infection. There were no deaths. CONCLUSION Initial non-operative management of appendiceal mass was successful in most cases and the complication rate after interval appendicecomy seems lower than with early operative treatment.
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Soder BL, Dart BW, Stanley JD. Appendicitis--Current Practices in a Tertiary Referral Center. Am Surg 2016; 82:E45-E46. [PMID: 26874123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Brent L Soder
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee, USA
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Cosyns S, Polyzos NP, Carprieaux M, Tournaye H, De Sutter P. The role of appendectomy as part of the treatment of a mucinous borderline ovarian tumor. EUR J GYNAECOL ONCOL 2016; 37:167-170. [PMID: 27172739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Guidelines in surgical treatment of mucinous ovarian neoplasms recommend the use of appendectomy as a measure to rule out a primary appendiceal origin of the ovarian tumor and proper staging. In extension this guideline is also applied for mucinous borderline ovarian tumors (mBOTs). As borderline ovarian tumors (BOTs) are often diagnosed postoperatively, most patients must undergo a second surgery to add appendectomy and staging to their surgical treatment. OBJECTIVE To assess the role of appendectomy as part of the surgical treatment of mucinous BOTs. MATERIALS AND METHODS A retrospective single institute based study was carried out. The authors evaluated the clinical charts of patients undergoing surgical treatment by a gynecologic oncologist in their institution for a mucinous BOT between January 1990 and January 2014. RESULTS Twenty-seven patients were included. Appendectomy was performed in 30% of patients during primary or secondary surgical treatment. No appendiceal carcinoma was identified in any of the cases. Five patients already had a previous appendectomy. In eight patients the appendix was described as normal during surgery and left in place. For six patients the authors did not retrieve any information on previous appendectomy neither on the intraoperative state of the appendix. In the present overall study population, 78% showed no appendiceal involvement. For the remaining patients this information was missing. CONCLUSIONS Secondary appendectomy to rule out a primary appendiceal origin of the mucinous BOT should not be performed when the appendix is described as grossly normal during primary laparoscopic surgery.
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Casadei R, Angeli G, Casucci P, Minelli L, Pasquini R. [Use Of Hospital Services By The Immigrant Population In Umbria, Italy]. Ig Sanita Pubbl 2016; 72:9-25. [PMID: 27077557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to identify possible inequalities in the quality of health care services for the management of conditions such as cardiovascolar diseases, psychiatric disorders, appendectomy, and hysterectomy, offered to the immigrant population in the Umbria region (central Italy). Hospital discharge data covering the period 2009-2012 were analysed and crude and standardized hospitalization rates per 100,000 calculated. Immigrants were found to have an increased risk of undergoing procedures such as appendectomy and hysterectomy for benign disease, indicating a greater degree of nonappropriateness in this category of users. In the young immigrant population, admissions were mainly due to reproductive health problems in women, and injuries/trauma in men. The results of this study confirm that, despite regional efforts to reduce social inequalities and consequently inequalities in health, through regional legislation, information to the population, training of healthcare personnel, and cultural mediation, some inequalities are present in the quality of health care delivered to foreign-born persons in the region. Hence, there is a need to strengthen information campaigns for immigrants, to keep them informed of their rights, and to strengthen training courses among healthcare and social workers.
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Affiliation(s)
- Riccardo Casadei
- Sezione di Sanità Pubblica - Dipartimento di Medicina Sperimentale, Centro Sperimentale per la Promozione della salute e l'educazione sanitaria - Università degli Studi di Perugia, Italia
| | - Giuseppe Angeli
- Sezione di Sanità Pubblica - Dipartimento di Medicina Sperimentale, Centro Sperimentale per la Promozione della salute e l'educazione sanitaria - Università degli Studi di Perugia, Italia
| | - Paola Casucci
- Direzione Regionale Coesione sociale e Welfare, Servizio Mobilità sanitaria e gestione Sistema informativo sanitario e sociale - Regione Umbria, Italia
| | - Liliana Minelli
- Sezione di Sanità Pubblica - Dipartimento di Medicina Sperimentale, Centro Sperimentale per la Promozione della salute e l'educazione sanitaria - Università degli Studi di Perugia, Italia
| | - Rossana Pasquini
- Dipartimento di Filosofia, Scienze Sociali, Umane e della Formazione - Università degli Studi di Perugia, Italia
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