Nonoperative Treatment of Diverticulitis and Appendicitis: Which Antibiotic Regimen Fails?

INTRODUCTION

Diverticulitis and appendicitis are common emergency general surgical conditions. Both can be treated with antibiotics alone; however, no antibiotic regimen has been identified as superior to others. In this study, we review different antibiotic regimens and their rates of failure.

METHODS

Retrospective cohort study of patients treated empirically with antibiotics for diverticulitis or appendicitis from January 1, 2018, to December 31, 2020, at an independent academic hospital in the Midwest.

RESULTS

A total of 587 (appendicitis, n = 43; diverticulitis, n = 544) patients were included in the cohort. They were equally male (49%) and female (51%) with a median age of 59 y. Three major antibiotic classes were compared: cephalosporin + metronidazole (C + M), penicillins, and quinolone + metronidazole. Appendicitis patients were more likely to receive C + M for empiric treatment (73%, P < 0.001), while diverticulitis patients were more likely to receive quinolone + metronidazole (45%, P < 0.001). Patients empirically treated with antibiotics for appendicitis were more likely than those treated for diverticulitis to require additional antibiotics or procedure within 90 d (33% versus 13%, respectively; P = 0.005). Empiric treatment with C + M for diverticulitis was more likely to be associated with the need for additional antibiotics or procedures within 90 d than treatment with other regimens (P = 0.003). Choice of antibiotic for empiric treatment did not correlate with death at 90 d for appendicitis or diverticulitis. Diverticulitis patients who were initially treated as inpatients and were prescribed C + M at hospital discharge had a higher rate of death than those who were prescribed the other antibiotics (P = 0.04).

CONCLUSIONS

Empiric antibiotic treatment of appendicitis is more likely to be associated with additional antibiotics or procedure when compared with diverticulitis; however, antibiotic choice did not correlate with any of the other outcomes. Empiric treatment with a C + M for diverticulitis was more likely to be correlated with the need for additional antibiotics or procedure within 90 d.

Health care costs for adolescents and young adults with cancer: a Wisconsin community-based hospital study between 2005 and 2020

INTRODUCTION

Adolescents and young adults (AYA) with cancer are at risk of high cumulative healthcare system costs potentially associated with poor health and financial outcomes. Although this has been studied at academic centers, little data on AYA costs at community-based practices exist. The goals of this study were to understand direct health care costs for AYA patients, identify factors for high costs, and assess how total health care costs may relate to survival.

METHODS

AYA patients (15-39 years) treated at a community hospital in Wisconsin (USA) between 2005 and 2020 were identified. Patient demographics, cancer characteristics, therapies, support services, and all direct health care charges (including up to 1 year prior to diagnosis to capture any diagnostic workup) were collected. Logistic and Cox proportional hazard regression models identified factors associated with high costs and survival, respectively.

RESULTS

The 388 AYA patients had a median follow-up of 9 years (97% survival). Most were 30-39 years (62%), female (61%), white (95%), diagnosed early-stage (85%), and underwent surgery (83%). Complete health care costs were available for 233 patients (60%). Median total costs per patient were $123 K (range, $73-$215 K). On adjusted analysis, higher direct health care costs (> $125 K) were associated with greater odds of hospital admissions (odds ratio [OR] = 1.7, 95% CI = 1.35-2.27), chemotherapy (OR = 4.1, 95% CI = 1.44-12.70), and breast cancer diagnosis (OR = 3.8, 95% CI = 1.07-14.70). Living farther from the hospital (OR = 0.1, 95% CI = 0.02-0.50), later year of diagnosis (OR = 0.7, 95% CI = 0.55-0.77), and uninsured/unknown insurance status (OR = 0.1, 95% CI = 0.01-0.57) were associated with decreased odds of having higher health care costs. On adjusted analysis, death was associated with greater odds of higher direct health care costs per $125 K (hazards ratio [HR] = 7.9, 95% CI = 2.22-27.80) and radiation (HR = 31.8, 95% CI = 3.15-321) but lower odds of hormone therapy (HR = 0.1, 95% CI = 0.01-0.72) and later year of diagnosis (HR = 0.3, 95% CI = 0.12-0.60).

CONCLUSION

High direct health care costs among AYA patients are associated with hospital admissions, chemotherapy, breast cancer diagnosis, hospital proximity, and earlier year of diagnosis. Death was associated with high direct health care costs, earlier years of diagnosis, and radiation therapy. Total health care costs in community-based hospitals should be considered in the context of AYA patients with cancer.

Health care costs among adolescent young adults with cancer at a community-based hospital

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Background: Adolescent Young Adults (AYAs) are likely to live for decades after a cancer diagnosis and thus have the potential to accumulate high healthcare costs. Prior research has shown high costs can be associated with increased risk of morbidity and mortality. However, there is limited understanding of how costs impact AYAs, especially in a community hospital. The purpose of this study is to 1) understand total community hospital healthcare costs for AYA patients with cancer, 2) identify risk factors for high costs, and 3) assess the impact of costs on survival. Methods: AYA patients (ages 15-29) treated at a community hospital were identified. Data collected included patient demographics, cancer characteristics, treatments (chemotherapy, radiation, surgery, immunotherapy, hormone therapy), support services (financial counseling, social work, survivorship), hospital admissions, miles from the hospital (great-circle distance), and all healthcare charges from one year prior to cancer diagnosis until last follow-up between 2000-2020. Multivariate logistic regression analyses were used to identify patients with costs greater than the median ($125K). Cox Proportional Hazard (CPH) regression models were used to identify factors associated with the risk of all-cause mortality. Results: A total of 388 AYA patients were identified with a median follow-up of 9 years and 97% survival. Most patients were age 30-39 years (62%), female (61%), white (95%), married (63%), non-smoker (59%), had insurance (78%), had early-stage cancer (85%), and were treated with surgery (83%). The most common cancers were melanoma (17%), breast cancer (14%), and thyroid cancer (14%). Median distance from treatment site was 23 miles. Median number of admissions was one. About a third of patients received chemotherapy (37%), radiation (28%), or hormone therapy (30%). Two-hundred thirty-three patients (60%) had complete healthcare cost data with a median total costs per patient of $123K (range, $73K-$215K). In adjusted analysis, patients with higher than median healthcare cost ( > $125K) had greater odds of hospital admission (odds ratio [OR] = 1.5, p < .001) and chemotherapy treatment (OR = 3.4, p = .005) as well as lower odds of living further from the hospital per one mile (OR = 0.3, p = .049) and being uninsured/unknown insurance (OR = 0.1, p = .047). In adjusted analysis, increased risk of death was associated with receiving radiation therapy (HR = 7.8, p = .02) and higher healthcare costs per $125K (HR = 3.8, p = .001). Conclusions: High costs of healthcare among AYA patients with cancer are related to chemotherapy, hospital admissions, and hospital proximity. High healthcare costs and radiation therapy may be associated with increased risk of death in the AYA population. This data may guide physician decision making for AYA patients ensuring mindfulness of high costs of care and how it relates to poor survival outcomes in community hospitals.

The 67P/Churyumov-Gerasimenko observation campaign in support of the Rosetta mission

We present a summary of the campaign of remote observations that supported the European Space Agency's Rosetta mission. Telescopes across the globe (and in space) followed comet 67P/Churyumov-Gerasimenko from before Rosetta's arrival until nearly the end of the mission in September 2016. These provided essential data for mission planning, large-scale context information for the coma and tails beyond the spacecraft and a way to directly compare 67P with other comets. The observations revealed 67P to be a relatively 'well-behaved' comet, typical of Jupiter family comets and with activity patterns that repeat from orbit to orbit. Comparison between this large collection of telescopic observations and the in situ results from Rosetta will allow us to better understand comet coma chemistry and structure. This work is just beginning as the mission ends-in this paper, we present a summary of the ground-based observations and early results, and point to many questions that will be addressed in future studies.This article is part of the themed issue 'Cometary science after Rosetta'.

The impact and recovery of asteroid 2008 TC(3)

In the absence of a firm link between individual meteorites and their asteroidal parent bodies, asteroids are typically characterized only by their light reflection properties, and grouped accordingly into classes. On 6 October 2008, a small asteroid was discovered with a flat reflectance spectrum in the 554-995 nm wavelength range, and designated 2008 TC(3) (refs 4-6). It subsequently hit the Earth. Because it exploded at 37 km altitude, no macroscopic fragments were expected to survive. Here we report that a dedicated search along the approach trajectory recovered 47 meteorites, fragments of a single body named Almahata Sitta, with a total mass of 3.95 kg. Analysis of one of these meteorites shows it to be an achondrite, a polymict ureilite, anomalous in its class: ultra-fine-grained and porous, with large carbonaceous grains. The combined asteroid and meteorite reflectance spectra identify the asteroid as F class, now firmly linked to dark carbon-rich anomalous ureilites, a material so fragile it was not previously represented in meteorite collections.

Deep Impact: observations from a worldwide Earth-based campaign

On 4 July 2005, many observatories around the world and in space observed the collision of Deep Impact with comet 9P/Tempel 1 or its aftermath. This was an unprecedented coordinated observational campaign. These data show that (i) there was new material after impact that was compositionally different from that seen before impact; (ii) the ratio of dust mass to gas mass in the ejecta was much larger than before impact; (iii) the new activity did not last more than a few days, and by 9 July the comet's behavior was indistinguishable from its pre-impact behavior; and (iv) there were interesting transient phenomena that may be correlated with cratering physics.