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Islam T, Sagor MS, Tamanna NT, Bappy MKI, Danishuddin, Haque MA, Lackner M. Exploring the Immunological Role of the Microbial Composition of the Appendix and the Associated Risks of Appendectomies. J Pers Med 2025; 15:112. [PMID: 40137428 PMCID: PMC11943658 DOI: 10.3390/jpm15030112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 03/05/2025] [Accepted: 03/10/2025] [Indexed: 03/27/2025] Open
Abstract
The appendix, an integral part of the large intestine, may serve two purposes. First of all, it is a concentration of lymphoid tissue that resembles Peyer's patches. It is also the main location in the body for the creation of immunoglobulin A (IgA), which is essential for controlling intestinal flora's density and quality. Second, the appendix constitutes a special place for commensal bacteria in the body because of its location and form. Inflammation of the appendix, brought on by a variety of infectious agents, including bacteria, viruses, or parasites, is known as appendicitis. According to a number of studies, the consequences of appendectomies may be more subtle, and may relate to the emergence of heart disease, inflammatory bowel disease (IBD), and Parkinson's disease (PD), among other unexpected illnesses. A poorer prognosis for recurrent Clostridium difficile infection is also predicted by the absence of an appendix. Appendectomies result in gut dysbiosis, which consequently causes different disease outcomes. In this review, we compared the compositional differences between the appendix and gut microbiome, the immunological role of appendix and appendix microbiome (AM), and discussed how appendectomy is linked to different disease consequences.
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Affiliation(s)
- Tarequl Islam
- Department of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh; (T.I.); (M.K.I.B.)
| | - Md Shahjalal Sagor
- Department of Microbiology, Jagannath University, Dhaka 1100, Bangladesh;
| | - Noshin Tabassum Tamanna
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali 3814, Bangladesh;
| | - Md Kamrul Islam Bappy
- Department of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh; (T.I.); (M.K.I.B.)
| | - Danishuddin
- Department of Biotechnology, Yeungnam University, Gyeongsan, 38541, Republic of Korea;
| | - Md Azizul Haque
- Department of Biotechnology, Yeungnam University, Gyeongsan, 38541, Republic of Korea;
| | - Maximilian Lackner
- Department of Industrial Engineering, University of Applied Sciences Technikum Wien, Hoechstaedtplatz 6, 1200 Vienna, Austria
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Salö M, Tiselius C, Rosemar A, Öst E, Sohlberg S, Andersson RE. Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children. BJS Open 2025; 9:zrae165. [PMID: 40203150 PMCID: PMC11980984 DOI: 10.1093/bjsopen/zrae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/19/2024] [Accepted: 12/15/2024] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Acute appendicitis is one of the most common causes of acute abdominal pain. Differences in the management of this large group of patients has important consequences for the patients and the healthcare system. Controversies regarding the understanding of the natural course of the disease, the utility of new diagnostic methods, and alternative treatments have lead to large variations in practice patterns between centres. These national guidelines present evidence-based recommendations aiming at a uniform, safe and cost-efficient management of this large group of patients. METHOD A working group of six experts with broad clinical and research experience was formed. Additional expertise from outside was consulted during the process. A national survey revealed significant variations in the management of patients with suspicion of appendicitis. The evidence provided in published guidelines and reviews were extracted and systematically graded, according to the GRADE methodology. This was supplemented by additional more recent and more directed search of the literature. Patients treated for appendicitis were involved through interviews. The guidelines were reviewed by external experts before the final version was determined. RESULTS The guidelines cover an extensive number of issues: pathology, epidemiology, aetiology, natural history, clinical and laboratory diagnosis, diagnostic scoring systems, diagnostic imaging, treatment, nursing care, follow-up, quality registers and quality indicators, among others. Special considerations related to children and pregnant women are covered. CONCLUSION These national guidelines present an extensive and thorough review of the current knowledge base related to appendicitis, and provide up-to-date evidence-based recommendations for the management of this large group of patients.
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Affiliation(s)
- Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Catarina Tiselius
- Department of Surgery, Västmanland Hospital Västerås, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anders Rosemar
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elin Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Sohlberg
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Roland E Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Futurum Academy for Health and Care, Jönköping County Council, Jönköping, Sweden
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Henriksen SR, Rosenberg J, Fonnes S. European surgical societies rarely have recommendations for the treatment of appendicitis - a survey. Eur J Trauma Emerg Surg 2025; 51:64. [PMID: 39856349 DOI: 10.1007/s00068-024-02704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 10/24/2024] [Indexed: 01/27/2025]
Abstract
PURPOSE Guidelines for management and treatment of appendicitis recommends the removal of a normal-looking appendix, but the recommendations are deemed as weak because they are based on low quality evidence. We aimed to provide an overview of the recommendations from the European societies or associations of surgeons regarding the treatment of acute appendicitis and especially recommendations for the macroscopically normal-looking appendix. METHODS European surgical societies were contacted and sent an electronic questionnaire. Questions concerned if the association had a national guideline or recommended an existing one, and if they recommended a specific approach for the management of the normal-looking appendix, including who decided to remove the appendix. RESULTS We contacted surgical societies from 28 European countries, and 17 surgical societies (61%) responded. Two societies had a national guideline for the treatment of appendicitis and one of these addressed how to treat the normal-looking appendix. Most societies (59%) answered that the operating surgeon decided whether to remove the normal-looking appendix. Eleven societies recommended using an existing guideline (65%), four societies (24%) did not recommend a guideline, and two societies did not know. CONCLUSION Only two surgical societies had a published national recommendation or guideline on the treatment of suspected appendicitis, only one had a guideline for the management of the normal-looking appendix, and most societies answered that the operating surgeon decided.
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Affiliation(s)
- Siri Rønholdt Henriksen
- Centre for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, DK-2730, Denmark.
| | - Jacob Rosenberg
- Centre for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, DK-2730, Denmark
| | - Siv Fonnes
- Centre for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, DK-2730, Denmark
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Lin D, Su M, Guo Z, Hu J, Zhong Q, Chen Y, Deng J, Guo X. Direct visualization endoscopic retrograde appendicitis therapy for treatment of acute uncomplicated appendicitis. Surg Endosc 2024; 38:6156-6160. [PMID: 39179688 DOI: 10.1007/s00464-024-11112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE To investigate the diagnostic and therapeutic value of direct visualization (single-use eyeMax subscope) endoscopic management of acute uncomplicated appendicitis. METHODS Thirty-six patients diagnosed with acute uncomplicated appendicitis, confirmed by computed tomography or ultrasonography, from Jan 2023 to Feb 2024 were enrolled in this study. We collected demographics, colonoscopy findings, subscope findings, clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT), and adverse events associated with ERAT. RESULTS Appendiceal intubation was successful for all 36 patients. Thirty-five patients (97.2%) were definitely confirmed as having acute uncomplicated appendicitis. One patient with negative appendicitis was diagnosed as having cecal diverticulitis with fecalith incarceration. The mean procedure time was 13.1 ± 13.6 min. One patient presented with worsening abdominal pain, and a computed tomography scan suggested a perforated appendix. The mean length of hospitalizations was 1.78 ± 2 days. The mean follow-up was 158 days; during this period, two patients (5.6%) experienced recurrent abdominal pain after 23 and 88 days and subsequently underwent laparoscopic appendectomy. CONCLUSION Direct visualization ERAT may be effective for diagnosing and treating acute uncomplicated appendicitis and seems to have a low complication rate.
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Affiliation(s)
- Dezheng Lin
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Mingli Su
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zehui Guo
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiancong Hu
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Endoscopy, Yuexi Hospital of the Sixth Affiliated Hospital, Sun Yat-Sen University, Xinyi, Guangdong, China
| | - Qinghua Zhong
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yongcheng Chen
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiaxin Deng
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xuefeng Guo
- Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, China.
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Tao Z, Brasel K. Setting Expectations: The Role of Preoperative Counselling in High-Risk Surgery for the Older adult. CURRENT GERIATRICS REPORTS 2024; 13:200-206. [DOI: 10.1007/s13670-024-00424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 01/05/2025]
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Rafaqat W, Lagazzi E, Jehanzeb H, Abiad M, Hwabejire JO, Parks JJ, Kaafarani HM, DeWane MP. Which Volume Matters More? Systematic Review and Meta-Analysis of Hospital vs Surgeon Volume in Intra-Abdominal Emergency Surgery. J Am Coll Surg 2024; 238:332-346. [PMID: 37991251 DOI: 10.1097/xcs.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Wardah Rafaqat
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Emanuele Lagazzi
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Hamzah Jehanzeb
- Medical College, Aga Khan University, Karachi, Pakistan (Jehanzeb)
| | - May Abiad
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - John O Hwabejire
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Jonathan J Parks
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Haytham M Kaafarani
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Michael P DeWane
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
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Hsiao YW, Hsiao CY, Huang J, Lai PS, Chen PY. Surgical Outcomes and Quality of Care Among Adult Appendicitis Patients: A Comparative Study of Tertiary Care Hospitals and Regional Hospitals. World J Surg 2023; 47:3149-3158. [PMID: 37851067 DOI: 10.1007/s00268-023-07219-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute appendicitis is one of the most common abdominal emergencies, with management approaches that vary depending on the available resources and setting. However, there is a lack of studies on the differences of surgical outcomes and quality of care between tertiary care hospitals and regional hospitals. METHODS This multicenter retrospective study included 2158 consecutive adult patients between January 2014 and June 2018 at three hospitals. The patient cohort was divided into regional hospital group (N = 1223) and tertiary care hospital group (N = 935). Baseline characteristics and perioperative outcomes were compared, and factors associated with surgical delay and postoperative complication were investigated. RESULTS Patients in tertiary care hospital group had longer surgical waiting time (17.3 vs. 12.0 h, p < 0.001), higher risks of surgical delay exceeding 24 h (OR = 2.94, 95% CI 2.17-4.01, p < 0.001), longer operation time (64 vs. 50 min, p < 0.001), more appendix perforation (22.4 vs. 13.3%, p < 0.001), and higher hospital cost compared with regional hospital group. In multivariate analysis, factors associated with surgical delay were tertiary care hospital (OR = 2.94, 95% CI 2.18-4.01, p < 0.001) and delay diagnosis (OR = 18.7, 95% CI 11.7-30.1, p < 0.001), while those associated with postoperative complications were older age (OR = 1.02, 95% CI 1.00-1.04, p = 0.013), male sex (OR = 2.38, 95% CI 1.11-5.52, p = 0.031), surgical delay (OR = 2.99, 95% CI 1.30-6.47, p = 0.007), and appendix perforation (OR = 5.61, 95% CI 2.72-11.85, p < 0.001). CONCLUSIONS Patients at tertiary care hospitals had longer waiting time, more surgical delays, and appendix perforations, and these were risk factors of postoperative complications. Establishing an effective referral system to redirect appendicitis patients with less complex medical histories from tertiary care hospitals to regional hospitals may enhance the quality of patient care and outcomes, while also reducing medical costs.
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Affiliation(s)
- Ya-Wen Hsiao
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, Taiwan
| | - Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, Taiwan.
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - John Huang
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, Taiwan
| | - Peng-Sheng Lai
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan
| | - Po-Yen Chen
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
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Bahta NNA, Rosenberg J, Fonnes S. Many diagnostic tools for appendicitis: a scoping review. Surg Endosc 2023; 37:3419-3429. [PMID: 36735050 DOI: 10.1007/s00464-023-09890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to provide an overview of all diagnostic tools developed to diagnose appendicitis with their reported accuracy and to further characterize these including their need for diagnostic equipment. METHODS This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and a protocol was registered at Open Science Framework. We performed a systematic literature search in PubMed, Embase, China National Knowledge Infrastructure, Índice Bibliográfico Espanhol de Ciências da Saúde, and Latin American and Caribbean Health Sciences Literature. We included original articles of all languages with the purpose to derive an accessible diagnostic tool. We extracted data regarding study- and diagnostic tool characteristics, and the accuracy of each diagnostic tool. RESULTS The search led to 6419 records, where 74 studies were included, yielding 82 diagnostic tools reported in seven different languages. Among these tools, 35% included patient characteristics, 85% symptoms, 93% physical examinations, 37% vital signs, 78% laboratory values, and 16% imaging. Among the diagnostic tools, 35% relied on a medical doctor/surgeon with access to a laboratory, and six diagnostic tools did not require a bedside medical doctor/surgeon. The median positive predictive value, negative predictive value, sensitivity, and specificity across diagnostic tools were 91%, 94%, 89%, and 86%, respectively. CONCLUSIONS We identified 82 diagnostic tools that most frequently were based on symptoms and physical examinations. Most diagnostic tools relied on a medical doctor/surgeon with access to laboratory values. The accuracy was high across the diagnostic tools.
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Affiliation(s)
- Nadir Noureldin Abdella Bahta
- Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Jacob Rosenberg
- Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Siv Fonnes
- Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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Fonnes S, Erichsen R, Rosenberg J. Validity of the coding for appendicitis, appendectomy, and diagnostic laparoscopy in the Danish National Patient Registry. Scand J Surg 2023; 112:48-55. [PMID: 36625452 DOI: 10.1177/14574969221148078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE We aimed to validate the diagnostic accuracy of appendicitis, its severity, its description, and the surgical approach, including open or laparoscopic appendectomy and diagnostic laparoscopy, in the Danish National Patient Registry (DNPR) against information from the electronic medical records. METHODS A random sample of 1046 patients of all ages and sexes recorded in the DNPR from the Capital Region of Denmark during 2010-2015 was investigated. Patients' admission had to include a discharge code for appendicitis (K35-K379) according to the International Classification of Disease version 10 (ICD-10) alone or in combination with a surgical code for appendectomy or the surgical code for a diagnostic laparoscopy. We calculated the positive predictive values (PPVs) with 95% confidence intervals. RESULTS Data from a total of 1018 patients were available for data analysis. The ICD-10 codes for appendicitis resulted in a good PPV of >95% when combined with a surgical code. ICD-10 codes combined with the surgical codes could discriminate between uncomplicated and complicated appendicitis with some caution as the PPVs ranged from 68% to 93%. Only the surgical code for laparoscopic appendectomy yielded a good PPV (99%) for the actual surgical approach. The surgical code for a diagnostic laparoscopy alone did not cover a normal diagnostic laparoscopy. CONCLUSIONS The diagnostic accuracy of appendicitis and appendectomy in routinely collected administrative health data is good for ICD-10 codes for appendicitis in combination with a surgical code and especially for laparoscopic appendectomy. Uncomplicated and complicated appendicitis can be distinguished with some caution.
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Affiliation(s)
- Siv Fonnes
- Centre for Perioperative Optimisation Department of Surgery Herlev and Gentofte Hospital University of Copenhagen Borgmester Ib Juuls Vej 1 DK-2730 Herlev Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Jacob Rosenberg
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study. J Clin Med 2022; 11:jcm11154495. [PMID: 35956110 PMCID: PMC9369616 DOI: 10.3390/jcm11154495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.
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Itamoto K, Kumamaru H, Aikou S, Yagi K, Yamashita H, Nomura S, Miyata H, Kuroda S, Fujiwara T, Endo S, Kitagawa Y, Kakeji Y, Seto Y. No association between hospital volume and short-term outcomes of some common surgeries: a retrospective cohort study based on a Japanese nationwide database. Surg Today 2022; 52:941-952. [DOI: 10.1007/s00595-022-02467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
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Metabolomics and Inflammatory Mediator Profiling for the Differentiation of Life-Threatening and Non-Severe Appendicitis in the Pediatric Population. Metabolites 2021; 11:metabo11100664. [PMID: 34677379 PMCID: PMC8539521 DOI: 10.3390/metabo11100664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
While children with appendicitis often have excellent clinical outcomes, some develop life-threatening complications including sepsis and organ dysfunction requiring pediatric intensive care unit (PICU) support. Our study applied a metabolomics and inflammatory protein mediator (IPM) profiling approach to determine the bio-profiles of children who developed severe appendicitis compared with those that did not. We performed a prospective case-control study of children aged 0-17 years with a diagnosis of appendicitis. Cases had severe disease resulting in PICU admission. Primary controls had moderate appendicitis (perforation without PICU); secondary controls had mild appendicitis (non-perforated). Serum samples were analyzed using Proton Nuclear Magnetic Resonance (1H NMR) Spectroscopy and Gas Chromatography-Mass Spectrometry (GC-MS); IPM analysis was performed using plasma bead-based multiplex profiling. Comparisons were made using multivariate data statistical analysis. Fifty-three children were included (15 severe, 38 non-severe). Separation between severe and moderate appendicitis demonstrated excellent sensitivity and specificity (100%, 88%; 14 compounds), separation between severe and mild appendicitis also showed excellent sensitivity and specificity (91%, 90%; 16 compounds). Biomarker patterns derived from metabolomics and IPM profiling are capable of distinguishing children with severe appendicitis from those with less severe disease. These findings provide an important first step towards developing non-invasive diagnostic tools for clinicians in early identification of children who are at a high risk of developing severe appendicitis.
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Affiliation(s)
- David A Talan
- From the Department of Emergency Medicine, UCLA Ronald Reagan Medical Center, and the David Geffen School of Medicine at UCLA - both in Los Angeles (D.A.T.); and the Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy (S.D.S.)
| | - Salomone Di Saverio
- From the Department of Emergency Medicine, UCLA Ronald Reagan Medical Center, and the David Geffen School of Medicine at UCLA - both in Los Angeles (D.A.T.); and the Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy (S.D.S.)
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Ugurlu C, Yildirim M, Ozturk A, Ozcan O, Bostan MS, Yilmaz S. Lymphocyte-to-C-reactive Protein Ratio: a New Biomarker to Predict Perforation in Acute Appendicitis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Collard MK, Christou N, Lakkis Z, Mege D, Bridoux V, Millet I, Sabbagh C, Loriau J, Lefevre JH, Ronot M, Maggiori L. Adult appendicitis: Clinical practice guidelines from the French Society of Digestive Surgery and the Society of Abdominal and Digestive Imaging. J Visc Surg 2021; 158:242-252. [PMID: 33419677 DOI: 10.1016/j.jviscsurg.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The French Society of Digestive Surgery (SFCD) and the Society of Abdominal and Digestive Imaging (SIAD) have collaborated to propose recommendations for clinical practice in the management of adult appendicitis. METHODS An analysis of the literature was carried out according to the methodology of the French National Authority for Health (HAS). A selection was performed from collected references and then a manual review of the references listed in the selected articles was made in search of additional relevant articles. The research was limited to articles whose language of publication was English or French. Articles focusing on the pediatric population were excluded. Based on the literature review, the working group proposed recommendations whenever possible. These recommendations were reviewed and approved by a committee of experts. RESULTS Recommendations about appendicitis in adult patients were proposed with regard to clinical, laboratory and radiological diagnostic modalities, treatment strategy for uncomplicated and complicated appendicitis, surgical technique, and specificities in the case of macroscopically healthy appendix, terminal ileitis and appendicitis in the elderly and in pregnant women. CONCLUSION These recommendations for clinical practice may be useful to the surgeon in optimizing the management of acute appendicitis in adults.
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Affiliation(s)
- M K Collard
- Department of digestive surgery, Sorbonne université, Saint-Antoine hospital, AP-HP, Paris, France
| | - N Christou
- Department of digestive, general and endocrine surgery, CHU Dupuytren, Limoges, France
| | - Z Lakkis
- Department of visceral, digestive and oncological surgery, CHU Besançon, Besançon, France
| | - D Mege
- Department of digestive and general surgery, Timone hospital, Marseille, France
| | - V Bridoux
- Department of digestive surgery, Charles-Nicolle hospital, Rouen, France
| | - I Millet
- Radiology department, Lapeyronie hospital, Montpellier, France
| | - C Sabbagh
- Department of digestive surgery, CHU Amiens-Picardie, Amiens, France
| | - J Loriau
- Department of digestive surgery, Saint-Joseph hospital, Paris, France
| | - J H Lefevre
- Department of digestive surgery, Sorbonne université, Saint-Antoine hospital, AP-HP, Paris, France
| | - M Ronot
- Radiology department, Beaujon hospital, Clichy-la-Garenne, France
| | - L Maggiori
- Department of digestive, oncologic and endocrine surgery, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université de Paris, Paris, France.
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Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade. Eur J Trauma Emerg Surg 2021; 48:799-810. [PMID: 33847766 PMCID: PMC9001541 DOI: 10.1007/s00068-021-01647-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/11/2021] [Indexed: 12/14/2022]
Abstract
As population age, healthcare systems and providers are likely to experience a substantial increase in the proportion of elderly patients requiring emergency surgery. Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes due to the short time available for diagnosis, optimization, and intervention in patients presenting with physiological derangement. These patient populations, who are often frail and burdened with a variety of co-morbidities, have lower reserves to deal with the stress of the acute condition and the required emergency surgical intervention. In this review article, we discuss topical areas where mitigation of the physiological stress posed by the acute condition and asociated surgical intervention may be feasible. We consider the impact of the adrenergic response and use of beta blockers for these high-risk patients and discuss common risk factors such as frailty and delirium. A proactive multidisciplinary approach to peri-operative care aimed at mitigation of the stress response and proactive management of common conditions in the older emergency surgical patient could yield more favorable outcomes.
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Wickramasinghe DP, Xavier C, Samarasekera DN. The Worldwide Epidemiology of Acute Appendicitis: An Analysis of the Global Health Data Exchange Dataset. World J Surg 2021; 45:1999-2008. [PMID: 33755751 DOI: 10.1007/s00268-021-06077-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aims to describe the worldwide epidemiology and changing disease trends of acute appendicitis (AA). METHODS Epidemiological data on the incidence of AA and deaths were collected from the Global Health Data Exchange repository from 1990 to 2019. Data were stratified by age, sex and Socio-Demographic Index (SDI). RESULTS In 2019, there were an estimated 17.7 million cases (incidence 228/100,000) with over 33,400 deaths (0.43/100,000). Both the absolute number and the incidence had increased from 1990 to 2019 (+ 38.8% and + 11.4%, respectively). The number of deaths and deaths per 100,000 declined during this period (- 21.8% and - 46.2%, respectively). These trends were largely similar in all 5 SDI groups. There was a significant difference in the incidence of AA between the SDI groups, with low SDI group having the lowest and high SDI group having the highest. The high SDI group had the lowest mortality rate (Kruskall-Wallis test, p < 0.001). The peak incidence was in the 15-19-year age group. The mortality rate increased exponentially from the third decade of life. CONCLUSIONS The mortality rate of AA is declining worldwide, while the incidence is increasing. The peak incidence is in the 15-19-year group.
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Affiliation(s)
| | - Chrisjit Xavier
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Aguilar-Frasco JL, Rodríguez-Quintero JH, Moctezuma-Velázquez P, Morales-Maza J, Moctezuma-Velázquez C, Pastor-Sifuentes F, Medina-Franco H. Frailty index as a predictive preoperative tool in the elder population undergoing major abdominal surgery: a prospective analysis of clinical utility. Langenbecks Arch Surg 2021; 406:1189-1198. [PMID: 33656576 DOI: 10.1007/s00423-021-02128-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The geriatric population has increased considerably in the last decades. Such increases come along with new challenges for surgical practitioners, who now face a risen number of frail patients in need of major operations. The value of frailty indexes in this setting has been discussed recently. This study assessed the modified Rockwood frailty index (mRFI) as a predictive tool for postoperative complications in older adults subjected to major abdominal operations and correlated it with other scores widely utilized for this purpose. METHODS We performed a prospective study utilizing the mRFI including all patients older than 65 years subjected to major abdominal surgery between May 2017 and May 2019 in a third-level academic center. A comparison between frail (mRFI >0.25) and non-frail patients (mRFI <0.25) was performed. We performed logistic regression to identify predictors of postoperative complications and 30-day mortality. We analyzed the correlation between mRFI and ACS-NSQIP, P-POSSUM, PMP, and Charlson score risk calculators. RESULTS One hundred forty patients were included in our study, of whom 49 (35%) were identified as frail. Frail patients demonstrated significantly prolonged hospital stay (p<.0001), ICU admission rates (p=0.004), hospital readmissions (p=0.007), and higher mortality rates (p=0.02). Our univariate analysis associated frailty (mRFI>0.25), ASA >III, increased age, and BMI with postoperative complications. In our multivariate analysis, frailty remained an independent predictor for postoperative complications (OR 6.38, 95% CI [2.45-16.58], p<0.001). Frailty was also associated with length of stay (LOS) regardless of the type of surgery (OR 3.35, 95% CI [0.37-6.33], p= 0.03). mRFI>0.25 demonstrated a sensitivity (Se) of 70% and specificity (Sp) 67% with area under the curve (AUC) 0.75 for perioperative complications, Se 69% and Sp 70% with AUC 0.74 for ICU admissions, and Se 83% and Sp 68% with AUC 0.83 for mortality. CONCLUSION Frail patients demonstrated significantly prolonged hospital stay, ICU admission rates, hospital readmissions, and higher mortality rates. mRFI is an independent predictor for perioperative complications with a Se of 70% and Sp 67% and AUC 0.75.
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Affiliation(s)
- Jorge Luis Aguilar-Frasco
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Jorge Humberto Rodríguez-Quintero
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México. .,Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA.
| | - Paulina Moctezuma-Velázquez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Jesús Morales-Maza
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Carlos Moctezuma-Velázquez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Francisco Pastor-Sifuentes
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Heriberto Medina-Franco
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
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Gaitanidis A, Mikdad S, Breen K, Kongkaewpaisan N, Mendoza A, Saillant N, Fawley J, Parks J, Velmahos G, Kaafarani H. The Emergency Surgery Score (ESS) accurately predicts outcomes in elderly patients undergoing emergency general surgery. Am J Surg 2020; 220:1052-1057. [PMID: 32089243 DOI: 10.1016/j.amjsurg.2020.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The performance of the Emergency Surgery Score (ESS), a validated risk calculator, in the elderly emergency general surgery (EGS) patient remains unclear. We hypothesized that ESS accurately predicts outcomes in elderly EGS patients, including octogenarians and nonagenarians. METHODS Using the 2007-2017 National Surgical Quality Improvement Program (NSQIP) database, we included all EGS patients ≥65 years old. The correlation between ESS, mortality and morbidity was assessed in the 3 patient cohorts (>65, octogenarians and nonagenarians), using the area under the curve (AUC). RESULTS A total of 124,335 patients were included, of which 34,215 (28%) were octogenarians and 7239 (6%) were nonagenarians. In patients ≥65 years, ESS accurately predicted mortality (AUC 0.81). For octogenarians and nonagenarians, ESS predicted mortality moderately well (AUC 0.77 and 0.69, respectively. CONCLUSION ESS accurately predicts mortality and morbidity in the elderly EGS patient, but its accuracy in predicting morbidity decreases for nonagenarians.
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Affiliation(s)
- Apostolos Gaitanidis
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Mikdad
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Kerry Breen
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - April Mendoza
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jason Fawley
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Haytham Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA, USA.
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Gelpke K, Hamminga JTH, van Bastelaar JJ, de Vos B, Bodegom ME, Heineman E, Hofker HS, El Moumni M, Haveman JW. Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort and validation study. Int J Surg 2020; 79:257-264. [PMID: 32387211 DOI: 10.1016/j.ijsu.2020.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Approximately nine percent of all acute appendectomies are unintentionally performed on a normal appendix. Failure of treatment (negative appendectomy or missed appendicitis) is associated with higher morbidity and mortality when compared to appendectomy for uncomplicated appendicitis. The Laparoscopic APPendicitis (LAPP) score was developed in order to systematically evaluate the appendix for the presence of inflammation. This study aims to determine whether the LAPP score reduces the negative appendectomy rate without missing appendicitis. METHODS From September 2013 through May 2016, 322 adult patients presenting with a clinical suspicion of acute appendicitis and an indication for diagnostic laparoscopy were included and analyzed in this multicenter prospective validation study. Depending on the LAPP score, the appendix was either removed (n = 300) or left in situ (n = 22). These patients were compared to a historical control group of 584 patients treated at the same hospitals. The appendix was examined by a pathologist and the negative appendectomy rate was calculated. RESULTS The negative appendectomy rate was significantly lower when the LAPP score was used (4,7% vs. 8,4%; P = 0,034). None of the patients with a negative LAPP score, in which the appendix remained in situ, developed acute appendicitis within three months. There were no significant differences in operation time, complications, or readmissions. Using the LAPP score was associated with significantly higher rates of preoperative radiological imaging (98% vs. 70%; P < 0,001). After adjusting for covariables, including radiological imaging, use of the LAPP score led to fewer treatment failures when compared to not using the LAPP score (OR: 0,48, 95% C.I. 0,251 to 0,914; P = 0,025). CONCLUSION The LAPP score is a safe and simple tool to reduce the negative appendectomy rate during laparoscopic surgery without missing cases of acute appendicitis.
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Affiliation(s)
- Koen Gelpke
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jenneke T H Hamminga
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - James J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen & Heerlen, the Netherlands
| | - Bart de Vos
- Department of Surgery, Wilhelmina Hospital, Assen, the Netherlands
| | - Maarten E Bodegom
- Department of Surgery, Bethesda Hospital, Hoogeveen, the Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H Sijbrand Hofker
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mostafa El Moumni
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Logie K, Robinson T, VanHouwelingen L. Management of the normal-appearing appendix during laparoscopy for clinically suspected acute appendicitis in the pediatric population. J Pediatr Surg 2020; 55:893-898. [PMID: 32081356 DOI: 10.1016/j.jpedsurg.2020.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The widespread use of laparoscopy has brought forth the question of how to manage a macroscopically normal-appearing appendix in cases of clinically suspected appendicitis. This study aimed to determine the current practices of pediatric general surgeons in Canada regarding this matter. METHODS An online survey was created following the American Pediatric Surgical Association (APSA) guidelines and distributed via email to the Canadian Association of Pediatric Surgeons (CAPS) staff surgeons. The questions assessed clinician characteristics, standard practice, and rationale. Results were analyzed using descriptive statistics. RESULTS A total of 54/72 (75%) CAPS members practicing in Canada completed the survey. All (100%) agreed they would remove a normal-appearing appendix during laparoscopy for suspected acute appendicitis. The most common reasons were: possibility of microscopic appendicitis (39/54, 72.2%), avoiding future diagnostic confusion (28/54, 51.9%), and patient preference/consent discussion (21/54, 38.9%). Most (53/54, 98.1%) had performed a negative appendectomy and 49/54 (90.7%) agreed there were no sufficient guidelines. CONCLUSIONS The majority of pediatric surgeons agree sufficient guidelines do not exist to support decision making when a normal-appearing appendix is found during laparoscopy for suspected acute appendicitis. This survey shows that removal of the appendix in this case would be supported by the majority of Canadian pediatric surgeons. TYPE OF STUDY Survey LEVEL OF EVIDENCE: VII (Expert Opinion).
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Affiliation(s)
- Kathleen Logie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tessa Robinson
- Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada.
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Perforated appendicitis: Short duration antibiotics are noninferior to traditional long duration antibiotics. Surgery 2020; 167:475-477. [PMID: 31587914 DOI: 10.1016/j.surg.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 01/07/2023]
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Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Sci Rep 2019; 9:14793. [PMID: 31616053 PMCID: PMC6794313 DOI: 10.1038/s41598-019-51172-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022] Open
Abstract
Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95% CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95% CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes.
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Young E, Stewart S, McCulloch GAJ, Maddern GJ. Appendicectomy mortality: an Australian national audit. ANZ J Surg 2019; 89:1441-1445. [PMID: 31566305 DOI: 10.1111/ans.15439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/02/2019] [Accepted: 08/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Appendicectomy is a safe surgical procedure with minimal risks. Low mortality rates (0.04-0.24%) have been reported from a number of countries. Appendicectomy mortality rates have not been reported in Australia in recent years. The aim of the study was to conduct an appendicectomy mortality audit, to identify clinical management issues and to calculate the mortality rate of appendicectomy in Australia. METHODS This study analysed data from a peer review of appendicectomy deaths in Australian hospitals of all states and territories, from 2006 to 2017. Additional procedural data were obtained from the Australian Institute of Health and Welfare for the calculation of mortality rates. RESULTS The final analysis included 82 patients of whom 62 were elderly (age >65 years) with 47 males and 35 females. Two or more comorbidities were present in 68 patients. Open operation was performed in 62 patients, with complicated appendicitis found in 50 cases. The majority of management issues were non-surgical. Of the 16 surgical management issues identified, 11 issues occurred post-operatively in the elderly, which were potentially preventable. The overall mortality was 0.02% with 0.01% in the young (age <65 years) and 0.20% in the elderly. CONCLUSION Australia's appendicectomy mortality rate was very low and comparable to international figures. Surgical management of appendicectomy was satisfactory in general. However, post-operative care in the elderly was found to be poor at times, with room for improvement. Further research is needed whether improvements in post-operative care could alter the clinical course to death in the elderly.
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Affiliation(s)
- Edward Young
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sasha Stewart
- South Australian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Glenn A J McCulloch
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia.,Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Association of chronic and acute inflammation of the mucosa-associated lymphoid tissue with psychiatric disorders and suicidal behavior. Transl Psychiatry 2019; 9:227. [PMID: 31515504 PMCID: PMC6742630 DOI: 10.1038/s41398-019-0568-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Immune dysregulation due to chronic inflammation is a hypothesized risk factor underlying psychiatric disorders and suicidal behavior. Whether tonsillectomy and acute appendicitis used, respectively, as proxies for chronic and acute inflammation within the mucosa-associated lymphoid tissue (MALT) are associated with psychiatric disorders and suicidal behavior is currently unknown. A birth cohort study was conducted including 3,052,875 individuals born in Sweden between 1973 and 2003. We identified 210,686 individuals ever exposed to tonsillectomy and 86,928 individuals ever exposed to acute appendicitis, as well as 317,214 clusters of siblings discordant for tonsillectomy, and 160,079 sibling clusters discordant for acute appendicitis. Outcomes were an aggregate risk of 'any psychiatric disorder', 'any suicidal behavior', 12 individual psychiatric disorders, suicide attempts and deaths by suicide. Tonsillectomy was associated with increased odds of 'any psychiatric disorder' (adjusted odds ratio [aOR] = 1.39; 95% confidence interval (CI) = 1.38-1.41) and 'any suicidal behavior' (aOR = 1.41; 95% CI = 1.37-1.44), and most individual disorders. Acute appendicitis also increased the odds of 'any psychiatric disorder' and 'any suicidal behavior' (aOR = 1.23; 95% CI = 1.20-1.25, and aOR = 1.32; 95% CI = 1.28-1.37, respectively). Exposure to both tonsillectomy and appendicitis was associated with the highest odds of 'any psychiatric disorder' (aOR = 1.70; 95% CI = 1.59-1.82) and 'any suicidal behavior' (aOR = 1.90; 95% CI = 1.70-2.12). In sibling comparisons, the associations were attenuated but remained significant. We conclude that inflammation within the MALT, particularly when chronic, is robustly associated with a broad range of psychiatric disorders and suicidal behavior.
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Intraperitoneal administration of fosfomycin, metronidazole, and granulocyte-macrophage colony-stimulating factor in patients undergoing appendectomy is safe: a phase II clinical trial. Sci Rep 2019; 9:6727. [PMID: 31040341 PMCID: PMC6491470 DOI: 10.1038/s41598-019-43151-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 04/17/2019] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate the safety of intraperitoneal administration of the combination of fosfomycin, metronidazole, and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in patients undergoing appendectomy. We conducted a prospective phase II clinical trial in 14 otherwise healthy men suffering from uncomplicated appendicitis. After appendectomy, the trial treatment was administered intraperitoneally and left in the abdominal cavity. Trial treatment consisted of 4 g fosfomycin, 1 g metronidazole, and 50 µg rhGM-CSF in a total volume of 500 ml. Safety was evaluated through white blood cell count where a toxic effect was predefined. We evaluated harms and adverse events, repeated biochemical markers, vital signs, and length of stay. White blood cell count did not drop below the toxic range. The recorded harms were dizziness, discomfort when breathing deeply, no flatus, and bloating. Adverse events included three patients with diarrhoea after discharge and one patient with a hypotensive episode. No serious adverse events or infectious complications occurred. Intraperitoneal administration of fosfomycin, metronidazole, and rhGM-CSF was safe in otherwise healthy men undergoing laparoscopic appendectomy. There were some possible harms and adverse events but we were unable to assess if they were related to anaesthesia, surgery, or the trial treatment.
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Naqvi SA, Thompson GC, Joffe AR, Blackwood J, Martin DA, Brindle M, Barkema HW, Jenne CN. Cytokines and Chemokines in Pediatric Appendicitis: A Multiplex Analysis of Inflammatory Protein Mediators. Mediators Inflamm 2019; 2019:2359681. [PMID: 30918467 PMCID: PMC6409077 DOI: 10.1155/2019/2359681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/15/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We aimed to demonstrate the potential of precision medicine to describe the inflammatory landscape present in children with suspected appendicitis. Our primary objective was to determine levels of seven inflammatory protein mediators previously associated with intra-abdominal inflammation (C-reactive protein-CRP, procalcitonin-PCT, interleukin-6 (IL), IL-8, IL-10, monocyte chemoattractant protein-1-MCP-1, and serum amyloid A-SAA) in a cohort of children with suspected appendicitis. Subsequently, using a multiplex proteomics approach, we examined an expansive array of novel candidate cytokine and chemokines within this population. METHODS We performed a secondary analysis of targeted proteomics data from Alberta Sepsis Network studies. Plasma mediator levels, analyzed by Luminex multiplex assays, were evaluated in children aged 5-17 years with nonappendicitis abdominal pain (NAAP), acute appendicitis (AA), and nonappendicitis sepsis (NAS). We used multivariate regression analysis to evaluate the seven target proteins, followed by decision tree and heat mapping analyses for all proteins evaluated. RESULTS 185 children were included: 83 with NAAP, 79 AA, and 23 NAS. Plasma levels of IL-6, CRP, MCP-1, PCT, and SAA were significantly different in children with AA compared to those with NAAP (p < 0.001). Expansive proteomic analysis demonstrated 6 patterns in inflammatory mediator profiles based on severity of illness. A decision tree incorporating the proteins CRP, ferritin, SAA, regulated on activation normal T-cell expressed and secreted (RANTES), monokine induced by gamma interferon (MIG), and PCT demonstrated excellent specificity (0.920) and negative predictive value (0.882) for children with appendicitis. CONCLUSIONS Multiplex proteomic analyses described the inflammatory landscape of children presenting to the ED with suspected appendicitis. We have demonstrated the feasibility of this approach to identify potential novel candidate cytokines/chemokine patterns associated with a specific illness (appendicitis) amongst those with a broad ED presentation (abdominal pain). This approach can be modelled for future research initiatives in pediatric emergency medicine.
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Affiliation(s)
- S. Ali Naqvi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary AB, Canada
| | - Graham C. Thompson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Ari R. Joffe
- Department of Pediatrics, Division of Critical Care, University of Alberta, Edmonton AB, Canada
| | - Jaime Blackwood
- Department of Pediatrics, Division of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Dori-Ann Martin
- Department of Pediatrics, Division of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Mary Brindle
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Herman W. Barkema
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary AB, Canada
| | - Craig N. Jenne
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
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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: 1.5] [Reference Citation Analysis] [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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Som R, Seymour N, Thrumurthy SG, Khattak S, Joshi S, Sorelli PG. Establishing the need for clinical follow-up after emergency appendicectomy in the modern era: Retrospective case series of 145 patients. Ann Med Surg (Lond) 2018; 34:23-27. [PMID: 30191061 PMCID: PMC6125798 DOI: 10.1016/j.amsu.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/29/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Emergency appendicectomy (EA) is a commonly performed operation, with an increasing number of EAs being performed as day-case. The aim of this study is to establish if there is a need for post-operative follow-up and if this could prevent adverse outcomes. Methods A retrospective analysis of patients who underwent EA at multiple centres over a six-month period was undertaken. They were contacted by telephone and a standardised questionnaire was used to ascertain post-operative outcomes, including duration of analgesia use, duration before return to normal daily activity (ADLs), surgical site infection rates (SSI) and rates of re-presentation to medical services. Patients were stratified into those who underwent laparoscopic versus open appendicectomy, smokers versus non-smokers, and body mass index (BMI). Results A total of 145 patients were included in the study. Patients undergoing open surgery (vs. laparoscopic surgery) required analgesia for significantly longer periods, with a significantly longer return to ADLs. Smokers, when compared to non-smokers experienced a significantly longer return to work/school; and significantly higher risk of SSI and re-presenting to accident & emergency; as did patients with a BMI >30 when compared to those with a BMI <30. Conclusion Most patients do not need formal outpatient assessment after EA. However, there is clearly a subset of higher risk patients who may benefit from this - patients who are smokers or obese. They have prolonged recovery times, and are at greater risk of SSI. Earlier surgical outpatient follow-up of these patients could prevent adverse outcomes.
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Affiliation(s)
- Robin Som
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Nicky Seymour
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Sri G Thrumurthy
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Sophia Khattak
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Shivani Joshi
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Paolo G Sorelli
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
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Appendectomy and Risk of Subsequent Diverticular Disease Requiring Hospitalization: A Population-Based Case-Control Study. Dis Colon Rectum 2018; 61:830-839. [PMID: 29878951 DOI: 10.1097/dcr.0000000000001086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Appendicitis and acute diverticulitis share clinical features and are both influenced by genetic and environmental factors. Appendectomy has been positively associated with diverticular disease in hospital-based case-control studies. OBJECTIVE The aim of the present study was to investigate, in a population-based setting, whether appendectomy, with or without appendicitis, is associated with an altered risk of hospitalization with diverticular disease. DESIGN This was a population-based case-control study. SETTINGS The study was based on national healthcare and population registers. PATIENTS We studied 41,988 individuals hospitalized between 2000 and 2010 with a first-time diagnosis of colonic diverticular disease and 413,115 matched control subjects. MAIN OUTCOME MEASURES The association between appendectomy with or without appendicitis and diverticular disease was investigated by conditional logistic regression, including a model adjusting for hospital use. RESULTS A total of 2813 cases (6.7%) and 19,037 controls (4.6%) had a previous record of appendectomy (appendectomy with acute appendicitis: adjusted OR = 1.31 (95% CI, 1.24-1.39); without appendicitis: adjusted OR = 1.30 (95% CI, 1.23-1.38)). Appendectomy was most strongly associated with an increased risk of diverticular disease within 1 year (with appendicitis: adjusted OR = 2.26 (95% CI, 1.61-3.16); without appendicitis: adjusted OR = 3.98 (95% CI, 2.71-5.83)), but the association was still present ≥20 years after appendectomy (with appendicitis: adjusted OR = 1.22 (95% CI, 1.12-1.32); without appendicitis: adjusted OR = 1.19 (95% CI, 1.10-1.28)). LIMITATIONS Detailed clinical information on the cases was not available. There were unmeasured potential confounders, such as smoking and dietary factors. CONCLUSIONS The findings are consistent with a hypothesis of appendectomy causing an increased risk of diverticular disease, for example, by affecting the mucosal immune system or the gut microbiome. However, several other mechanisms may contribute to, or account for, the positive association, including a propensity for abdominal pain increasing the risk of both the exposure and the outcome. See Video Abstract at http://links.lww.com/DCR/A604.
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Bolger JC, Zaidi A, Fuentes-Bonachera A, Kelly ME, Abbas A, Rogers A, McCormack T, Waldron B, Murray KP. Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting. Geriatr Gerontol Int 2018; 18:1211-1214. [PMID: 29897164 DOI: 10.1111/ggi.13456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
AIM The Western world has an expanding older population, who are living longer with increasing numbers of comorbidities. In addition, expectations of patients and relatives are increasing. As a general hospital operating in a rural setting, our University Hospital Kerry, Tralee, Ireland, deals with a significant number of emergency presentations to the acute surgical service. The aim of the present study was to examine outcomes for patients in the extremes of age who present requiring emergency surgical procedures. METHODS A retrospective review of theater and admission logs was carried out to identify all emergency surgeries from January 2008 to December 2015. All patients aged >80 years at the time of surgery were identified. Details of surgery were recorded, in addition to biochemical and hematological data, use of intensive care unit, length of stay and mortality. RESULTS In total, 128 octogenarians underwent an emergency surgery. The average patient age was 84.3 years (range 80-94 years). The commonest procedures were laparotomy (65%, n = 84), repair of strangulated/incarcerated hernia (18%, n = 23) and laparoscopic procedures (16%, n = 21). The 30-day all-cause mortality was 22.6%. On multivariate analysis, American Society of Anesthesia status and intensive care unit utilization predicted mortality (P = 0.04 and 0.05, respectively). A total of 82 patients required intensive care unit admission, with an average length of stay of 4.8 days, using 484 bed days in total. CONCLUSIONS Emergency surgery in octogenarians is a significant part of the workload of general surgeons. Poor baseline status is associated with an increased risk of mortality. Emergency surgery in older adults only utilizes a fraction of available intensive care unit resources. Geriatr Gerontol Int 2018; 18: 1211-1214.
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Affiliation(s)
- Jarlath C Bolger
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Akif Zaidi
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | | | - Michael E Kelly
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Aqeel Abbas
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Ailin Rogers
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Tom McCormack
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Brian Waldron
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Kevin P Murray
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
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Rasmussen T, Fonnes S, Rosenberg J. Long-Term Complications of Appendectomy: A Systematic Review. Scand J Surg 2018; 107:189-196. [PMID: 29764306 DOI: 10.1177/1457496918772379] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Appendectomy is a common surgical procedure, but no overview of the long-term consequences exists. Our aim was to systematically review the long-term complications of appendectomy for acute appendicitis. MATERIALS AND METHODS This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42017064662). The databases PubMed and EMBASE were searched for original reports on appendectomy with n ≥ 500 and follow-up >30 days. The surgical outcomes were ileus and incisional hernia; other outcomes were inflammatory bowel disease, cancer, fertility, and mortality. RESULTS We included 37 studies. The pooled estimate of the ileus prevalence was 1.0% over a follow-up period of 4.6 (range, 0.5-15) years. Regarding incisional hernia, we found a pooled estimate of 0.7% prevalence within a follow-up period of 6.5 (range, 1.9-10) years. Ulcerative colitis had a pooled estimate of 0.15% prevalence in the appendectomy group and 0.19% in controls. The opposite pattern was found regarding Crohn's disease with a pooled estimate of 0.20% prevalence in the appendectomy group and 0.12% in controls. No clear pattern was found regarding most of the examined cancers in appendectomy groups compared with background populations. Pregnancy rates increased after appendicitis compared with controls in most studies. Mortality was low after appendectomy. CONCLUSION Appendectomy had a low prevalence of long-term surgical complications. We did not find any significant other long-term complications, though the prevalence of Crohn's disease was higher and the prevalence of ulcerative colitis was lower after appendectomy than in controls. Appendectomy did not impair fertility.
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Affiliation(s)
- T Rasmussen
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - S Fonnes
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Impact of Radiation Dose Reduction in Abdominal Computed Tomography on Diagnostic Accuracy and Diagnostic Performance in Patients with Suspected Appendicitis: An Intraindividual Comparison. Acad Radiol 2018; 25:309-316. [PMID: 29174188 DOI: 10.1016/j.acra.2017.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/10/2017] [Accepted: 09/12/2017] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the intraindividual impact of radiation dose reduction in abdominal computed tomography (CT) on diagnostic performance in patients with suspected appendicitis. MATERIALS AND METHODS This study was approved by the institutional review board. Seventy-five patients who underwent standard contrast-enhanced abdominal CT for suspected appendicitis between 2004 and 2009 were retrospectively included. Low-dose CT reconstructions with 75%, 50%, and 25% of the original radiation dose level were generated by applying realistic reduced-dose simulation. Two blinded, independent readers assessed image quality, signal-to-noise ratio, and diagnostic confidence on each dataset. Diagnostic accuracy for detection of appendicitis and complications were calculated for each reader. Paired univariate tests were used to determine intraindividual differences. RESULTS Among 75 subjects included in the analysis (57% female, mean age: 41 ± 18 years), the prevalence of histopathologically confirmed appendicitis was 59%. Signal-to-noise ratio and subjective image quality of 50% and 25% reduced-dose CTs were significantly lower than the reference datasets (all P < .005). Appendicitis was correctly identified in all reference and low-dose datasets (sensitivity: 100%, negative predictive value: 100%). Presence of complications was correctly detected in all reference, 75%, and 50% datasets, but was decreased in 25% datasets (sensitivity: 77.8% and negative predictive value: 97.4%). Diagnostic confidence was high for original and 75% datasets, but significantly lower for 50% and 25% datasets (P < .001). CONCLUSIONS Our results indicate that diagnostic accuracy in abdominal CT acquisitions acquired at 75% and 50% of radiation dose is maintained in patients with suspected appendicitis, whereas further reduction of radiation exposition is associated with decreased diagnostic performance.
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Abstract
OBJECTIVES To determine the proportion of true-positive blood culture results in children presenting to the ED with suspected appendicitis. To describe the current practice of obtaining blood cultures in children with suspected appendicitis. METHODS We performed a 2-year retrospective health record review of all children aged 2 through 17 years investigated for suspected appendicitis at a tertiary Pediatric Emergency Department. Subjects were identified by searching (a) institutional records for ICD-10-CA coding, (b) diagnostic imaging records of ultrasounds for appendicitis, and (c) surgical database records for nonincidental appendectomies. Abstracted demographic and clinical data were matched to regional laboratory services data to describe the performance and result of blood cultures. RESULTS Overall, 1315 children investigated for appendicitis were reviewed. Seven hundred fifty (57.0%) were girls, the average age was 11.7 years (SD, 4.0). Blood cultures were obtained in 288 (21.9%) of 1315 patients. Of the 11 (3.8%) cultures that were positive, only 1 (0.35%) was a true positive. Young age, high triage acuity, and presence of fever were associated with the acquisition of cultures (P < 0.001 for all). The proportion of children undergoing appendectomy and the negative appendectomy rate was similar between those with and without blood culture (P = 0.10 and P = 0.96, respectively). CONCLUSIONS True-positive blood cultures are very rare in children presenting to the ED with suspected appendicitis. Given the potential for false-positive cultures and the social/economic implications of initial testing/retesting of false positives, the use of routine blood cultures for children with suspected appendicitis is not supported.
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Kotaluoto S, Ukkonen M, Pauniaho SL, Helminen M, Sand J, Rantanen T. Mortality Related to Appendectomy; a Population Based Analysis over Two Decades in Finland. World J Surg 2017; 41:64-69. [PMID: 27535664 DOI: 10.1007/s00268-016-3688-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT To define the mortality rate of appendectomy patients and appendectomy-related risk factors. BACKGROUND Appendectomy has been considered as a safe operation and negative appendectomies acceptable in order to avoid perforations. There are few publications on appendectomy-related mortality. Removal of a normal appendix has been suggested to be related to a higher mortality rate versus removal of an inflamed appendix. METHODS Data on all appendectomy patients between 1990 and 2010 in Finland were retrieved from the Discharge Register of the National Institute for Health and Welfare and combined with data from the Death Certificate Register of Statistics Finland. Thirty-day mortality was identified and compared with overall mortality. Detailed information from death certificates of patients dying within 30-day post-surgery was collected and analyzed. RESULTS Over the study period, the thirty-day post-appendectomy mortality rate was 2.1/1000. Increased mortality was found in patients over 60 years of age. Negative appendectomy and complicated appendicitis were related to mortality. The negative appendectomy rate was higher in patients older than 40 years of age. During the study period, both mortality and the rate of negative appendectomies decreased, while the rate of laparoscopic appendectomies increased. CONCLUSIONS Post-appendectomy mortality is related to both negative appendectomies and complicated appendicitis. Diagnostic accuracy is fundamental in the care of patients with acute appendicitis, especially in the elderly. Improved diagnostic accuracy may have reduced mortality over the last two decades in Finland.
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Affiliation(s)
- Sannamari Kotaluoto
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Mika Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Satu-Liisa Pauniaho
- Emergency Division of Pirkanmaa Hospital District, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Mika Helminen
- Science Center, Pirkanmaa Hospital District, Tampere and School of Health Sciences, University of Tampere, Tampere, Finland
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, Box 100, 70029 KYS, Kuopio, Finland.
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Ito S, Masuda T, Harada N, Matsuyama A, Hamatake M, Maeda T, Tsutsui S, Matsuda H, Mimori K, Ishida T. Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient: A case report. Ann Med Surg (Lond) 2017; 21:109-113. [PMID: 28861268 PMCID: PMC5567747 DOI: 10.1016/j.amsu.2017.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. PRESENTATION OF CASE A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. DISCUSSION Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. CONCLUSION Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.
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Affiliation(s)
- Shuhei Ito
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.,Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Takaaki Masuda
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Noboru Harada
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Ayumi Matsuyama
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Motoharu Hamatake
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Shinichi Tsutsui
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Hiroyuki Matsuda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Teruyoshi Ishida
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
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Zouari M, Abid I, Ben Dhaou M, Louati H, Jallouli M, Mhiri R. Predictive factors of negative appendectomy in children. Am J Emerg Med 2017; 36:335-336. [PMID: 28760379 DOI: 10.1016/j.ajem.2017.07.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- M Zouari
- Department of pediatric surgery, Hedi-Chaker Hospital, 3029 Sfax, Tunisia.
| | - I Abid
- Department of pediatric surgery, Hedi-Chaker Hospital, 3029 Sfax, Tunisia
| | - M Ben Dhaou
- Department of pediatric surgery, Hedi-Chaker Hospital, 3029 Sfax, Tunisia
| | - H Louati
- Department of pediatric surgery, Hedi-Chaker Hospital, 3029 Sfax, Tunisia
| | - M Jallouli
- Department of pediatric surgery, Hedi-Chaker Hospital, 3029 Sfax, Tunisia
| | - R Mhiri
- Department of pediatric surgery, Hedi-Chaker Hospital, 3029 Sfax, Tunisia
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Mikaere H, Zeng I, Lauti M, Kularatna M, MacCormick AD. Derivation and validation of the APPEND score: an acute appendicitis clinical prediction rule. ANZ J Surg 2017; 88:E303-E307. [PMID: 28512853 DOI: 10.1111/ans.14022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/14/2017] [Accepted: 03/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although many clinical prediction rules (CPRs) for appendicitis exist, none have been developed for a New Zealand population presenting with right iliac fossa (RIF) pain. The aim of this study was to derive and validate an appendicitis CPR for our population. METHOD This is a retrospective review of all patients from December 2010 to February 2012 of at least 15 years of age presenting to the general surgery service with RIF pain. Patient data were divided into derivation and validation groups. Univariate and multiple regression analyses identified significant predictors of appendicitis which were used to construct a CPR. A retrospective validation study was then performed and the CPR was refined accordingly. Finally, the accuracy of the CPR was tested. RESULTS The final components of the new CPR, the APPEND score, were Anorexia, migratory Pain, local Peritonism, Elevated C-reactive protein, Neutrophilia and male gender (Dude). This CPR has an area under the receiver operating characteristic curve of 0.84. The CPR can stratify patients into low, intermediate and high-risk groups which may standardize patient care and reduce the negative appendicectomy rate. CONCLUSION A new CPR for predicting appendicitis, in patients presenting with RIF pain, has been derived and validated for use in our population. A prospective study to further evaluate its performance is required.
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Affiliation(s)
| | - Irene Zeng
- Research and Evaluation Office, Health Intelligence and Informatics, Ko Awatea, Counties Manukau Health, Auckland, New Zealand
| | - Melanie Lauti
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Malsha Kularatna
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
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Cheng CJ, Chen PC, Lian SY, Wang YL, Ho SC, Chen YF, Tang YH, Ker CG. Effects of computed tomography for preoperative diagnosis of acute appendicitis on hospital expenditure. FORMOSAN JOURNAL OF SURGERY 2016; 49:223-229. [DOI: 10.1016/j.fjs.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Chung SD, Huang CC, Lin HC, Tsai MC, Chen CH. Increased Risk of Clinically Significant Gallstones following an Appendectomy: A Five-Year Follow-Up Study. PLoS One 2016; 11:e0165829. [PMID: 27788255 PMCID: PMC5082793 DOI: 10.1371/journal.pone.0165829] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/05/2016] [Indexed: 12/12/2022] Open
Abstract
Although the vermiform appendix is commonly considered a vestigial organ, adverse health consequences after an appendectomy have garnered increasing attention. In this study, we investigated the risks of gallstone occurrence during a 5-year follow-up period after an appendectomy, using a population-based dataset. We used data from the Taiwan Longitudinal Health Insurance Database 2005. The exposed cohort included 4916 patients who underwent an appendectomy. The unexposed cohort was retrieved by randomly selecting 4916 patients matched with the exposed cohort in terms of sex, age, and year. We individually tracked each patient for a 5-year period to identify those who received a diagnosis of gallstones during the follow-up period. Cox proportional hazard regressions were performed for the analysis. During the 5-year follow-up period, the incidence rate per 1000 person-years was 4.71 for patients who had undergone an appendectomy, compared to a rate of 2.59 for patients in the unexposed cohort (p<0.001). Patients who had undergone an appendectomy were independently associated with a 1.79 (95% CI = 1.29~2.48)-fold increased risk of being diagnosed with gallstones during the 5-year follow-up period. We found that among female patients, the adjusted hazard ratio of gallstones was 2.25 (95% CI = 1.41~3.59) for patients who underwent an appendectomy compared to unexposed patients. However, for male patients, we failed to observe an increased hazard for gallstones among patients who underwent an appendectomy compared to unexposed patients. We found an increased risk of a subsequent gallstone diagnosis within 5 years after an appendectomy.
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Affiliation(s)
- Shiu-Dong Chung
- Department of Surgery, Far Eastern Memorial Hospital, Banciao, Taipei, Taiwan
- Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chung-Chien Huang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chieh Tsai
- Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Hsinchu Branch, Taiwan
| | - Chao-Hung Chen
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
- Department & Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Jeon BG. Predictive factors and outcomes of negative appendectomy. Am J Surg 2016; 213:731-738. [PMID: 27769547 DOI: 10.1016/j.amjsurg.2016.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/02/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to assess predictive factors for negative appendectomy and to evaluate the outcomes of negative appendectomy. METHODS A retrospective chart review of 4,878 patients who underwent appendectomy at our institution from January 2008 to December 2014 was performed. RESULTS Younger age (≤15 years), normal white blood cell count, appendix diameter of less than 6 mm on computed tomography (CT), and CT grade less than 3 were found to be independent predictive factors for negative appendectomy. When complications were investigated according to the results of pathologic diagnosis, negative appendectomy had more complications than appendectomy for nonperforated appendicitis, and this was statistically significant. CONCLUSIONS When CT findings are equivocal, in deciding to operate for acute appendicitis, additional ultrasonography can be performed. Furthermore, if the patient is younger than 15 years and the white blood cell count is normal, it is recommended to monitor changes in symptoms a little longer rather than operating hastily.
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Affiliation(s)
- Byeong Geon Jeon
- Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Gyeonggi-do, Republic of Korea.
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Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016; 11:34. [PMID: 27437029 PMCID: PMC4949879 DOI: 10.1186/s13017-016-0090-5] [Citation(s) in RCA: 245] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023] Open
Abstract
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
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Affiliation(s)
| | - Arianna Birindelli
- />S. Orsola Malpighi University Hospital – University of Bologna, Bologna, Italy
| | - Micheal D. Kelly
- />Locum Surgeon, Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - Fausto Catena
- />Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Dieter G. Weber
- />Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | | | | | - Mark De Moya
- />Harvard Medical School - Massachusetts General Hospital, Boston, USA
| | - Carlos Augusto Gomes
- />Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil
| | - Aneel Bhangu
- />Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | | | - Ernest E. Moore
- />Denver Health System – Denver Health Medical Center, Denver, USA
| | - Kjetil Soreide
- />Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Ewen Griffiths
- />University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital, Birmingham, UK
| | | | - Jeffry Kashuk
- />Department of Surgery, University of Jerusalem, Jerusalem, Israel
| | - Yoram Kluger
- />Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppaniemi
- />Abdominal Center, University of Helsinki, Helsinki, Finland
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Manne Andersson
- />Department of Surgery, Linkoping University, Linkoping, Sweden
| | | | - Raul Coimbra
- />UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA USA
| | | | | | - Walter Biffl
- />Queen’s Medical Center, University of Hawaii, Honolulu, HI USA
| | | | - Fred Moore
- />University of Florida, Gainesville, USA
| | - Andrew B. Peitzman
- />Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gustavo P. Fraga
- />Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil
| | | | - Ronald V. Maier
- />Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA
| | | | - Zsolt J Balogh
- />Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Cino Bendinelli
- />Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Roberto Cirocchi
- />Department of Surgery, Terni Hospital, University of Perugia, Terni, Italy
| | - Valeria Tonini
- />S. Orsola Malpighi University Hospital – University of Bologna, Bologna, Italy
| | - Alice Piccinini
- />Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy
| | | | - Elio Jovine
- />Department of Surgery, Maggiore Hospital AUSL, Bologna, Italy
| | - Roberto Persiani
- />Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Antonio Biondi
- />Department of Surgery, University of Catania, Catania, Italy
| | | | - Philip Stahel
- />Denver Health System – Denver Health Medical Center, Denver, USA
| | - Rao Ivatury
- />Professor Emeritus Virginia Commonwealth University, Richmond, VA USA
| | - George Velmahos
- />Harvard Medical School - Chief of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
| | - Roland Andersson
- />Department of Surgery, Linkoping University, Linkoping, Sweden
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Sundbom M, Hedberg J. Use of Laparoscopy in Gastrointestinal Surgery in Sweden 1998–2014: A Nationwide Study. Scand J Surg 2016; 106:34-39. [DOI: 10.1177/1457496916630645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background and Aims: One by one, minimally invasive alternatives to established gastrointestinal procedures have become clinical routine. We have studied the use of laparoscopy in four common procedures—cholecystectomy, appendectomy, reflux surgery, and bariatric surgery—as well as in major resectional gastrointestinal surgery in Sweden. Materials and Methods: The National Patient Registry was used to identify all in-hospital procedures performed in patients above the age of 15 during 1998–2014, meeting our inclusion criteria. For each group, the annual number of procedures and proportion of laparoscopic surgery were studied, as well as applicable subgroups. Differences in age, gender, as well as geographical differences were evaluated in the most recent 3-year period (2012–2014). Results: In total, 537,817 procedures were studied, 43% by laparoscopic approach. In 2012–2014, the proportion of laparoscopic surgery ranged from high rates in the four common procedures (cholecystectomy 81%, appendectomy 47%, reflux surgery 72%, and bariatric surgery 97%) to rather low numbers in resectional surgery (4%–10%), however, increasing in the last years. In appendectomy and cholecystectomy, men were less likely to have laparoscopic surgery (42% versus 51% and 74% versus 85%, respectively, p < 0.001). Substantial geographical differences in the use of laparoscopy were also noted, for example, the proportion of laparoscopic appendectomy varied from 11% to 76% among the 21 different Swedish counties. Conclusion: The proportion of laparoscopy was high in the four common procedures and low, but rising, in major resectional surgery. A large variation in the proportion of laparoscopic surgery by age, gender, and place of residence was noted.
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Affiliation(s)
- M. Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J. Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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45
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Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, Wydler J, Clavien PA, Hahnloser D. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications. Langenbecks Arch Surg 2016; 401:643-9. [PMID: 27146319 DOI: 10.1007/s00423-016-1444-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/27/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Negative appendectomies are costly and are embedded with unnecessary risks for the patients. A careful indication for surgery seems mandatory even more so, since conservative therapy emerges as a potential alternative to surgery. The aims of this population-based study were to analyze whether radiological examinations for suspected appendicitis decreased the rate of negative appendectomies without increasing the rate of perforation or worsening postoperative outcomes. METHOD This study is a retrospective analysis of a prospective population-based database. The data collection included preoperative investigations and intraoperative and postoperative outcomes. RESULTS Based on 2559 patients, the rate of negative appendectomies decreased significantly with the use of CT scan as compared to clinical evaluation only (9.3 vs 5 %, p = 0.019), whereas ultrasonography alone was not able to decrease this rate (9.3 vs 6.2 %, p = 0.074). Delaying surgery for radiological investigation did not increase the rate of perforation (18.1 vs 19.2 %; adjusted odds ratio (OR) 1.01; 0.8-1.3; p = 0.899). Postoperative complications (surgical reintervention, postoperative wound infection, postoperative hematoma, postoperative intra-abdominal abscess, postoperative ileus) were all comparable. CONCLUSION In this population-based study, CT scan was the only radiological modality that significantly reduced the rate of negative appendectomy. The delay induced by such additional imaging did not increase perforation nor complication rates. Abdominal CT scans for suspected appendicitis should therefore be more frequently used if clinical findings are unconclusive.
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Affiliation(s)
- M-O Sauvain
- Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - K Slankamenac
- Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
| | - M K Muller
- Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - S Wildi
- Department of Surgery, Waid Hospital, Zürich, Switzerland
| | - U Metzger
- Department of Surgery Triemli Hospital, Zürich, Switzerland
| | - W Schmid
- Hospital Zollikerberg, Zürich, Switzerland
| | - J Wydler
- Hospital Männedorf, Zürich, Switzerland
| | - P-A Clavien
- Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
| | - D Hahnloser
- Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland. .,Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
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Song H, Abnet CC, Andrén-Sandberg Å, Chaturvedi AK, Ye W. Risk of Gastrointestinal Cancers among Patients with Appendectomy: A Large-Scale Swedish Register-Based Cohort Study during 1970-2009. PLoS One 2016; 11:e0151262. [PMID: 26959234 PMCID: PMC4784880 DOI: 10.1371/journal.pone.0151262] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/25/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Removal of the appendix might induce physiological changes in the gastrointestinal tract, and subsequently play a role in carcinogenesis. Therefore, we conducted a nationwide register-based cohort study in Sweden to investigate whether appendectomy is associated with altered risks of gastrointestinal cancers. METHODS A population-based cohort study was conducted using the Swedish national registries, including 480,382 eligible patients followed during the period of 1970-2009 for the occurrence of site-specific gastrointestinal cancer (esophageal/gastric/colon/rectal cancer). Outcome and censoring information was collected by linkage to health and demography registers. We examined the incidence of appendectomy in Sweden using data from 1987-2009. We also calculated standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) to estimate the relative gastrointestinal cancer risk through comparison to the general population. RESULTS We noted an overall decrease in the age-standardized incidence of appendectomy among the entire Swedish population from 189.3 to 105.6 per 100,000 individuals between 1987 and 2009. Grouped by different discharge diagnosis, acute appendicitis, incidental appendectomy, and entirely negative appendectomy continuously decreased over the study period, while the perforation ratio (18%-23%) stayed relatively constant. Compared to the general population, no excess cancer risk was observed for gastrointestinal cancers under study with the exception of a marginally elevated risk for esophageal adenocarcinoma (SIR 1.32, 95% CI 1.09-1.58). CONCLUSIONS In Sweden, the incidence of appendectomy and acute appendicitis has decreased during 1987-2009. No excess gastrointestinal cancer risks were observed among these appendectomized patients, with the possible exception of esophageal adenocarcinoma.
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Affiliation(s)
- Huan Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Åke Andrén-Sandberg
- Department of Digestive Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg 2015; 103:e52-61. [PMID: 26620724 DOI: 10.1002/bjs.10044] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. METHODS This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. RESULTS The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. CONCLUSION Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.
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Affiliation(s)
- K F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - T Veen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386:1278-1287. [PMID: 26460662 DOI: 10.1016/s0140-6736(15)00275-5] [Citation(s) in RCA: 669] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acute appendicitis is one of the most common abdominal emergencies worldwide. The cause remains poorly understood, with few advances in the past few decades. To obtain a confident preoperative diagnosis is still a challenge, since the possibility of appendicitis must be entertained in any patient presenting with an acute abdomen. Although biomarkers and imaging are valuable adjuncts to history and examination, their limitations mean that clinical assessment is still the mainstay of diagnosis. A clinical classification is used to stratify management based on simple (non-perforated) and complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal diagnosis, which is one of the most challenging dilemmas. An observed divide in disease course suggests that some cases of simple appendicitis might be self-limiting or respond to antibiotics alone, whereas another type often seems to perforate before the patient reaches hospital. Although the mortality rate is low, postoperative complications are common in complex disease. We discuss existing knowledge in pathogenesis, modern diagnosis, and evolving strategies in management that are leading to stratified care for patients.
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Affiliation(s)
- Aneel Bhangu
- Academic Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Salomone Di Saverio
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna, Italy
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49
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Salö M, Ohlsson B, Arnbjörnsson E, Stenström P. Appendicitis in children from a gender perspective. Pediatr Surg Int 2015; 31:845-53. [PMID: 26140839 DOI: 10.1007/s00383-015-3729-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND The incidence in appendicitis and the appendectomy rate are different between boys and girls. This study aimed to further evaluate appendicitis in children from a gender perspective. Gender differences in presentation, perioperative care, and outcome after appendectomy were examined. METHOD A single, institution-based, retrospective study was conducted at a tertiary pediatric surgery center. All children <15 years of age who underwent appendectomy for suspected appendicitis or who were conservatively treated for an appendiceal abscess, from 2006 to 2014, were included. Patient demographics, symptoms, preoperative management including time to appendectomy, operative characteristics, and postoperative course including complications and length of hospital stay were evaluated. RESULTS The study included 427 children: 183 girls and 244 boys. The median postoperative follow-up time was 40 (range 1-106) months. The genders did not differ significantly in age, mean weight, symptoms, laboratory results, time to appendectomy, postoperative complications, postoperative pain management, antibiotic treatment, and length of hospital stay. The frequencies of hopping/percussion/coughing tenderness in the right lower quadrant (61 and 51%, p = 0.042), phlegmonous appendicitis (56 and 45%, p = 0.032), perforated appendicitis (18 and 10%, p = 0.043), and open appendectomy (57 and 28%, p = 0.048) were significantly higher in boys. Girls had significantly higher frequencies of preoperative imaging (50 and 38%, p = 0.021), negative appendectomy (18 and 7%, p = 0.005), gangrenous appendicitis (18 and 11%, p = 0.049), and operative complications (7 and 2%, p = 0.015). In girls, the Pediatric Appendicitis Score (PAS) was more specific (59 and 41%, respectively, p = 0.032) and had a greater negative predictive value (33 and 11%, respectively, p = 0.003) than in boys. CONCLUSION In children with appendicitis, there are some gender differences. Girls had negative appendectomies more often, despite having more preoperative imaging and they had operative complications more frequently, despite having less frequent perforations. Boys had a higher frequency of perforation even though their time to appendectomy equaled that of girls. These findings and the reasons behind them must be further studied.
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Affiliation(s)
- Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden,
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Murata A, Mayumi T, Muramatsu K, Ohtani M, Matsuda S. Effect of hospital volume on outcomes of laparoscopic appendectomy for acute appendicitis: an observational study. J Gastrointest Surg 2015; 19:897-904. [PMID: 25595310 DOI: 10.1007/s11605-015-2746-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/05/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study investigated the effect of hospital volume on outcomes of laparoscopic appendectomy for acute appendicitis. METHODS In total, 30,525 patients who underwent laparoscopic appendectomy for acute appendicitis were referred to 825 hospitals in Japan from 2010 to 2012. We compared appendectomy-related complications, length of stay (LOS), and medical costs in relation to hospital volume. For this study period, hospitals were categorized as low-volume hospitals (LVHs, <50 cases), medium-volume hospitals (MVHs, 50-100 cases), or high-volume hospitals (HVHs, >100 cases). RESULTS Significant differences in appendectomy-related complications were observed among the LVHs, MVHs, and HVHs (6.9, 7.2, and 6.0 %, respectively; p = 0.001). Multiple logistic regression revealed that HVHs were associated with a lower relative risk of appendectomy-related complications than were LVHs and MVHs (odds ratio [OR], 0.84; 95 % confidence interval [CI], 0.74-0.95; p = 0.006). Multiple linear regression showed that HVHs were associated with shorter LOS and lower medical costs than were LVHs and MVHs. The unstandardized coefficient for LOS was -0.92 days (95 % CI, -1.07 to -0.78; p < 0.001), whereas that for medical costs was - $167.4 (95 % CI, -256.2 to -78.6; p < 0.001). CONCLUSIONS Hospital volume was significantly associated with laparoscopic appendectomy outcomes.
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Affiliation(s)
- Atsuhiko Murata
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan,
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