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Stewart S, Cruz-Centeno N, Marlor DR, St Peter SD, Oyetunji TA. Bridging the Gap: Pediatric General Surgery for the Pediatrician. Pediatr Rev 2023; 44:632-643. [PMID: 37907417 DOI: 10.1542/pir.2022-005894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
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Wu C, Fields AC, Zhao B, Castillo-Angeles M, Havens JM, Salim A, Askari R, Nitzschke SL. Early surgery for perforated appendicitis: Are we moving the needle on postoperative abscess? Am J Surg 2023; 226:256-260. [PMID: 37210329 DOI: 10.1016/j.amjsurg.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Perforated appendicitis is often managed nonoperatively though upfront surgery is becoming more common. We describe postoperative outcomes for patients undergoing surgery at their index hospitalization for perforated appendicitis. METHODS We used the 2016-2020 National Surgical Quality Improvement Program database to identify patients with appendicitis who underwent appendectomy or partial colectomy. The primary outcome was surgical site infection (SSI). RESULTS 132,443 patients with appendicitis underwent immediate surgery. Of 14.1% patients with perforated appendicitis, 84.3% underwent laparoscopic appendectomy. Intra-abdominal abscess rates were lowest after laparoscopic appendectomy (9.4%). Open appendectomy (OR 5.14, 95% CI 4.06-6.51) and laparoscopic partial colectomy (OR 4.60, 95% CI 2.38-8.89) were associated with higher likelihoods of SSIs. CONCLUSIONS Upfront surgical management of perforated appendicitis is now predominantly approached by laparoscopy, often without bowel resection. Postoperative complications occurred less frequently with laparoscopic appendectomy compared to other approaches. Laparoscopic appendectomy during the index hospitalization is an effective approach to perforated appendicitis.
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Affiliation(s)
- Christine Wu
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Adam C Fields
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Bixiao Zhao
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Stephanie L Nitzschke
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Zorzetti N, Lauro A, Bellini MI, Vaccari S, Dalla Via B, Cervellera M, Cirocchi R, Sorrenti S, D’Andrea V, Tonini V. Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis. World J Gastrointest Surg 2022; 14:1060-1071. [PMID: 36185568 PMCID: PMC9521468 DOI: 10.4240/wjgs.v14.i9.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/22/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to utilize, especially with regards to the endoloop (EL) vs endostapler (ES) when it comes to stump closure.
AIM To compare safety and cost-effectiveness of EL vs ES.
METHODS From a prospectively maintained database, data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) were retrieved. A meta-analysis was performed in terms of surgical complications, in comparison to the international literature published from 1995 to 2021.
RESULTS The meta-analysis showed no evidence regarding wound infections, abdominal abscesses, and total post-operative complications, in terms of superiority of a surgical technique for the stump closure in LA.
CONCLUSION Even when AA is complicated, the routine use of EL is safe in most patients.
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Affiliation(s)
- Noemi Zorzetti
- Department of General Surgery, Ospedale Civile A Costa, Porretta Terme 40046, Italy
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | | | - Samuele Vaccari
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
- Department of General Surgery, Ospedale di Bentivoglio, Bologna 40010, Italy
| | - Barbara Dalla Via
- Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
| | - Maurizio Cervellera
- Department of General Surgery, Ospedale Santissima Annunziata, Taranto 74121, Italy
| | - Roberto Cirocchi
- Department of General Surgery, Ospedale di Terni, Università di Perugia, Terni 05100, Italy
| | | | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | - Valeria Tonini
- Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
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Arakawa S, Kato H, Asano Y, Horiguchi A, Yamamoto M, Miura F, Okamoto K, Kimura Y, Sakaguchi T, Yoshida M. Emergency appendectomy versus elective appendectomy following conservative treatment for acute appendicitis: a multicenter retrospective clinical study by the Japanese Society for Abdominal Emergency Medicine. Surg Today 2022; 52:1607-1619. [PMID: 35695921 DOI: 10.1007/s00595-022-02526-3] [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: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To establish the best treatment strategy for acute appendicitis. METHODS We collected data on 2142 appendectomies performed in 2017 and compared the backgrounds and surgical outcomes of patients who underwent early surgery (ES) (< 48 h) with those managed with non-ES (> 48 h). We performed a risk factor analysis to predict postoperative complications and subgroup analysis to propose a standard treatment strategy. RESULTS The incidence of postoperative complications was significantly higher in the ES group than in the non-ES group, and significantly lower in the laparoscopic surgery group than in the laparotomy group. Surgical outcomes, including the incidence of postoperative complications, were comparable after acute surgery (< 12 h) and subacute surgery (12-48 h), following antibiotic treatment. The risk factors for postoperative complications in the ES group were a higher age, history of abdominal surgery, perforation, high C-reactive protein level, histological evidence of gangrenous or perforated appendicitis, a long operation time, and intraoperative complications. The risk factors for postoperative complications in the non-ES group were perforation and unsuccessful conservative treatment. CONCLUSIONS Non-early appendectomy is feasible for acute appendicitis but should be applied with care in patients with risk factors for postoperative complications or failure of pretreatment, including diabetes mellitus, abscess formation, and perforation.
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Affiliation(s)
- Satoshi Arakawa
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan.
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | | | - Fumihiko Miura
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata, Hospital, Kitakyushu, Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takanori Sakaguchi
- Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan
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Yamada T, Endo H, Hasegawa H, Kimura T, Kakeji Y, Koda K, Ishida H, Sakamoto K, Hirata K, Yamamoto H, Miyata H, Matsuda A, Yoshida H, Kitagawa Y. Risk of emergency surgery for complicated appendicitis: Japanese nationwide study. Ann Gastroenterol Surg 2021; 5:236-242. [PMID: 33860144 PMCID: PMC8034695 DOI: 10.1002/ags3.12408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/02/2020] [Accepted: 10/10/2020] [Indexed: 12/12/2022] Open
Abstract
AIM Appendicitis is divided into two categories: complicated appendicitis (CA) and uncomplicated appendicitis (UA). In pediatric patients with CA, the use of interval appendectomy (IA), which is non-operative management followed by elective surgery, has decreased the number of postoperative complications. Before discussing the merit of IA for adult patients, we need to clarify whether the frequency and seriousness of the complication rate after emergency surgery is higher for CA than for UA. METHODS This retrospective cohort study included adult patients who underwent appendectomy and who were registered in the National Clinical Database (NCD) from 2014 to 2016. Patients with CA who underwent emergency appendectomy comprised the CA group. Patients with UA comprised the UA group. Patients with chronic or recurrent appendicitis who underwent elective appendectomy comprised the elective appendectomy (EA) group. Primary outcomes were all morbidity, serious morbidity, and mortality within 30 days after appendectomy. RESULTS We included 109 256 patients in the study: 14 798 CA, 86 876 UA, and 7582 EA patients. Compared with the UA group, the rates of all morbidity, serious morbidity, and mortality were significantly higher in the CA group. All morbidity, serious morbidity, and mortality rates were significantly lower in the EA group than in the other two groups. CONCLUSIONS We confirmed that emergency surgery for CA places the patient at relatively higher risk. We also showed that the risk associated with EA is significantly lower than that for the other methods.
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Affiliation(s)
- Takeshi Yamada
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Hideki Endo
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroshi Hasegawa
- Project Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Toshimoto Kimura
- Project Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Keiji Koda
- Department of SurgeryTeikyo University Chiba Comprehensive Medical CenterChibaJapan
| | - Hideyuki Ishida
- Department of Digestive Tract and General SurgerySaitama Medical UniversitySaitamaJapan
| | - Kazuhiro Sakamoto
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Keiji Hirata
- Department of Surgery 1University of Occupational and Environmental HealthKitakyushuJapan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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Zorzetti N, Lauro A, Vaccari S, Ussia A, Brighi M, D'andrea V, Cervellera M, Tonini V. A systematic review on the cost evaluation of two different laparoscopic surgical techniques among 996 appendectomies from a single center. Updates Surg 2020; 72:1167-1174. [PMID: 32474801 DOI: 10.1007/s13304-020-00817-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/20/2020] [Indexed: 02/08/2023]
Abstract
Acute appendicitis is one of the main indications for urgent surgery representing a high-volume procedure worldwide. The current spending review in Italy (and not only in this country) affects the health service and warrants care regarding the use of different surgical devices. The aim of our study is to perform a cost evaluation, comparing the use of endoloops and staplers in complicated acute appendicitis (phlegmonous and gangrenous), taking into consideration the cost of the device in relation to the management of any associated postoperative complications. We retrospectively evaluated 996 laparoscopic appendectomies of adult patients performed in the Emergency General Surgery-St. Orsola University Hospital in Bologna (Italy). Surgical procedures together with the related choice of using endoloops or staplers were performed by attending surgeons or resident surgeons supervised by a tutor. A systematic review was performed to compare our outcomes with those reported in the literature. In our experience, the routine use of endoloop leads to a real estimated saving of 375€ for each performed laparoscopic appendectomy, even considering post-operative complications. Comparing endoloop and stapler groups, the total number of complications is significantly lower in the endoloop group. Our systematic review confirmed these findings even if the superiority of one technique has not been proved yet. Our analysis shows that the routine use of endoloop is safe in most patients affected by acute appendicitis, even when complicated, and it is a cost-effective device even when taking into consideration extra costs for potential post-operative complications.
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Affiliation(s)
- Noemi Zorzetti
- Department of General Surgery, "Santa Maria Delle Croci" Hospital, Ravenna, Italy.
| | - Augusto Lauro
- Emergency General Surgery, St. Orsola University Hospital, Bologna, Italy
| | - Samuele Vaccari
- Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
| | - Alessandro Ussia
- Emergency General Surgery, St. Orsola University Hospital, Bologna, Italy
| | - Manuela Brighi
- Emergency General Surgery, St. Orsola University Hospital, Bologna, Italy
| | - Vito D'andrea
- Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
| | | | - Valeria Tonini
- Emergency General Surgery, St. Orsola University Hospital, Bologna, Italy
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Pregnant patients requiring appendectomy: comparison between open and laparoscopic approaches in NY State. Surg Endosc 2020; 35:4681-4690. [PMID: 32926252 DOI: 10.1007/s00464-020-07911-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Even though acute appendicitis is the most common general surgical condition encountered during pregnancy, the preferred approach to appendectomy in pregnant patients remains controversial. Current guidelines support laparoscopic appendectomy as the treatment of choice for pregnant women with appendicitis, regardless of trimester. However, recent published data suggests that the laparoscopic approach contributes to higher rates of fetal demise. Our study aims to compare laparoscopic and open appendectomy in pregnancy at a statewide population level. METHODS ICD-9 codes were used to extract 1006 pregnant patients undergoing appendectomy between 2005 and 2014 from the NY Statewide Planning and Research Cooperative System (SPARCS) database. Surgical outcomes (any complications, 30-day readmission rate, length of stay (LOS)) and obstetrical outcomes (antepartum hemorrhage, preterm delivery, cesarean section, sepsis, chorioamnionitis) were compared between open and laparoscopic appendectomy. Multivariable generalized linear regression models were used to compare different outcomes between two surgical approaches after adjusting for possible confounders. RESULTS The laparoscopic cohort (n = 547, 54.4%) had significantly shorter LOS than the open group (median ± IQR: 2.00 ± 2.00 days versus 3.00 ± 2.00 days, p value < 0.0001, ratio = 0.789, 95% CI 0.727-0.856). Patients with complicated appendicitis had longer LOS than those with simple appendicitis (p value < 0.0001, ratio = 1.660, 95% CI 1.501-1.835). Obstetrical outcomes (p value = 0.097, OR 1.254, 95% CI 0.961-1.638), 30-day non-delivery readmission (p value = 0.762, OR 1.117, 95% CI 0.538-2.319), and any complications (p value = 0.753, OR 0.924, 95% CI 0.564-1.517) were not statistically significant between the laparoscopic versus open appendectomy groups. Three cases of fetal demise occurred, all within the laparoscopic appendectomy group. CONCLUSIONS The laparoscopic approach resulted in a shorter LOS. Although fetal demise only occurred in the laparoscopic group, these results were not significant (p value = 0.255). Our large population-based study further supports current guidelines that laparoscopic appendectomy may offer benefits over open surgery for pregnant patients in any trimester due to reduced time in the hospital and fetal and maternal outcomes comparable to open appendectomy.
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Elsamna ST, Hasan S, Shapiro ME, Merchant AM. Factors Contributing to Extended Hospital Length of Stay in Emergency General Surgery †. J INVEST SURG 2020; 34:1399-1406. [PMID: 32791866 DOI: 10.1080/08941939.2020.1805829] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emergency general surgery (EGS) is a field characterized by disproportionately high costs, post-operative mortality, and complications. We attempted to identify independent factors predictive of an increased postoperative length of stay (LOS), a key contributor to economic burden and worse outcomes. METHODS The ACS-NSQIP database was queried for data from2005 to 2017. Current procedural terminology (CPT) codes were used to identify the most commonly performed EGS procedures: appendectomy, bowel resection, colectomy, and cholecystectomy. Cohorts above and below 75th percentile LOS were determined, compared by preoperative variables, and evaluated with univariate and multivariate logistic regression to quantify risk. RESULTS Of 267,495 cases, 70,703 cases were above the 75th percentile for LOS. A larger proportion of patients in the extended LOS group were 41 years or older (88.6% vs 45.7%). More Blacks (10.3% vs 6.7%) were observed in the extended LOS group. Age, race, cardiopulmonary, hepatic, and renal disease, diabetes, recent weight loss, steroid use, and sepsis history were significant factors on multivariate analysis but varied in terms of risk proportion by procedure. Age (61+), Black race, hypertension, sepsis, and cancer were significant for all 4 procedures. CONCLUSIONS Several factors are independently associated with extended LOS for those undergoing the most common EGS procedures. Five of these were associated with an increased LOS for all four procedures. These included, age (61+), hypertension, sepsis, cancer, and Black race.
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Affiliation(s)
- Samer T Elsamna
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Saif Hasan
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Michael E Shapiro
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aziz M Merchant
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Baum P, Diers J, Lichthardt S, Kastner C, Schlegel N, Germer CT, Wiegering A. Mortality and Complications Following Visceral Surgery: A Nationwide Analysis Based on the Diagnostic Categories Used in German Hospital Invoicing Data. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:739-746. [PMID: 31774053 DOI: 10.3238/arztebl.2019.0739] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 06/24/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The in-hospital mortality after visceral surgery in Germany is unknown. METHODS In this retrospective, descriptive analysis, nationwide hospital billing data based on diagnosis-related groups (DRG) over the period 2009-2015 were studied to determine the in-hospital mortality, complications and their management, and deaths after documented severe complications (failure to rescue, FTR) after visceral surgery in Germany. Organ-system subgroups were defined and subdivided into frequent operations (inguinal hernia repair, appendectomy, thyroid operations, cholecystec- tomy), colorectal operations, and complex operations (surgery of the esophagus, pancreas, liver, and stomach). RESULTS 3 287 199 patients from 1392 hospitals were included in the analysis. The in-hospital mortality after visceral surgery was 1.9%. The lowest mortality was after the frequently performed operations (0.04-0.4%), the highest after complex surgery of the esophagus (8.6%) and stomach (11.7%). Severe complications were most commonly seen after complex surgery of the pan- creas (27.7%), liver (24.3%), esophagus (37.8%), and stomach (36.7%). 90.6% of deaths occurred after colorectal or complex operations, which together accounted for 23% of all operations. The FTR rate was 8.4% after appendectomy and cholecystec- tomy (95% confidence interval [8.34; 8.46]) and 20.3% after esophageal surgery ([19.8; 20.8]). CONCLUSION In Germany, in-hospital mortality after visceral surgery is not uncommon, with a frequency of nearly 2%. Improved complication management after complex operations appears necessary. A limitation of this study is the identification of compli- cations from anonymized billing data.
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Affiliation(s)
- Philip Baum
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery University Hospital of Würzburg; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg; Biochemistry and Molecular Biology, University of Würzburg
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Westfall KM, Charles AG. Risk of Perforation in the Era of Nonemergent Management for Acute Appendicitis. Am Surg 2020. [DOI: 10.1177/000313481908501124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to perforation. Recently, studies have suggested nonemergent management of acute appendicitis. Our study aimed to determine changes in risk of rupture and complications in patients with appendicitis, with increasing time from symptom onset to treatment. Retrospective study of patients aged ≥18 years presenting to the University of North Carolina Hospitals with signs and symptoms of acute appendicitis who subsequently underwent appendectomy from 2011 to 2015 was performed. Demographic, clinical, laboratory, and pathologic data were reviewed. Bivariate analysis was performed to assess variables associated with increased risk of perforation. Poisson regression modeling was completed to evaluate the risk of perforation and postoperative abscess based on time from symptoms to treatment. Within our database of 1007 patients, the mean time from onset of symptoms to operative intervention was 3.24 ± 2.2 days. Modified Poisson regression modeling demonstrated the relative risk for perforation increases by 9% (RR 1.09, P < 0.001) for each day delay. Age (RR 1.03), male gender (RR 1.50), temperature on admission (RR 1.32), and the presence of fecalith (RR 1.89) statistically significantly increased the risk of perforation. Furthermore, for each day delay, there is an 8% increased risk of postoperative abscess (RR 1.08, P = 0.027). The relative risk for appendiceal perforation is 9 per cent per day delay with a resultant 8 per cent increased risk of postoperative abscess. Thus, appendectomy for acute appendicitis should remain an emergent procedure, given that delays in operative management lead to complications and increases in cost of care.
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Affiliation(s)
- Kristen M. Westfall
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anthony G. Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
OBJECTIVE To explore geographic variations in Irish laparoscopic and open appendectomy procedures. DESIGN Analysis based on 2014-2017 administrative hospital data from public hospitals. SETTING Counties of Ireland. PARTICIPANTS Irish residents with hospital admissions for an appendectomy as the principal procedure. MAIN OUTCOME MEASURES Age and gender standardised laparoscopic and open appendectomy rates for 26 counties. Geographic variation measured with the extremal quotient (EQ), coefficient of variation (CV) and the systematic component of variation (SCV). RESULTS 23 684 appendectomies were included. 77.6% (n= 18,387) were performed laparoscopically. An EQ of 8.3 for laparoscopy and 10.0 for open appendectomy was determined. A high CV was demonstrated with a value of 36.7 and 80.8 for laparoscopic and open appendectomy, respectively. An SCV of 14.2 and 124.8 for laparoscopic and open appendectomy was observed. A wider variation was determined when children and adults were assessed separately. CONCLUSIONS The geographic distribution in rates of appendectomy varies considerably across Irish counties. Our data suggest that a patient's likelihood of undergoing a laparoscopic or open appendectomy is associated with their county of residence.
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Affiliation(s)
- Ola Ahmed
- General Surgery, Wexford General Hospital, Wexford, Ireland
| | - Ken Mealy
- General and Colorectal Surgery, Wexford General Hospital, Wexford, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Patel SV, Nanji S, Brogly SB, Lajkosz K, Groome PA, Merchant S. High complication rate among patients undergoing appendectomy in Ontario: a population-based retrospective cohort study. Can J Surg 2019; 61:412-417. [PMID: 30265637 DOI: 10.1503/cjs.011517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Appendectomy is a common emergency procedure. The risks have been reported in previous studies but often are limited to inpatient complications. The purpose of this study was to describe inpatient and outpatient rates of complications associated with appendectomy in a contemporary population-based cohort and explore factors associated with these complications. METHODS We conducted a retrospective study using linked data for Ontario within Institute for Clinical Evaluative Sciences databases. Patients who underwent emergent appendectomy between 2009 and 2014 were included. The primary outcome was a complication (death, readmission, emergency department visit, lengthy [> 7 d] hospital stay, percutaneous abscess drainage, reoperation or 1 of the predefined complication codes) occurring within 30 days of surgery. We used modified Poisson regression to identify predictors of complications. RESULTS A total of 50 369 patients underwent emergent appendectomy over the study period, of whom 16 953 (33.7%) had a perforated appendix. Overall, 14 451 patients (28.7%) (8428 [25.2%] in the nonperforated group and 6023 [35.5%] in the perforated group) had at least 1 complication. The most common complication was an emergency department visit (7942 patients [15.8%]), followed by surgical site infection (4792 [9.5%]). Increasing age, female sex, rural residence, perforation status, daytime surgery and open surgical technique were associated with increased risk of complications. CONCLUSION We found a higher rate of complications after appendectomy than previously reported. The most common complication was presentation to the emergency department. Our definition of complications is more inclusive than in previous studies and provides a deeper understanding of complications after appendectomy.
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Affiliation(s)
- Sunil V Patel
- From the Department of Surgery, Kingston Health Sciences Centre, Kingston, Ont. (Patel, Nanji, Brogly, Merchant); the Faculty of Health Sciences, Queen's University, Kingston, Ont. (Patel, Nanji, Merchant); the Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ont. (Lajkosz, Groome); and the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Groome)
| | - Sulaiman Nanji
- From the Department of Surgery, Kingston Health Sciences Centre, Kingston, Ont. (Patel, Nanji, Brogly, Merchant); the Faculty of Health Sciences, Queen's University, Kingston, Ont. (Patel, Nanji, Merchant); the Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ont. (Lajkosz, Groome); and the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Groome)
| | - Susan B Brogly
- From the Department of Surgery, Kingston Health Sciences Centre, Kingston, Ont. (Patel, Nanji, Brogly, Merchant); the Faculty of Health Sciences, Queen's University, Kingston, Ont. (Patel, Nanji, Merchant); the Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ont. (Lajkosz, Groome); and the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Groome)
| | - Katherine Lajkosz
- From the Department of Surgery, Kingston Health Sciences Centre, Kingston, Ont. (Patel, Nanji, Brogly, Merchant); the Faculty of Health Sciences, Queen's University, Kingston, Ont. (Patel, Nanji, Merchant); the Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ont. (Lajkosz, Groome); and the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Groome)
| | - Patti A Groome
- From the Department of Surgery, Kingston Health Sciences Centre, Kingston, Ont. (Patel, Nanji, Brogly, Merchant); the Faculty of Health Sciences, Queen's University, Kingston, Ont. (Patel, Nanji, Merchant); the Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ont. (Lajkosz, Groome); and the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Groome)
| | - Shaila Merchant
- From the Department of Surgery, Kingston Health Sciences Centre, Kingston, Ont. (Patel, Nanji, Brogly, Merchant); the Faculty of Health Sciences, Queen's University, Kingston, Ont. (Patel, Nanji, Merchant); the Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ont. (Lajkosz, Groome); and the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Groome)
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Abstract
Nearly 3 million patients are hospitalized every year for emergent gastrointestinal (GI) surgical problems and nearly one third of those will require surgery. This article reviews the scope of GI surgical emergencies within the context of emergency general surgery (EGS), costs of care, overview of several common GI surgical problems, and traditional and emerging treatment modalities. This article also argues for ongoing work in the area of risk assessment for EGS, and describes quality metrics as well as outcomes of care for these patients.
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14
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Childers CP, Dworsky JQ, Maggard-Gibbons M, Russell MM. The contemporary appendectomy for acute uncomplicated appendicitis in adults. Surgery 2019; 165:593-601. [PMID: 30385123 DOI: 10.1016/j.surg.2018.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/31/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
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15
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Choi SJ, Chae G, Park SB, Hong SK, Kim YH, Moon SB, Kim SY, Kim H. Horseshoe appendix identified during laparoscopic appendectomy: A case report and literature review. Medicine (Baltimore) 2019; 98:e14104. [PMID: 30702564 PMCID: PMC6380734 DOI: 10.1097/md.0000000000014104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE The horseshoe anomaly of the vermiform appendix is extremely rare. Preoperative confirmation of this anomaly is difficult; therefore, routine procedures, such as appendectomy, may become unexpectedly challenging when such anomalies are encountered during the surgical process. PATIENT CONCERNS A 33-year-old man presented with abdominal pain in the right lower abdomen owing to acute appendicitis confirmed via computed tomography. Immediate laparoscopic appendectomy was decided as the method for treatment. DIAGNOSIS Horseshoe anomaly was diagnosed as a gross finding during surgery. INTERVENTION First, the appendiceal base was resected and appendectomy was performed via the retrograde method because the appendiceal tip was curled behind the cecum. However, it was discovered that the appendiceal tip was connected to the lateral part of the ascending colon and showed a horseshoe-shaped anomaly. The second appendiceal base arising from the ascending colon was also ligated, and the appendectomy was completed without any further complications. OUTCOMES After successful completion of appendectomy, the patient was discharged without any complications 2 days later. LESSONS An appendiceal anomaly is rarely seen during appendectomy or other forms of abdominal surgery; however, the ability of surgeons to both recognize and categorize an appendiceal anomaly is crucial if detected during surgery. After successfully recognizing the horseshoe anomaly of the appendix, it is important to know that 2 appendiceal base ligations will be required to complete the surgery successfully.
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16
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Dumas RP, Subramanian M, Hodgman E, Arevalo M, Nguyen G, Li K, Aijwe T, Williams B, Eastman A, Luk S, Minshall C, Cripps M. Laparoscopic Appendectomy: A Report on 1164 Operations at a Single-Institution, Safety-Net Hospital. Am Surg 2018. [DOI: 10.1177/000313481808400674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Laparoscopic appendectomy (LA) is the standard of care for the treatment of acute appendicitis. There is an ongoing debate regarding the optimal management of appendicitis, which led us to study outcomes after an appendectomy at a large safety-net hospital. We hypothesize that despite a high-risk population, LA remains a safe and effective treatment for acute appendicitis. A retrospective review was performed of all patients who underwent an appendectomy from 2011 to 2013. The primary end point was significant morbidity defined as a score of three or greater on the Clavien-Dindo scale of surgical morbidity. Thousand hundred and sixty-four patients underwent an appendectomy. A total of 1102 (94.7%) patients underwent either an LA or laparoscopic converted to open appendectomy, and 62 (5.3%) patients underwent an open appendectomy (OA). Two hundred and forty six patients (21.1%) had complicated appendicitis. Laparoscopic converted to OA conversion rate was 4.4 per cent and differed between years (P < 0.001). LA had a significantly shorter length of stay, shorter length of postoperative antibiotics, and less postoperative morbidity. When limited to only patients with complicated appendicitis, major morbidity was still greater in the OA group (22.6 vs 52.0%, P = 0.001). Length of stay was significantly longer in the OA group [3.42 (2.01, 5.97) vs 7.04 (5.05, 10.13), P < 0.001]. Odds for complication were 2.6 times greater in the OA group compared with the LA group. In the absence of peritonitis and systemic illness necessitating urgent laparotomy, patients who are laparoscopic surgical candidates should be offered an LA. Our study demonstrates that these patients have better outcomes and shorter hospital stays.
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Affiliation(s)
- Ryan P. Dumas
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Madhu Subramanian
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erica Hodgman
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michelle Arevalo
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gabriella Nguyen
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Li
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tochi Aijwe
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brian Williams
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander Eastman
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Luk
- From the University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Michaelw Cripps
- From the University of Texas Southwestern Medical Center, Dallas, Texas
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17
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DiBrito SR, Olorundare IO, Holscher CM, Landazabal CS, Orandi BJ, Dagher NN, Segev DL, Garonzik-Wang J. Surgical approach, cost, and complications of appendectomy in kidney transplant recipients. Clin Transplant 2018; 32:e13245. [PMID: 29577448 DOI: 10.1111/ctr.13245] [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] [Accepted: 03/19/2018] [Indexed: 12/17/2022]
Abstract
Kidney transplant recipients (KTRs) have greater morbidity and length of stay (LOS) following certain surgical procedures than non-KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2 640 247 non-KTR postappendectomy at transplant and nontransplant centers in the United States from 2000 to 2011, using NIS data and adjusting for patient-level and hospital-level factors. Postoperative complications were identified using ICD-9 codes. Among KTR, there were no post-appendectomy in-hospital deaths, compared to a 0.2% in non-KTR (P = .5). Overall complications were similar among KTR and non-KTR (17.0% vs 11.6%; aOR:0.77 1.121.61 ). LOS and costs were greater for KTR compared to non-KTR (LOS ratio 1.19 1.311.45 ; cost ratio 1.11 1.171.26 ). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non-KTR, but had similar complication rates (10.6 vs 8.7%, P = .5). When treated at transplant centers, KTR had similar complications (aOR 0.44 0.791.43 ), but longer LOS (ratio 1.21 1.371.55 ) and greater hospital-associated costs (ratio 1.19 1.291.41 ) than non-KTR. Conversely, at nontransplant centers, KTR and non-KTR had similar complications (aOR 0.75 1.232.0 ), LOS (ratio 0.84 0.961.09 ), and cost (ratio 0.93 1.011.10 ). Contrary to other procedures, KTR did not constitute a high-risk group for patients undergoing appendectomy.
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Affiliation(s)
- Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Israel O Olorundare
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claudia S Landazabal
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Babak J Orandi
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Nabil N Dagher
- NYU Langone Medical Center, Transplant Institute, New York, NY, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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18
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Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, Coccolini F, Vijayan D, Abbas A, Abongwa HK, Agboola J, Ahmed A, Akhmeteli L, Akkapulu N, Akkucuk S, Altintoprak F, Andreiev AL, Anyfantakis D, Atanasov B, Bala M, Balalis D, Baraket O, Bellanova G, Beltran M, Melo RB, Bini R, Bouliaris K, Brunelli D, Castillo A, Catani M, Che Jusoh A, Chichom-Mefire A, Cocorullo G, Coimbra R, Colak E, Costa S, Das K, Delibegovic S, Demetrashvili Z, Di Carlo I, Kiseleva N, El Zalabany T, Faro M, Ferreira M, Fraga GP, Gachabayov M, Ghnnam WM, Giménez Maurel T, Gkiokas G, Gomes CA, Griffiths E, Guner A, Gupta S, Hecker A, Hirano ES, Hodonou A, Hutan M, Ioannidis O, Isik A, Ivakhov G, Jain S, Jokubauskas M, Karamarkovic A, Kauhanen S, Kaushik R, Kavalakat A, Kenig J, Khokha V, Khor D, Kim D, Kim JI, Kong V, Lasithiotakis K, Leão P, Leon M, Litvin A, Lohsiriwat V, López-Tomassetti Fernandez E, Lostoridis E, Maciel J, Major P, Dimova A, Manatakis D, Marinis A, Martinez-Perez A, Marwah S, McFarlane M, Mesina C, Pędziwiatr M, Michalopoulos N, Misiakos E, Mohamedahmed A, Moldovanu R, Montori G, Mysore Narayana R, Negoi I, Nikolopoulos I, Novelli G, Novikovs V, Olaoye I, et alSartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, Coccolini F, Vijayan D, Abbas A, Abongwa HK, Agboola J, Ahmed A, Akhmeteli L, Akkapulu N, Akkucuk S, Altintoprak F, Andreiev AL, Anyfantakis D, Atanasov B, Bala M, Balalis D, Baraket O, Bellanova G, Beltran M, Melo RB, Bini R, Bouliaris K, Brunelli D, Castillo A, Catani M, Che Jusoh A, Chichom-Mefire A, Cocorullo G, Coimbra R, Colak E, Costa S, Das K, Delibegovic S, Demetrashvili Z, Di Carlo I, Kiseleva N, El Zalabany T, Faro M, Ferreira M, Fraga GP, Gachabayov M, Ghnnam WM, Giménez Maurel T, Gkiokas G, Gomes CA, Griffiths E, Guner A, Gupta S, Hecker A, Hirano ES, Hodonou A, Hutan M, Ioannidis O, Isik A, Ivakhov G, Jain S, Jokubauskas M, Karamarkovic A, Kauhanen S, Kaushik R, Kavalakat A, Kenig J, Khokha V, Khor D, Kim D, Kim JI, Kong V, Lasithiotakis K, Leão P, Leon M, Litvin A, Lohsiriwat V, López-Tomassetti Fernandez E, Lostoridis E, Maciel J, Major P, Dimova A, Manatakis D, Marinis A, Martinez-Perez A, Marwah S, McFarlane M, Mesina C, Pędziwiatr M, Michalopoulos N, Misiakos E, Mohamedahmed A, Moldovanu R, Montori G, Mysore Narayana R, Negoi I, Nikolopoulos I, Novelli G, Novikovs V, Olaoye I, Omari A, Ordoñez CA, Ouadii M, Ozkan Z, Pal A, Palini GM, Partecke LI, Pata F, Pędziwiatr M, Pereira Júnior GA, Pintar T, Pisarska M, Ploneda-Valencia CF, Pouggouras K, Prabhu V, Ramakrishnapillai P, Regimbeau JM, Reitz M, Rios-Cruz D, Saar S, Sakakushev B, Seretis C, Sazhin A, Shelat V, Skrovina M, Smirnov D, Spyropoulos C, Strzałka M, Talving P, Teixeira Gonsaga RA, Theobald G, Tomadze G, Torba M, Tranà C, Ulrych J, Uzunoğlu MY, Vasilescu A, Occhionorelli S, Venara A, Vereczkei A, Vettoretto N, Vlad N, Walędziak M, Yilmaz TU, Yuan KC, Yunfeng C, Zilinskas J, Grelpois G, Catena F. Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Surg 2018; 13:19. [PMID: 29686725 PMCID: PMC5902943 DOI: 10.1186/s13017-018-0179-0] [Show More Authors] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/04/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. METHODS This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. RESULTS A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. CONCLUSIONS The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.
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Affiliation(s)
| | - Gian L. Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Francesco Ferrara
- General Surgery and Polytrauma, San Carlo Borromeo Hospital, Milan, Italy
| | - Francesco M. Labricciosa
- Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, UNIVPM, Ancona, Italy
| | - Luca Ansaloni
- Department of Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Deepak Vijayan
- General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ashraf Abbas
- Emergency Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - John Agboola
- Surgery, Kwara State General Hospital, Ilorin, Kwara Nigeria
| | - Adamu Ahmed
- Surgery, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
| | | | - Nezih Akkapulu
- General Surgery, Baskent Universitesi Adana Eğitim ve Uygulama Hastanesi, Adana, Turkey
| | - Seckin Akkucuk
- General Surgery, Training and Research Hospital of Mustafa Kemal University, Hatay, Turkey
| | - Fatih Altintoprak
- General Surgery, Sakarya University School of Medicine, Sakarya, Turkey
| | - Aurelia L. Andreiev
- General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Boiko Atanasov
- Department of General Surgery, Medical University of Plovdiv, UMHAT Eurohospital, Plovdiv, Bulgaria
| | - Miklosh Bala
- General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Dimitrios Balalis
- Surgical Department, Agios Savvas Anticaner Hospital, Athens, Greece
| | - Oussama Baraket
- General Surgery, Hospital Habib Bouguefa de Bizerte, Bizerte, Tunisia
| | | | - Marcelo Beltran
- Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | | | - Roberto Bini
- General and Emergency Surgery, San Giovanni Bosco Hospital, Turin, Italy
| | | | | | - Adrian Castillo
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Marco Catani
- DEA, La Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Asri Che Jusoh
- General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
| | | | - Gianfranco Cocorullo
- Emergency Surgery, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Raul Coimbra
- Trauma/Acute Care Surgery, University of California San Diego, San Diego, USA
| | - Elif Colak
- General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Silvia Costa
- Surgery, CHVNG/E, EPE, Vila Nova de Gaia, Portugal
| | - Koray Das
- General Surgery, Numune Training and Research Hospital, Adana, Turkey
| | - Samir Delibegovic
- Colorectal Surgery, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | - Nadezda Kiseleva
- General and Emergency Surgery, Riga East University Hospital “Gailezers”, Riga, Latvia
| | | | - Mario Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo Andreì, SP Brazil
| | | | - Gustavo P. Fraga
- Division of Trauma Surgery, Hospital de Clinicas, University of Campinas (Unicamp), Campinas, Brazil
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Wagih M. Ghnnam
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Teresa Giménez Maurel
- Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Georgios Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos A. Gomes
- Surgery, Therezinha de Jesus University Hospital, Juiz de Fora, Brazil
| | - Ewen Griffiths
- Upper GI/General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ali Guner
- Department of General Surgery, Karadeniz Technical University, Farabi Hospital, Trabzon, Turkey
| | - Sanjay Gupta
- Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital, Giessen, Germany
| | - Elcio S. Hirano
- Division of Trauma Surgery, Hospital de Clinicas, University of Campinas (Unicamp), Campinas, Brazil
| | | | - Martin Hutan
- Surgical Department, Landesklinikum Hainburg, Hainburg An Der Donau, Austria
| | - Orestis Ioannidis
- 4th Surgical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- General Hospital “George Papanikoalou”, Thessaloniki, Greece
| | - Arda Isik
- General Surgery, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | | | - Sumita Jain
- Surgery, S M S Medical college, Jaipur, India
| | - Mantas Jokubauskas
- Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | | | - Saila Kauhanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Robin Kaushik
- Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Alfie Kavalakat
- General Surgery, Jubilee Mission Medical College & Research Institute, Thrissur, India
| | - Jakub Kenig
- 3rd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Desmond Khor
- Acute Care Surgery, LAC+USC Medical Center, California, USA
| | - Dennis Kim
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Jae I. Kim
- Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Victor Kong
- Department of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | | | - Pedro Leão
- General Surgery, Colorectal Unit, Hospital de Braga, Braga, Portugal
| | - Miguel Leon
- General and Digestive Surgery, Hospital Fundación Jimenez Diaz, Madrid, Spain
| | - Andrey Litvin
- Surgical Disciplines, Regional Clinical Hospital, Kaliningrad, Russia
| | - Varut Lohsiriwat
- Faculty of Medicine, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - James Maciel
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Piotr Major
- 2nd Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Ana Dimova
- Clinic of surgery, Department of Gastrointestinal Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | | | - Aleix Martinez-Perez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sanjay Marwah
- Department of General Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- Department of Surgery, Radiology, Anaesthetics and Intensive Care, University of the West Indies, Kingston, Jamaica
- University Hospital of the West Indies, Kingston, Jamaica
| | - Cristian Mesina
- Department of Surgery Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
| | - Michał Pędziwiatr
- Department of General Surgery and Emergency Medicine, University Hospital, Kraków, Poland
| | | | - Evangelos Misiakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Radu Moldovanu
- Department of Visceral, Digestive and Oncologic Surgery, Clinique Sainte Marie, Cambrai, France
| | | | | | - Ionut Negoi
- General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | | | - Viktors Novikovs
- General and Emergency Surgery, Riga East University Hospital “Gailezers”, Riga, Latvia
| | - Iyiade Olaoye
- Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Abdelkarim Omari
- General Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Carlos A. Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad del Valle, Cali, Colombia
| | - Mouaqit Ouadii
- Surgery Departement, Medical School of Fezm, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Zeynep Ozkan
- General Surgery, Elazig Training and Research Hospital, Elazig, Turkey
| | - Ajay Pal
- General Surgery, King George’s Medical University, Lucknow, India
| | - Gian M. Palini
- General, Emergency Surgery, Infermi Hospital, Rimini, Italy
| | | | - Francesco Pata
- Department of General Surgery, Sant’Antonio Abate Hospital, Gallarate, Italy
| | - Michał Pędziwiatr
- Department of Emergency Surgery and Trauma Centre, University Hospital, Kraków, Poland
| | | | - Tadeja Pintar
- Abdominal surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Magdalena Pisarska
- Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, The University Hospital in Krakow, Kraków, Poland
| | | | | | - Vinod Prabhu
- Surgery, Bharati Vidyapeeth Deemed University Medical College & Hospital, Sangli, Maharashtra India
| | | | | | - Marianne Reitz
- General Surgery, Hospital Municipal Dr. Jose de Carvalho Florence, Sao Jose Dos Campos, Brazil
| | - Daniel Rios-Cruz
- General Surgery, Hospital General Regional # 1 I.M.S.S, Cuernavaca, Mexico
| | - Sten Saar
- Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Boris Sakakushev
- General Surgery, University Hospital St George, Plovdiv, Bulgaria
| | | | | | - Vishal Shelat
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Matej Skrovina
- Surgery, Hospital & Oncological Centre Novy Jicin, Novy Jicin, Czech Republic
| | - Dmitry Smirnov
- General Surgery, Clinical Hospital at Chelyabinsk Station OJSC “Russian Railways”, Chelyabinsk, Russian Federation
| | | | - Marcin Strzałka
- General Surgery and Polytrauma, University Hospital, Medical College, Jagiellonian University, Kraków, Poland
| | - Peep Talving
- Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | | | - George Theobald
- General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gia Tomadze
- Surgery Department #2, Tbilisi State Medical University, Tbilisi, Georgia
| | - Myftar Torba
- General Surgery, Trauma University Hospital, Tirana, Albania
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Jan Ulrych
- 1st Department of Surgery—Department of Abdominal Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - Mustafa Y. Uzunoğlu
- General Surgery, Training and Research Hospital of Mustafa Kemal University, Hatay, Turkey
| | - Alin Vasilescu
- First Surgical Clinic, St. Spiridon University Hospital, Iasi, Romania
| | | | - Aurélien Venara
- Digestive and Endocrinal Surgery, University Hospital, Angers, France
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pécs, Hungary
| | | | - Nutu Vlad
- First Surgical Clinic, St. Spiridon University Hospital, Iasi, Romania
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine in Warsaw, Warsaw, Poland
| | - Tonguç U. Yilmaz
- Department of General Surgery, Kocaeli University, Kocaeli, Turkey
| | - Kuo-Ching Yuan
- Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cui Yunfeng
- Department of Surgery, Tianjin Nankai Hospital, Tianjin, China
| | - Justas Zilinskas
- Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | | | - Fausto Catena
- Emergency Surgery, Mansoura University Hospital, Mansoura, Egypt
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19
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Castro ADAE, Skare TL, Yamauchi FI, Tachibana A, Ribeiro SPP, Fonseca EKUN, Sakuma AT, Peixoto MR, Rodrigues MAS, Barreiros MAM. DIAGNOSTIC VALUE OF C-REACTIVE PROTEIN AND THE INFLUENCE OF VISCERAL FAT IN PATIENTS WITH OBESITY AND ACUTE APPENDICITIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1339. [PMID: 29513800 PMCID: PMC5863996 DOI: 10.1590/0102-672020180001e1339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/30/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The C reactive protein (CRP) is one of the most accurate inflammatory markers in acute appendicitis (AA). Obesity leads to a pro-inflammatory state with increased CRP, which may interfere with the interpretation of this laboratory test in AA. AIM To assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP in patients with AA and their correlation to body mass index (BMI) and body fat composition. METHOD This is a retrospective study based on clinical records and imaging studies of 191 subjects with histopathologically confirmed AA compared to 249 controls who underwent abdominal computed tomography (CT). Clinical and epidemiological data, BMI, and CRP values were extracted from medical records. CT scans were assessed for AA findings and body composition measurements. RESULTS CRP values increased according to patients' BMI, with varying sensitivity from 79.78% in subjects with normal or lean BMI, 87.87% in overweight, and 93.5% in individuals with obesity. A similar pattern was observed for NPV: an increase with increasing BMI, 69.3% in individuals with normal or lean BMI, 84.3% in overweight, and 91.3% in individuals with obesity. There was a positive correlation between CRP and visceral fat area in patients with AA. CONCLUSIONS Variations exist for sensitivity, specificity, PPV, and NPV values of CRP in patients with AA, stratified by BMI. An increase in visceral fat area is associated with elevated CRP across the BMI spectrum.
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Affiliation(s)
- Adham do Amaral E Castro
- Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP
- Post-Graduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Thelma Larocca Skare
- Post-Graduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | | | - Adriano Tachibana
- Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP
| | | | | | - Andressa Tamy Sakuma
- Post-Graduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
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20
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Lv B, Zhang X, Li J, Leng S, Li S, Zeng Y, Wang B, Yuan J, Fan J, Xing S, Li C. Absorbable polymeric surgical clips for appendicular stump closure: A randomized control trial of laparoscopic appendectomy with lapro-clips. Oncotarget 2018; 7:41265-41273. [PMID: 27183915 PMCID: PMC5173057 DOI: 10.18632/oncotarget.9283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/22/2016] [Indexed: 01/24/2023] Open
Abstract
A randomized control trial was performed to evaluate the effectiveness and safety of absorbable polymeric clips for appendicular stump closure in laparoscopic appendectomy (LA). Patients were randomly enrolled into an experimental group (ligation of the appendicular base with Lapro-Clips, L-C group) or control group (ligation of the appendicular base with Hem-o-lok Clips, H-C group). We identified 1,100 patients who underwent LA between April 1, 2012 and February 3, 2015. Overall, 99 patients (9.0%, 99/1,100) developed a complication following LA (47 [8.5%] in the L-C group and 52 [9.5%] in the H-C group (P = 0.598). No statistically significant differences were observed in intra-abdominal abscesses, stump leakage, superficial wound infections, post-operative abdominal pain, overall adverse events, or the duration of the operations and hospital stays between the groups (all p > 0.05). Adverse risk factors associated with the use of absorbable clips in LA included body mass index ≥ 27.5 kg/m2, diabetes, American Society of Anesthesiologists degree ≥ III, gangrenous appendicitis, severe inflammation of the appendix base, appendix perforation, and the absence of peritoneal drainage. The results indicate that the Lapro-Clip is a safe and effective device for closing the appendicular stump in LA in select patients with appendicitis.
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Affiliation(s)
- Bo Lv
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Xin Zhang
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Jun Li
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China.,Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Shusheng Leng
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Shuqiang Li
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Yunlong Zeng
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Bing Wang
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Jiatian Yuan
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Jun Fan
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Shasha Xing
- Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
| | - Ci Li
- Pathology Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, P.R. China
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21
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Sohn M, Agha A, Bremer S, Lehmann KS, Bormann M, Hochrein A. Surgical management of acute appendicitis in adults: A review of current techniques. Int J Surg 2017; 48:232-239. [DOI: 10.1016/j.ijsu.2017.11.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/24/2017] [Accepted: 11/12/2017] [Indexed: 01/12/2023]
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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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Rosen DR, Inaba K, Oh PJ, Gutierrez AC, Strumwasser AM, Biswas S, Cala M, Ault GT. Outpatient Laparoscopic Appendectomy: Feasible in a Public County Hospital? J Am Coll Surg 2017; 224:862-867. [PMID: 28433247 DOI: 10.1016/j.jamcollsurg.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/29/2022]
Abstract
Outpatient laparoscopic appendectomy is being used increasingly as a treatment option for acute, uncomplicated appendicitis. This was a prospective validation study in a large, urban, public safety-net hospital. From 2014 to 2016, all patients undergoing laparoscopic appendectomy for acute, uncomplicated appendicitis were enrolled in a prospective observational trial. Standard baseline perioperative practice (control group) was documented for 1 year. An outpatient appendectomy protocol was then introduced. Inclusion criteria required intraoperative confirmation of uncomplicated appendicitis and strict discharge criteria, including physician assessment before discharge. Data collection then continued for 1 year (outpatient group). The outcomes measures examined included complications, length of stay, nursing transitions, emergency department visits, readmissions, and patient satisfaction. The study enrolled 351 patients (178 control, 173 outpatient). Of the 173 candidates for outpatient appendectomy, 113 went home. Reasons for admission included surgeon discretion due to intraoperative findings/medical comorbidities and lack of transportation home. The outpatient group had shorter operative time (69 vs 83 minutes; p < 0.001), longer time in recovery (242 vs 141 minutes; p < 0.001), fewer nursing transitions (4 vs 5; p < 0.001), and shorter postoperative length of stay (9 vs 19 hours; p < 0.001). There was no difference in complications, emergency department visits, or readmissions. In the outpatient group, none of the patients sent home from recovery had postoperative complications or required readmission. Satisfaction surveys revealed no change in satisfaction with either protocol. Outpatient appendectomy is safe in a public hospital and results in shorter hospital length of stay and decreased healthcare costs. Strict criteria for discharge are important to identify patients who should be admitted for observation.
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Affiliation(s)
- David R Rosen
- Division of Colon and Rectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA Division of Trauma, Acute Care Surgery, Surgical Critical Care, LAC+USC Medical Center, Los Angeles, CA
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24
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Uzman S, Donmez T, Erdem VM, Hut A, Yildirim D, Akinci M. Combined spinal-epidural anesthesia in laparoscopic appendectomy: a prospective feasibility study. Ann Surg Treat Res 2017; 92:208-213. [PMID: 28382293 PMCID: PMC5378561 DOI: 10.4174/astr.2017.92.4.208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/16/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose Laparoscopic appendectomy (LA) is routinely performed under general, not regional anesthesia. This study assessed the feasibility, efficacy, and side effects of combined spinal-epidural anesthesia (CSEA) in LA. Methods Thirty-three American Society of Anesthesiologist (ASA) physical status classification grade I patients underwent LA under CSEA. CSEA was performed using the needle-through-needle technique at the L3–L4 interspace. Preoperative and postoperative adverse events related to CSEA, patient satisfaction, and postoperative pain levels were recorded. Results LA under CSEA was performed successfully in 33 patients (84.6%). Peroperatively, right shoulder pain was observed in 8 patients (24.1%), abdominal discomfort in 6 (18.2%), anxiety in 5 (15.2%), hypotension in 2 (6.1%) and nausea-vomiting in 1 (3%). In the first 24 hours after LA, headache, urinary retention, right shoulder pain, and postoperative nausea/vomiting (PONV) occurred in 18.1%, 12.1%, 9.1%, and 0% of patients, respectively. In the first 6 hours postoperation, no patients had operation-site pain that required analgesic treatment. Thirty-one patients (94%) evaluated their satisfaction with the procedure as good or moderate. Conclusion CSEA is an efficient and suitable anesthesia technique in LA for ASA physical status classification grade I healthy patients. CSEA is associated with good postoperative pain control and the absence of PONV and intubation-associated complications.
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Affiliation(s)
- Sinan Uzman
- Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Turgut Donmez
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Vuslat Muslu Erdem
- Department of Anesthesiology and Reanimation, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Adnan Hut
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Dogan Yildirim
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Akinci
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
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25
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Yu MC, Feng YJ, Wang W, Fan W, Cheng HT, Xu J. Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis. Int J Surg 2017; 40:187-197. [PMID: 28302449 DOI: 10.1016/j.ijsu.2017.03.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND laparoscopic appendectomy(LA) has proved to be a safe alternative to open appendectomy(OA) in uncomplicated appendicitis; however, the feasibility of LA for complicated appendicitis(CA) has not been conclusively determined. OBJECTIVES To assess the feasibility and safety of LA for CA through a systematic review and meta-analysis. METHODS A literature search in PubMed, Embase, Cochrane Library, and web of Science was performed for eligible studies published from the inception of the databases to January 2016. All studies comparing LA and OA for CA were reviewed. After literature selection, data extraction and quality assessment were performed by two reviewers independently, and meta-analysis was conducted using Revman software, vision 5.2. RESULTS Two randomized controlled trials (RCTs) and 14 retrospective cohort studies(RCSs) were finally identified. Our meta-analysis showed that LA for CA could reduce the rate of surgical site infections (SSIs) (OR = 0.28; 95% CI: 0.25 to0.31, P < 0.00001), but LA did not increase the rate of postoperative intra-abdominal abscess(IAA) (OR = 0.79; 95% CI: 0.45 to 1.34, P = 0.40). The results showed that the operating time in the LA groups was much longer than that in the OA groups (WMD = 13.78, 95% CI: 8.99 to 18.57, P < 0.00001). However, the length of hospital stays in the LA groups were significantly shorter than those in the OA groups (WMD = -2.47, 95%CI: -3.75 to -1.19, P < 0.0002), and the time until oral intake(TTOI) was much earlier in the LA groups than in the OA groups (WMD = -0.88, 95% CI: -1.20 to -0.55, P < 0.00001). No significant difference was observed in the times of postoperative analgesia between the two groups(P > 0.05). CONCLUSION LA was feasible and safe for complicated appendicitis, and it not only could shorten the hospital stays and the time until oral intake, but it could also reduce the risk of surgical site infection.
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Affiliation(s)
- Man-Cheng Yu
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
| | - Yao-Jun Feng
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Wei Wang
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Wei Fan
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Hong-Tao Cheng
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Juan Xu
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
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26
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Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PM, Harmsen AMK, van den Helder RS, Iordache F, Ket JCF, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 2016; 30:4668-4690. [PMID: 27660247 PMCID: PMC5082605 DOI: 10.1007/s00464-016-5245-7] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 02/08/2023]
Abstract
Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
- Department of Pediatric Surgery, VU University Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Gabor S A Abis
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Amish Acharya
- Department of Surgery, St Mary's Hospital, London, UK
| | - Marjolein Ankersmit
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Stavros A Antoniou
- Department of Surgery, Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany
- Department of Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Simone Arolfo
- Department of Surgery, University of Torino, Torino, Italy
| | - Benjamin Babic
- Department of Surgery, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luigi Boni
- Department of Surgery, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Marlieke Bruntink
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | | | - Barbara Defoort
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - Charlotte L Deijen
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - F Borja DeLacy
- Department of Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Peter Mnyh Go
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Florin Iordache
- Department of Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Filip E Muysoms
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - M Mahir Ozmen
- Department of Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Michail Papoulas
- Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Michael Rhodes
- Department of Surgery, Stepping Hill Hospital, Stockport, UK
| | - Jennifer Straatman
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Victor Turrado
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pecs, Hungary
| | - Ramon Vilallonga
- Department of Surgery, University Hospital Vall Hebrón, Barcelona, Spain
| | - Jort D Deelder
- Department of Surgery, Noordwest Clinics Alkmaar, Alkmaar, The Netherlands
| | - Jaap Bonjer
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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27
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Wise ES, Gadomski SP, Ilg AM, Bermudez C, Chan EW, Izmaylov ML, Gridley SJ, Kaczmarek JV, Melancon NT, Ahmad S, Hocking KM, Diaz JJ, Kavic SM. Independent Preoperative Predictors of Prolonged Length of Stay after Laparoscopic Appendectomy in Patients over 30 Years of Age: Experience from a Single Institution. Am Surg 2016. [DOI: 10.1177/000313481608201124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Prompt discharge after laparoscopic appendectomy (LA) is a marker of quality of care, fiscally desirable and feasible in select patients. Patients over 30 comprise a more heterogeneous cohort known to experience worse outcomes after LA. We aimed to identify easily available preoperative risk factors portending a postoperative length of stay ≥2 days among patients above age 30. In this investigation, 296 included patients from a single institution who underwent LA for acute appendicitis from 2010 to 2014 were retrospectively reviewed for preoperative demographics, laboratory studies, comorbidities, presentation characteristics, radiographic finding, and other rationally selected factors for association with postoperative length of stay ≥2 days. Bivariate and multivariate analysis was conducted to determine independent risk factors, which were subsequently modeled via receiver-operating characteristic curve generation and Kaplan-Meier analysis. “Classic” presentation [odds ratio (OR) = 0.5, P = .02], elevated red cell distribution width (RDW; OR = 1.5/% increase, P = 0.004) as well as evidence of rupture on CT (OR = 6.9, P < 0.001) were independently associated with postoperative length of stay ≥ 2 days. Modeling length of stay using these factors generated an area under the curve of 0.713 ± 0.037. Kaplan-Meier analysis of “classic” presentation, elevated RDW, and evidence of rupture on CT through the fifth postoperative day generated log-rank P values of 0.02, 0.05, and ≤ 0.001, respectively. In summary, lack of “classic” presentation, elevated RDW, and CT evidence of rupture are novel risk factors for prolonged postoperative length of stay in LA patients over 30. These findings may help target patients most appropriate for prompt discharge.
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Affiliation(s)
- Eric S. Wise
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Annette M. Ilg
- Vanderbilt University School of Medicine, Nashville Tennessee; and
| | - Camilo Bermudez
- Vanderbilt University School of Medicine, Nashville Tennessee; and
| | - Emily W. Chan
- Vanderbilt University School of Medicine, Nashville Tennessee; and
| | | | | | | | | | - Sarwat Ahmad
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kyle M. Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Jose J. Diaz
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen M. Kavic
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Interval Appendectomy: Finding the Breaking Point for Cost-Effectiveness. J Am Coll Surg 2016; 223:632-43. [PMID: 27502367 DOI: 10.1016/j.jamcollsurg.2016.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 12/29/2022]
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Kim KH, Lee SC, Lee SK, Choi BJ, Jeong W, Kim SJ. Does Korea's current diagnosis-related group-based reimbursement system appropriately classify appendectomy patients? Ann Surg Treat Res 2016; 91:66-73. [PMID: 27478811 PMCID: PMC4961888 DOI: 10.4174/astr.2016.91.2.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose As several years have passed since the implementation of the Korean diagnosis-related group (DRG) payment system for appendicitis, its early outcomes should be assessed to determine if further improvements are warranted. Methods We retrospectively analyzed clinical data from Korean patients who underwent appendectomy, dividing the sample into 2 groups of those who received services before and after implementation of the DRG system. Based on the DRG code classification, patient data were collected including the amount of DRG reimbursement and the total in-patient costs. We subsequently performed univariate and multivariate analyses to identify independent factors contributing to higher total in-patient cost. Results Although implementation of the DRG system for appendicitis significantly reduced postoperative length of stay (2.8 ± 1.0 days vs. 3.4 ± 1.9 days, P < 0.001), it did not reduce total in-hospital cost. The independent factors related to total inhospital cost included patient age of 70 years or more (odds ratio [OR], 3.214; 95% confidence interval [CI], 1.769–5.840; P < 0.001) and operation time longer than 100 minutes (OR, 3.690; 95% CI, 2.007–6.599, P < 0.001). In addition, older patients (≥70 years) showed a nearly 10 times greater relative risk for having a comorbid condition (95% CI, 5.141–20.214; P < 0.001) and a 3.255 times greater relative risk for having higher total in-hospital cost (95% CI, 1.731–6.119, P < 0.001). Conclusion It appears that older patients (>70 years) have greater comorbidities, which contribute to higher inpatient costs. Thus, our study suggests that patient age be considered as a DRG classification variable.
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Affiliation(s)
- Kee-Hwan Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Kuon Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wonjun Jeong
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 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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Sotelo-Anaya E, Sánchez-Muñoz MP, Ploneda-Valencia CF, de la Cerda-Trujillo LF, Varela-Muñoz O, Gutiérrez-Chávez C, López-Lizarraga CR. Acute appendicitis in an overweight and obese Mexican population: A retrospective cohort study. Int J Surg 2016; 32:6-9. [PMID: 27321379 DOI: 10.1016/j.ijsu.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION México is the second place in overweight and obese adults. Acute appendicitis (AA), is the most common indication for an emergency surgery around the world, with an estimated lifetime incidence of 7-14%. Laparoscopic appendectomy (LA) has been described as a safe and good surgery approach for this group of patients. Nevertheless, in México, there is not any evidence supporting these outcomes in our population. METHODS All the patients that came to the ER from July to December 2014 with age >16-year, body mass index (BMI) > 25 kg/m(2) (overweight) and, BMI >30 kg/m(2) (obese) were included in the study. We recorded the age, gender, BMI, grade of appendicitis, complications classified by the Clavien-Dindo Classification, and a follow-up period of 7-day, 30-day, 6-month, and 1-year. RESULTS 27 patients met the inclusion criteria, five had overweight (18.5%), and twenty-two were obese (81.5%). No surgical conversion was needed. The overall complications rate was 29.6%%, with 22.2% mild complications and 7.4% of moderate complication. The average in-hospital cost for the procedure was $15,860 MXN (range $12,860-$22,860 MXN). The surgical time was ≈53.7 ± 19.93 h and the LOS ≈1.6 ± 0.6 days. CONCLUSION The outcomes in the Mexican adult obese population with acute appendicitis when a laparoscopic appendectomy is performed are as good as reported in other countries.
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Affiliation(s)
- Eduardo Sotelo-Anaya
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | | | | | | | - Oscar Varela-Muñoz
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
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Are Antibiotics a Feasible Alternative to Surgery for Acute Appendicitis? Ann Emerg Med 2016; 69:362-363. [PMID: 27157453 DOI: 10.1016/j.annemergmed.2016.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Indexed: 11/21/2022]
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Laparoscopic Appendectomy Is Safe: Influence of Appendectomy Technique on Surgical-site Infections and Intra-abdominal Abscesses. Surg Laparosc Endosc Percutan Tech 2016; 25:e90-4. [PMID: 25462984 DOI: 10.1097/sle.0000000000000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical-site infections (SSIs) and intra-abdominal abscesses (IAAs) are the most frequent complications of appendectomy. The role of laparoscopy in the treatment of appendicitis remains controversial concerning the complication rate. The aim of this retrospective cohort study was to compare open and laparoscopic appendectomy for SSI and IAA. METHODS All patients undergoing appendectomy between January 1, 2007 and May 31, 2010 were included in the study. Perioperative data and data on postoperative complications were collected from patient files. A questionnaire was used to assess complications after discharge. Main outcome parameters were SSI and IAA. Open appendectomy (OAG) and laparoscopic appendectomy (LAG) were compared with univariate and multivariate analyses for the outcome parameters. RESULTS Four hundred thirty patients were included in the study. SSI (all: 10.6%, OAG: 11.7%, LAG: 7.5%, P=0.293) and IAA (all: 2.8%, OAG: 2.4%, LAG: 3.8%, P=0.506) were not significantly different between OAG and LAG. Risk factors for SSI were age (P=0.003), body mass index (P=0.017), ASA score (P=0.001), the intraoperative grade of inflammation (P=0.004), and the histologic grade of inflammation (P=0.015). The only risk factor for IAA was the intraoperative grade of inflammation (P=0.028). ASA score (odds ratio: 1.992, P=0.032) and the intraoperative grade of inflammation (odds ratio: 1.573, P=0.006) remained significant in the multivariate analysis for SSI. CONCLUSIONS A higher ASA score correlates with SSI. A higher grade of intraoperative inflammation correlates with SSI and IAA. Laparoscopy has no impact on SSI and IAA in appendectomy.
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Blackmore C, Tanyingo D, Kaplan GG, Dixon E, MacLean AR, Ball CG. A comparison of outcomes between laparoscopic and open appendectomy in Canada. Can J Surg 2016; 58:431-2. [PMID: 26574836 DOI: 10.1503/cjs.012715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
SUMMARY The benefit of a laparoscopic approach to appendectomy continues to be debated. We compared laparoscopic (LA) with open appendectomy (OA) for appendicitis in Canada using the Canadian Institute for Health Information database (2004-2008). The odds of female patients undergoing LA were 1.26 times higher than the odds of male patients, and the odds of patients with nonperforated pathology undergoing LA were 1.38 times higher than the odds of those with perforated pathology. Increasing comorbidities were associated with OA. While LA is becoming more frequent, the associated length of stay, postoperative complication rate and mortality are clearly lower than for OA. As a result, we support the continued increase in use of LA with regard to both safety and outcomes.
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Affiliation(s)
- Christopher Blackmore
- From the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Blackmore, Dixon, MacLean, Ball); and the Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Tanyingo, Kaplan)
| | - Divine Tanyingo
- From the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Blackmore, Dixon, MacLean, Ball); and the Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Tanyingo, Kaplan)
| | - Gilaad G Kaplan
- From the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Blackmore, Dixon, MacLean, Ball); and the Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Tanyingo, Kaplan)
| | - Elijah Dixon
- From the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Blackmore, Dixon, MacLean, Ball); and the Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Tanyingo, Kaplan)
| | - Anthony R MacLean
- From the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Blackmore, Dixon, MacLean, Ball); and the Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Tanyingo, Kaplan)
| | - Chad G Ball
- From the Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Blackmore, Dixon, MacLean, Ball); and the Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta. (Tanyingo, Kaplan)
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Humes DJ, Walker AJ, Hunt BJ, Sultan AA, Ludvigsson JF, West J. Risk of symptomatic venous thromboembolism following emergency appendicectomy in adults. Br J Surg 2016; 103:443-50. [DOI: 10.1002/bjs.10091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/30/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
Abstract
Background
Appendicectomy is the commonest intra-abdominal emergency surgical procedure, and little is known regarding the magnitude and timing of the risk of venous thromboembolism (VTE) after surgery. This study aimed to determine absolute and relative rates of symptomatic VTE following emergency appendicectomy.
Methods
A cohort study was undertaken using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data of patients who had undergone emergency appendicectomy from 2001 to 2011. Crude rates and adjusted incidence rate ratios (IRRs) for VTE were calculated using Poisson regression, compared with baseline risk in the year before appendicectomy.
Results
A total of 13 441 patients were identified, of whom 56 (0·4 per cent) had a VTE in the first year after surgery. The absolute rate of VTE was highest during the in-hospital period, with a rate of 91·29 per 1000 person-years, which was greatest in those with a length of stay of 7 days or more (267·12 per 1000 person-years). This risk remained high after discharge, with a 19·1- and 6·6-fold increased risk of VTE in the first and second months respectively after discharge, compared with the year before appendicectomy (adjusted IRR: month 1, 19·09 (95 per cent c.i. 9·56 to 38·12); month 2, 6·56 (2·62 to 16·44)).
Conclusion
The risk of symptomatic VTE following appendicectomy is relatively high during the in-hospital admission and remains increased after discharge. Trials of extended thromboprophylaxis are warranted in patients at particularly high risk.
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Affiliation(s)
- D J Humes
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - A J Walker
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
| | - B J Hunt
- Thrombosis and Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A A Sultan
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
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Transition towards laparoscopic appendicectomy at a UK center over a 7-year period. Surg Laparosc Endosc Percutan Tech 2015; 25:59-63. [PMID: 24732741 DOI: 10.1097/sle.0000000000000017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute appendicitis remains the most common indication for emergency abdominal surgery in the United Kingdom. Although laparoscopic appendicectomy has demonstrable advantages over open appendicectomy, uptake has not been universal. The aims of this study were to describe trends in laparoscopic appendicectomy in a District General Hospital in Scotland. METHODS Retrospective review of appendix histopathology records within NHS Fife between 2003 and 2010. Note review of cases of acute appendicitis managed with laparoscopic appendicectomy was performed. Perioperative variables in perforated and nonperforated appendicitis were compared. A multivariate logistic regression analysis to determine factors associated with developing complications was performed. RESULTS Between 2003 and 2010, 237 laparoscopic appendicectomies were performed. The rate of laparoscopic appendicectomy increased from 2.5% in 2003 to 78% in 2010. In 50% of cases, the trainee surgeon was the primary operator. Complications occurred in 9.6% and the mortality rate was 0.4%. No factors on multivariate logistic regression predicted development of complications. CONCLUSIONS We describe a change in practice towards laparoscopic appendicectomy for the treatment of acute appendicitis over a 7-year period. Furthermore, laparoscopic appendicectomy is associated with acceptable morbidity rates.
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Zhang H, Shi J, Yang Y, Liang Y, Gao X, Wang J, Liu H, Wu B, Zhao J. Transvaginal Surgical Management of Cesarean Scar Pregnancy II (CSP-II): An Analysis of 25 Cases. Med Sci Monit 2015; 21:3320-6. [PMID: 26520674 PMCID: PMC4634161 DOI: 10.12659/msm.893776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility and clinical value of transvaginal surgical treatment for cesarean scar pregnancy (CSP-II). MATERIAL AND METHODS This study was a retrospective analysis of 25 CSP-II patients who received transvaginal surgical treatments. These patients were admitted in our hospital between January 2010 and June 2012. RESULTS All surgical treatments were successful without overt complications. The average operation time was 61.5 minutes, the average intraoperative blood loss was 60.5 ml, the average hospital stay was 9.4 days and the average time that blood β-human chorionic gonadotropin (β-HCG) returned to normal range was 15 days. In all 25 patients, the cesarean scar mass located at the anterior wall of the lower uterine segment disappeared by B-ultrasound examination within 1 or 2 weeks after surgery. Postoperatively, the normal menstrual period started again with an average time of 28.9 days. No menstruation-related abnormalities, such as menstrual dripping or an abnormal amount of blood, were reported after surgery. CONCLUSIONS Transvaginal surgery for CSP-II is a novel surgical approach. It has several advantages, including a thorough one-time treatment lesion clearance, short operation time, minimized trauma, minimal intraoperative blood loss, quick reduction of blood β-HCG, and rapid menstruation recovery. It is a simple and feasible surgical approach of great clinical value and few treatment-related complications.
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Affiliation(s)
- Hui Zhang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Junrong Shi
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Yong'An Yang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Yijuan Liang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Xinping Gao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Jing Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Hui Liu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
| | - Bingge Wu
- Department of Ophthalmology, Baotou Eighth Hospital, Baotou, Inner Mongolia, China (mainland)
| | - Jinhui Zhao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, China (mainland)
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Lin HF, Chen YD, Lin KL, Wu MC, Wu CY, Chen SC. Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries. Am J Surg 2015; 210:326-33. [DOI: 10.1016/j.amjsurg.2014.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 11/26/2022]
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Rickert A, Krüger CM, Runkel N, Kuthe A, Köninger J, Jansen-Winkeln B, Gutt CN, Marcus DR, Hoey B, Wente MN, Kienle P. The TICAP-Study (titanium clips for appendicular stump closure): A prospective multicentre observational study on appendicular stump closure with an innovative titanium clip. BMC Surg 2015; 15:85. [PMID: 26185103 PMCID: PMC4504402 DOI: 10.1186/s12893-015-0068-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/25/2015] [Indexed: 01/27/2023] Open
Abstract
Background To evaluate the effectiveness and safety of the DS Titanium Ligation Clip for appendicular stump closure in laparoscopic appendectomy. Methods Overall, 502 patients undergoing laparoscopic appendectomy were recruited for this observational multicentre study in nine study centres between October 2011 and July 2013. The clip was finally applied in 390 patients. Primary outcome variables were feasibility of the clip, intra-abdominal surgical site (abscesses, stump leakages) and superficial wound infections. Patients were followed 30 days after surgery. Results The clip was applicable in nearly 80 % of patients. Reasons for not applying the clip were mainly an inflamed caecum or a too large diameter of the appendix base. Superficial wound infections were found in nine (2.31 %), intra-abdominal abscesses in five (1.28 %), appendicular stump leak in one (0.26 %), and other adverse events in 22 (5.64 %) patients. In total, 12 (3.08 %) patients were re-admitted to hospital for treatment. Seven re-admissions were surgery-related; ten (2.56 %) patients had to be re-operated. One patient died during the course of the study due to persisting peritonitis (mortality 0.26 %). Conclusions The results suggest that the DS Titanium Ligation Clip is a safe and effective option in securing the appendicular stump in laparoscopic appendectomy. The complication rates found with the use of the DS-Clip are comparable to the rates in the literature when other methods are used. Trial Registration NCT01734837.
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Affiliation(s)
- Alexander Rickert
- Department of Surgery, University medical centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Colin M Krüger
- Department of Surgery, Vivantes-Humboldt Klinikum, D-13509, Berlin, Germany
| | - Norbert Runkel
- Department of Surgery, Schwarzwald-Baar-Klinikum, D-78052, Villingen-Schwenningen, Germany
| | - Andreas Kuthe
- Department of Surgery, DRK Krankenhaus Clementinenhaus, D-30161, Hannover, Germany
| | - Jörg Köninger
- Department of Surgery, Katharinenhospital, D-70174, Stuttgart, Germany
| | | | - Carsten N Gutt
- Department of Surgery, Klinikum Memmingen, D-87700, Memmingen, Germany
| | - Daniel R Marcus
- Marina del Rey Hospital, Marina del Rey, California, CA, 90292, USA
| | - Brian Hoey
- General Surgery, St. Luke's university hospital, Bethlehem, PA, 18015, USA
| | - Moritz N Wente
- Medical Scientific Affairs, Aesculap AG, D-78532, Tuttlingen, Germany
| | - Peter Kienle
- Department of Surgery, University medical centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
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Does rural residence impact total ankle arthroplasty utilization and outcomes? Clin Rheumatol 2015; 35:381-6. [DOI: 10.1007/s10067-015-2908-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 01/12/2023]
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Sammalkorpi HE, Leppäniemi A, Mentula P. High admission C-reactive protein level and longer in-hospital delay to surgery are associated with increased risk of complicated appendicitis. Langenbecks Arch Surg 2015; 400:221-8. [PMID: 25586094 DOI: 10.1007/s00423-014-1271-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 12/29/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE Debate on the effect of in-hospital delay on the risk of perforation in appendicitis persists, and the results from previous studies are controversial. The aims of this study were to present the effect of in-hospital delay on the risk of perforation in appendicitis and to assess the utility of C-reactive protein (CRP) measurement in detecting the patients with complicated appendicitis. METHODS Prospectively collected data of 389 adult patients who underwent surgery for acute appendicitis were analyzed in order to find the most accurate method for recognizing the pre-hospital perforations. The effect of in-hospital delay on the further risk of perforation in patients with not yet perforated acute appendicitis was then analyzed. RESULTS Out of 389 patients with appendicitis, 91 patients (23.4 %) had complicated appendicitis, 23 with abscess, and 68 with free perforation. Admission CRP level of 99 mg/l or higher was 90.3 % specific for complicated appendicitis. In patients with admission CRP less than 99 mg/l, the incidence of perforation doubled from 9.5 to 18.9 % when the in-hospital delay increased from less than 6 h to more than 12 h. CONCLUSIONS Complicated appendicitis can be identified with a high CRP level on admission. Delaying surgery can increase the risk of perforation.
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Affiliation(s)
- Henna E Sammalkorpi
- Department of Abdominal Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland,
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Abstract
Transvaginal endoscopic salpingectomy for tubal ectopic pregnancy appears to be feasible and safe and may result in less postoperative pain compared with a laparoscopic approach. Objective: To explore the feasibility, safety, efficacy, and cosmetic outcomes of transvaginal endoscopic salpingectomy for tubal ectopic pregnancy. Methods: From May 2009 to May 2012, we prospectively enrolled 40 patients, each of whom had been scheduled for a salpingectomy because of a tubal ectopic pregnancy, and randomized them into two groups: transvaginal endoscopic surgery and laparoscopic approach. We recorded the estimated blood loss, time of anal exhaust, postoperative pain score, length of stay, and scar assessment scale associated with transvaginal endoscopic access (n = 18) (natural orifice transluminal endoscopic surgery) and laparoscopic salpingectomy (n = 20) (control group) for tubal ectopic pregnancy. The transvaginal salpingectomy was performed with a double-channel endoscope through a vaginal puncture. A single surgeon performed the surgical procedures in patients in both groups. Results: The group that underwent the transvaginal endoscopic procedure reported lesser pain at all postoperative visits than the group that underwent the laparoscopic approach. The duration of time for transvaginal endoscopic surgery was slightly longer than that for the laparoscopic approach. However, there was no statistically significant difference between the two groups in the duration of operative time. The group that underwent transvaginal endoscopic surgery was more satisfied with the absence of an external scar than the group that underwent the laparoscopic procedure, which left a scar. The estimated blood loss, time of anal exhaust, and length of stay were the same in both groups. Conclusion: The safety and efficacy of transvaginal endoscopic salpingectomy for tubal ectopic pregnancy are equivalent to those of the laparoscopic procedure. Lesser postoperative pain and a more satisfactory cosmetic outcome were found with the transvaginal endoscopic procedure, making it the more preferred method and superior to the laparoscopic approach.
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Affiliation(s)
- Boqun Xu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yawen Liu
- Institute of Digestive Endoscopy & Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Ying
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Xia Guan Qu, Nanjing 210011, China.
| | - Zhining Fan
- Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital, Yangzhou, China
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Wright GP, Ecker AM, Hobbs DJ, Wilkes AW, Hagelberg RS, Rodriguez CH, Scholten DJ. Old Dogs and New Tricks: Length of Stay for Appendicitis Improves with an Acute Care Surgery Program and Transition from Private Surgical Practice to Multispecialty Group Practice. Am Surg 2014. [DOI: 10.1177/000313481408001228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute care surgery (ACS) programs have emerged mainly at academic medical centers to provide timely care for emergency general surgery and trauma patients. We hypothesized that the development of an ACS program in a multispecialty group practice would improve outcomes for patients with acute appendicitis. A retrospective analysis of patients with acute appendicitis was performed in two time periods: 18 months of private practice and the following 12 months with ACS coverage. Length of stay was the primary outcome measure. A total of 871 patients were studied (526 private practice, 345 ACS). The ACS group had a greater proportion of laparoscopic appendectomies ( P < 0.001) and more transitions in care between surgeons ( P < 0.001). Length of stay was shorter in the ACS group (1.6 ± 1.5 [mean ± standard deviation] vs 1.9 ± 2.4 days, P = 0.01) and a greater proportion of surgeries were performed during the daytime (44.9 vs 36.6%, P = 0.02). Multivariate analysis demonstrated length of stay was related to appendicitis grade ( P < 0.001), American Society of Anesthesiologists class ( P < 0.001), symptom duration ( P = 0.001), and laparoscopic approach ( P < 0.001). The initial transition from private practice to ACS resulted in decreased length of stay with no increase in morbidity related to transitions of surgical care in patients with appendicitis.
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Affiliation(s)
- G. Paul Wright
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
| | - Amie M. Ecker
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
| | - David J. Hobbs
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
| | - Alexander W. Wilkes
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
| | - Richard S. Hagelberg
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
- Spectrum Health Medical Group, Division of Surgical Specialists, Grand Rapids, Michigan
| | - Carlos H. Rodriguez
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
- Spectrum Health Medical Group, Division of Surgical Specialists, Grand Rapids, Michigan
| | - Donald J. Scholten
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
- Spectrum Health Medical Group, Division of Surgical Specialists, Grand Rapids, Michigan
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Lin HF, Lai HS, Lai IR. Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 2014; 20:14338-14347. [PMID: 25339821 PMCID: PMC4202363 DOI: 10.3748/wjg.v20.i39.14338] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/18/2013] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.
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Bliss LA, Yang CJ, Kent TS, Ng SC, Critchlow JF, Tseng JF. Appendicitis in the modern era: universal problem and variable treatment. Surg Endosc 2014; 29:1897-902. [PMID: 25294554 DOI: 10.1007/s00464-014-3882-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
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Cheng HT, Wang YC, Lo HC, Su LT, Soh KS, Tzeng CW, Wu SC, Sung FC, Hsieh CH. Laparoscopic appendectomy versus open appendectomy in pregnancy: a population-based analysis of maternal outcome. Surg Endosc 2014; 29:1394-9. [PMID: 25171885 DOI: 10.1007/s00464-014-3810-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) is the standard treatment of acute appendicitis for the general population; however, there is still some doubt regarding its safety for pregnant patients. Therefore, the purpose of this study is to investigate and compare the maternal outcome of pregnant patients with acute appendicitis following either an open appendectomy (OA) or LA from a population-based database. METHODS This study is based on the National Health Insurance Research Database. Patients with both ICD-9-CM codes for appendicitis (540.9, 540.0, and 540.1) and pregnancy (V22) in the same admission were considered to have acute appendicitis during pregnancy. These patients were divided into three groups according to the type of treatment: LA, OA, and non-operative treatment. Outcome measures that were compared between the groups included maternal complications such as preterm labor, abortion, and the need of cesarean section. Besides, the differences of medical expenditure and length of hospital stay between the groups were also analyzed. RESULTS From 2005 to 2010, a total of 859 pregnant women who had acute appendicitis were identified. They had increased risks for preterm labor, abortion, and increased requirement of cesarean section compared to the control group (i.e., those without acute appendicitis). Among the three groups, the non-operated group has the highest risk of preterm labor. Patients who underwent LA did not have any increased risk of maternal complications compared to the OA group. Furthermore, LA patients had shorter hospital stay than OA. CONCLUSION Compared to non-operative treatment, appendectomy is the preferred treatment for pregnant patients who have acute appendicitis. LA can be performed safely in pregnant patients without bringing additional maternal complications compared to OA.
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Affiliation(s)
- Han-Tsung Cheng
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan, ROC,
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Yoo RN, Chung CW, Kim JW. Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea. Ann Surg Treat Res 2014; 87:148-55. [PMID: 25247169 PMCID: PMC4170584 DOI: 10.4174/astr.2014.87.3.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose The diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy of the current DRG system applied to a broad spectrum of the patients with appendicitis undergoing laparoscopic appendectomy. Methods A retrospective review was conducted of the patients who underwent laparoscopic appendectomy. Based on the DRG codes' classification, the patients were analyzed for the amount of DRG reimbursement and the total in-patient cost in relation to the time sequence of the disease onset. Statistical analysis was performed to find factors correlated with the DRG reimbursement and total in-patient cost. Results Findings indicate that, as the symptom duration becomes prolonged, the CRP level and the use of peritoneal drainage increased. Patients with a symptom duration greater than 24 hours required approximately 5 days of hospital stay, 0.5 day longer in the length of hospital stay than that of patients with less than 12 hours of the onset time. As expected, the amount of DRG reimbursement and the total in-patient cost accumulated as the symptom duration increased. Conclusion The current DRG reimbursement system for the patients undergoing laparoscopic appendectomy recompenses a broad spectrum of patients diagnosed with appendicitis effectively.
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Affiliation(s)
- Ri Na Yoo
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chul-Woon Chung
- Department of Surgery, International St. Mary's Hospital, Incheon, Korea
| | - Jong-Woo Kim
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Kiatpongsan S, Meng L, Eisenberg JD, Herring M, Avery LL, Kong CY, Pandharipande PV. Imaging for appendicitis: should radiation-induced cancer risks affect modality selection? Radiology 2014; 273:472-82. [PMID: 24988435 DOI: 10.1148/radiol.14132629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare life expectancy (LE) losses attributable to three imaging strategies for appendicitis in adults-computed tomography (CT), ultrasonography (US) followed by CT for negative or indeterminate US results, and magnetic resonance (MR) imaging-by using a decision-analytic model. MATERIALS AND METHODS In this model, for each imaging strategy, LE losses for 20-, 40-, and 65-year-old men and women were computed as a function of five key variables: baseline cohort LE, test performance, surgical mortality, risk of death from delayed diagnosis (missed appendicitis), and LE loss attributable to radiation-induced cancer death. Appendicitis prevalence, test performance, mortality rates from surgery and missed appendicitis, and radiation doses from CT were elicited from the published literature and institutional data. LE loss attributable to radiation exposure was projected by using a separate organ-specific model that accounted for anatomic coverage during a typical abdominopelvic CT examination. One- and two-way sensitivity analyses were performed to evaluate effects of model input variability on results. RESULTS Outcomes across imaging strategies differed minimally-for example, for 20-year-old men, corresponding LE losses were 5.8 days (MR imaging), 6.8 days (combined US and CT), and 8.2 days (CT). This order was sensitive to differences in test performance but was insensitive to variation in radiation-induced cancer deaths. For example, in the same cohort, MR imaging sensitivity had to be 91% at minimum (if specificity were 100%), and MR imaging specificity had to be 62% at minimum (if sensitivity were 100%) to incur the least LE loss. Conversely, LE loss attributable to radiation exposure would need to decrease by 74-fold for combined US and CT, instead of MR imaging, to incur the least LE loss. CONCLUSION The specific imaging strategy used to diagnose appendicitis minimally affects outcomes. Paradigm shifts to MR imaging owing to concerns over radiation should be considered only if MR imaging test performance is very high.
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Affiliation(s)
- Sorapop Kiatpongsan
- From the Massachusetts General Hospital Institute for Technology Assessment, 101 Merrimac St, 10th Floor, Boston, MA 02114 (S.K., L.M., J.D.E., M.H., C.Y.K., P.V.P.); Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (L.L.A., C.Y.K., P.V.P.); and Harvard Medical School, Boston, Mass (C.Y.K., P.V.P.)
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Andersson RE. Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg 2014; 101:1135-42. [PMID: 24979720 DOI: 10.1002/bjs.9552] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/14/2014] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Laparoscopic appendicectomy has been proposed as the standard for surgical treatment of acute appendicitis, based on controversial evidence. This study compared outcomes after open and laparoscopic appendicectomy in a national, population-based cohort.
Methods
All patients who underwent open or intended laparoscopic appendicectomy in Sweden between 1992 and 2008 were identified from the Swedish National Patient Register. The outcomes were analysed according to intention to treat with multivariable adjustment for confounding factors and survival analytical techniques where appropriate.
Results
A total of 169 896 patients underwent open (136 754) or intended laparoscopic (33 142) appendicectomy. The rate of intended laparoscopic appendicectomy increased from 3·8 per cent (425 of 11 175) in 1992 to 32·9 per cent (3066 of 9329) in 2008. Laparoscopy was used most frequently in middle-aged patients, women and patients with no co-morbidity. The rate of conversion from laparoscopy to open appendicectomy decreased from 75·3 per cent (320 of 425) in 1992 to 19·7 per cent (603 of 3066) in 2008. Conversion was more frequent in women and those with perforated appendicitis, and the rate increased with age and increasing co-morbidity. After adjustment for co-variables, compared with open appendicectomy, laparoscopy was associated with a shorter length of hospital stay (by 0·06 days), a lower frequency of negative appendicectomy (adjusted odds ratio (OR) 0·59; P < 0·001), wound infection (adjusted OR 0·54; P = 0·004) and wound rupture (adjusted OR 0·44; P = 0·010), but higher rates of intestinal injury (adjusted OR 1·32; P = 0·042), readmission (adjusted OR 1·10; P < 0·001), postoperative abdominal abscess (adjusted OR 1·58; P < 0·001) and urinary infection (adjusted OR 1·39; P = 0·020). Laparoscopy had a lower risk of postoperative small bowel obstruction during the first 2 years after surgery, but not thereafter.
Conclusion
The outcomes of laparoscopic and open appendicectomy showed a complex and contrasting pattern and small differences of limited clinical importance. The choice of surgical method therefore depends on the local situation, the surgeon's experience and the patient's preference.
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Affiliation(s)
- R E Andersson
- Department of Surgery, County Hospital Ryhov, Jönköping, and Department of Clinical and Experimental Medicine, Surgery, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Time trends in total ankle arthroplasty in the USA: a study of the National Inpatient Sample. Clin Rheumatol 2014; 35:239-45. [PMID: 24907036 DOI: 10.1007/s10067-014-2703-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/14/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
The objective of this study was to assess the time trends in utilization, clinical characteristics, and outcomes of patients undergoing total ankle arthroplasty (TAA) in the USA. We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time trends across the years and the analysis of variance (ANOVA), Wilcoxon test, or chi-squared test (as appropriate) to compare the first (1998-2000) and the last time periods (2009-2010). TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females, and from 0.11 to 0.81 per 100,000 in males (p < 0.0001 for each comparison for time trends). Compared to the 1998-2000 period, those undergoing TAA in 2009-2010 were older (41% fewer patients <50 years, p < 0.0001), less likely to have rheumatoid arthritis as the underlying diagnosis (55% fewer patients, p = 0.0001), more likely to have Deyo-Charlson index of 2 or more (197% more, p = 0.0010), and had a shorter length of stay at 2.5 days (17% reduction, p < 0.0001). Mortality was rare ranging from 0 to 0.6% and discharge to inpatient facility ranged 12.6-14.1%; we noted no significant time trends in either (p > 0.05). The utilization rate of TAA increased rapidly in the USA from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time.
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