Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases

Abstract

AIMTo investigate the epidemiology, treatment and outcomes of acute appendicitis (AA) in a large population study.METHODSThis is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system (more than 1 million inhabitants) from 1997 to 2013. Data about treatment, surgery, length of stay were collected. Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTSFrom 1997 to 2013 in the Bergamo district we collected 16544 cases of AA, with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17, 54.7% were male and the mean Charlson’s comorbidity index was 0.32 ± 0.92. Mortality was < 0.0001%. Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion. Laparoscopic appendectomy was performed in 48% of cases. Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSIONThe treatment of acute appendicitis in Northern Italy is slowly changing, with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option, but rich of promising results.

Which one in the diagnosis of acute appendicitis: Physical examination, laboratory or imaging? A retrospective analysis in the light of pathological results

“…A normal appendix may be found in 14 to 25% of the cases which are operated on the prediagnosis of acute appendicitis (2-4). Its incidence was reported 89/100000 per year (5).…”

Superioridad clínica de la apendicectomía laparoscópica sobre la técnica abierta: ¿adopción lenta de un nuevo estándar de tratamiento?

“…Las publicaciones más recientes refuerzan las conclusiones del estudio y sugieren la adopción de la apendicectomía laparoscópica como estándar de manejo [17][18][19][20] .…”

Relationship between the Hospital Visit-to-Operation Time Interval and the Risk of Appendiceal Perforation and Clinical Outcomes

“…[1][2][3][4][5][6][7] In this study, we analyzed appendectomy timing as a risk factor of complications of appendicitis, especially perforation and SSI. We demonstrated that a delay of more than 12 hours before appendectomy was significantly associated with an increased risk of perforation of the appendix.…”

“…Hence, to prevent potentially significant morbidities, complete surgical excision of the inflamed appendix before rupture is important. [1][2][3][4][5][6][7] Many recent studies have emphasized the importance of preventing appendiceal perforation. In particular, the time interval between hospital visit and surgery is one of the factors that can be objectively quantified and has been analyzed in many prior articles.…”