Appendicectomy mortality: an Australian national audit

Abstract

Background Appendicectomy is a safe surgical procedure with minimal risks. Low mortality rates (0.04–0.24%) have been reported from a number of countries. Appendicectomy mortality rates have not been reported in Australia in recent years. The aim of the study was to conduct an appendicectomy mortality audit, to identify clinical management issues and to calculate the mortality rate of appendicectomy in Australia. Methods This study analysed data from a peer review of appendicectomy deaths in Australian hospitals of all states and territories, from 2006 to 2017. Additional procedural data were obtained from the Australian Institute of Health and Welfare for the calculation of mortality rates. Results The final analysis included 82 patients of whom 62 were elderly (age >65 years) with 47 males and 35 females. Two or more comorbidities were present in 68 patients. Open operation was performed in 62 patients, with complicated appendicitis found in 50 cases. The majority of management issues were non‐surgical. Of the 16 surgical management issues identified, 11 issues occurred post‐operatively in the elderly, which were potentially preventable. The overall mortality was 0.02% with 0.01% in the young (age <65 years) and 0.20% in the elderly. Conclusion Australia's appendicectomy mortality rate was very low and comparable to international figures. Surgical management of appendicectomy was satisfactory in general. However, post‐operative care in the elderly was found to be poor at times, with room for improvement. Further research is needed whether improvements in post‐operative care could alter the clinical course to death in the elderly.

Appendicitis in Far North Queensland: a new take on an old story

“…In our series, about 20% of people required a longer hospital stay, consistent with other published studies 17,18 . Our study's reported indicators of complicated appendicitis, such as conversion to open surgery, hospital readmission and mortality rates are also consistent 4,19–21 …”

“…17,18 Our study's reported indicators of complicated appendicitis, such as conversion to open surgery, hospital readmission and mortality rates are also consistent . 4,[19][20][21] Indigenous patients tended to stay longer than their non-Indigenous counterparts. Very Remote patients (ARIA 5) had the longest LOS, median 2.6 days for Indigenous and 2.1 days for non-Indigenous patients.…”

Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis

“…Общепризнанным является мнение, что лапароскопия -это наиболее эффективный метод дифференциальной диагностики ОА. Принципиальным фактом является возможность перехода от диагностического этапа к лечебному, т. е. выполнению устранения заболевания, в том числе при выявлении другой патологии, требующей хирургической коррекции [2,4]. Благодаря этому статистические данные последних лет свидетельствуют о снижении числа аппендэктомий при отсутствии воспалительных изменений в червеобразном отростке, подтвержденных гистологически.…”

“…Ежегодно в мире от ОА и его осложнений умирает от 50 до 70 тыс. человек [4,[6][7][8]. Практически все вопросы по оказанию медицинской помощи при острых заболеваниях органов брюшной полости унифицированы в Национальных клинических рекомендациях (НКР), в частности по острому аппендициту, и международных рекомендациях различных хирургических сообществ -Всемирного сообщества по неотложной хирургии (WSES), Европейской ассоциации эндоскопических хирургов (EAES) [3,[9][10][11].…”

“…На сегодня убедительно доказано, что лапароскопическая аппендэктомия (ЛА) уменьшает сроки госпитализации пациентов, количество осложнений (включая внутрибрюшинные абсцессы и кишечную непроходимость) [12]. ЛА более безопасна по сравнению с открытой АЭ, особенно при лечении пациентов с ожирением, сопутствующими заболеваниями и пожилых [4,10,13].…”