Appendicitis in the modern era: universal problem and variable treatment

Abstract

Laparoscopic appendectomy is increasing but is unevenly deployed across patient groups. Appendectomy patients were increasingly older, with more comorbidities and with increasing rates of obesity. Black patients and patients with public insurance had less utilization of laparoscopy and inferior outcomes.

Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management

“…The US Nationwide Inpatient Sample of adults who underwent appendectomy from 2003 to 2011 revealed that mean stay decreased from 3.2 to 2.6 days while laparoscopically performed procedures increased from 40.7% to 80.1%. 18 Same-day laparoscopic appendectomy, using discharge criteria similar to ours, has been described, although it is not widely practiced. 35 …”

“…In the US, the trend is toward shorter hospital stays and, for appendicitis, length of postoperative hospitalization has decreased because more appendectomies are performed laparoscopically. 18 All previous trials have required patients randomized to antibiotics to be hospitalized, and most appendectomies in these trials were performed by open technique. Primary antibiotic therapy may offer the opportunity to avoid hospitalization with discharge from the emergency department (ED) after treatment initiation, observation, and symptom control.…”

Abscess After Appendectomy

“…This is supported by evidence that failure to treat appendicitis for greater than 48 hours is associated with increased postoperative complications [33]. Several other factors that are associated with increased rates of perforation have been identified, such as obesity, black race, male gender, age less than 4 years, age greater than 65 years, lack of private insurance, and rural location [19]. Some of these have been demonstrated to result in increased rates of postoperative IAA as well.…”

“…The number of patients with obesity, multiple comorbidities, and age greater than 65 years is increasing. A retrospective review of more than 1.5 million appendectomy patients in the US National (Nationwide) Inpatient Sample from 2003 to 2011 demonstrated increased incidence of complications among men, people older than 52 years, nonteaching hospitals, rural locations, Medicare patients, and African American race [19]. Although this article could not comment on specific complications, such as IAA formation, others have investigated some of these patient populations.…”

Imaging in acute appendicitis: What, when, and why?

“…A multitude of widely divergent and at times conflicting publications discussing about the ideal diagnostic modality and treatment algorithm for AA are being added regularly in the scientific knowledge bank, which by itself is a testimony for the uncertainty that exists in this field today. [3][4][5][6][7][8] Without a clearly defined, universally accepted diagnostic algorithm for AA, a condition which is so common in our day to day practice, diagnosticians are at crossroads in selecting the right path. In this review, we intend to make an attempt to organize the approach to AA, especially with reference to the imaging diagnosis.…”