Comparison of Outcomes of Laparoscopic and Open Appendectomy in Management of Uncomplicated and Complicated Appendicitis

Tiwari, Manish; Reynoso, Jason F.; Tsang, Albert W.; Oleynikov, Dmitry

doi:10.1097/sla.0b013e31822aa8ea

Cited by 148 publications

(131 citation statements)

References 27 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…[23][24][25][26][27][28] Condition-specific outcomes were as follows: receipt of cholecystectomy when admitted with acute cholecystitis; receipt of minimally-invasive appendectomy or cholecystectomy when undergoing surgery for acute appendicitis or cholecystitis; and avoidance of amputation when admitted with lower extremity peripheral artery disease. While alternative treatment may be appropriate for individual patients depending on specific presentation, we contend that receipt of optimal care as defined here represents the ideal management if patients present early and are healthy enough to receive it.…”

Section: Data Source and Outcomesmentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

et al. 2018

View full text Add to dashboard Cite

IMPORTANCE Lack of insurance coverage has been associated with delays in seeking care, more complicated diseases at the time of diagnosis, and decreased likelihood of receiving optimal surgical care. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansion has increased coverage among millions of low-income Americans, but its effect on care for common surgical conditions remains unknown. OBJECTIVE To evaluate the association of the ACA's Medicaid expansion with access to timely and recommended care for common and serious surgical conditions. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, difference-in-differences study used hospital administrative data to compare patient-level outcomes in expansion vs nonexpansion states before (2010-2013) vs after (2014-2015) expansion. A total of 293 529 patients aged 18 to 64 years with appendicitis, cholecystitis, diverticulitis, peripheral artery disease (PAD), or aortic aneurysm admitted to an academic medical center or affiliated hospital in 27 Medicaid expansion states and 15 nonexpansion states from January 1, 2010, through September 31, 2015, were included in the study. Data analysis was performed from November 1, 2016, to March 3, 2017. EXPOSURES State adoption of Medicaid expansion.MAIN OUTCOMES AND MEASURES Presentation with early uncomplicated disease (diverticulitis without abscess, fistula, or sepsis; nonruptured aortic aneurysm at time of repair; and PAD without ulcerations or gangrene) and receipt of optimal management (cholecystectomy for acute cholecystitis, laparoscopic approach for cholecystectomy or appendectomy, and limb salvage for PAD). RESULTSOf the 293 529 study patients (128 392 [43.7%] female and 165 137 [56.3%] male), 225 572 had admissions in Medicaid expansion states and 67 957 had admissions in nonexpansion states. Medicaid expansion was associated with a 7.5-percentage point decreased probability of patients being uninsured (95% CI, −12.2 to −2.9; P = .002) and an 8.6-percentage point increased probability of having Medicaid (95% CI, 6.1-11.1; P < .001). Medicaid expansion was associated with a 1.8-percentage point increase in the probability of early uncomplicated presentation (95% CI, 0.7-2.9; P = .001) and a 2.6-percentage point increase in the probability of receiving optimal management (95% CI, 0.8-4.4; P = .006). CONCLUSIONS AND RELEVANCEThe ACA's Medicaid expansion was associated with increased insurance coverage and improved receipt of timely care for 5 common surgical conditions. Health care systems and policymakers should be aware of the influence of insurance coverage expansion (or its repeal) on presentation with and management of surgical disease.

show abstract

Section: Data Source and Outcomesmentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The average length of stay was about 8 days with a complication rate of just under 20 %. If we fast-forward to the 2011 report in The Annals of Surgery by SAGES member Dimtri Oleynikov, we see that the superiority of laparoscopic appendectomy is demonstrated for simple and complicated appendicitis in a review of 40,000 patients [4]. Uncomplicated appendicitis is now an outpatient procedure, whereas the length of stay in this series for complicated appendicitis was 4 days when performed laparoscopically.…”

mentioning

confidence: 73%

You must be the change you wish to see in the world

Schwaitzberg

2012

Surg Endosc

View full text Add to dashboard Cite

“…Mnenja glede uporabe laparoskopske tehnike pri zapletenih vnetjih so različna, saj nekateri poročajo o višjem odstotku konverzij, daljšem času operacije, večji pojavnosti abscesov in daljši hospitalizaciji (3); drugi ugotavljajo ugoden potek LA tudi pri zapletenem apendicitisu (4,5). V Splošni bolnišnici Izola (SBI) je laparoskopska apendektomija metoda izbire pri zdravljenju akutnega vnetja slepiča, tako enostavnega kot zapletenega.…”

Section: Uvodunclassified

“…30 T. Jakomin, J. Gorjanc, J. Grosek). Velike svetovne statistike v zadnjih letih poročajo o bistveno ugodnejšem poteku in rezultatih LA tudi pri zapletenem apendicitisu (4,5). Na 13. slovenskem endoskopskem kongresu v Mariboru 2015 pa kolegi s Ptuja že poročajo o prevladujočem številu LA nad klasično apendektomijo (24).…”

Section: Razpravljanjeunclassified

Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

2017

View full text Add to dashboard Cite

IzvlečekIzhodišča: Laparoskopska apendektomija se vse bolj uveljavlja kot metoda izbire za kirurško zdravljenje vnetja slepiča. Pri zapletenih vnetjih pa so mnenja deljena. Poročajo namreč o višjem odstotku konverzij, daljšem času operacije, večji pojavnosti abscesov in daljši hospitalizaciji. Cilj naše študije je bil primerjati način diagnosticiranja, zdravljenja in zapletov pri enostavnih vnetjih slepiča z zapletenimi.Metode: V naši ustanovi je laparoskopska apendektomija metoda izbire kirurškega zdravljenja vseh oblik akutnega vnetja slepiča. V retrospektivno raziskavo smo vključili vse bolnike z akutnim vnetjem slepiča, ki so bili operirani v letu 2013 in 2014 v Splošni bolnišnici Izola. Izmed 273 jih je bilo iz analize izključenih 19 bolnikov, ki so bili operirani primarno s klasično tehniko in 1 bolnik, ki je bil po operaciji ponovno kirurško obravnavan z apendektomijo. Tako smo pri 253 bolnikih spremljali delež zapletenih vnetij glede na starost, mesec v letu, čas hospitalizacije, diagnostične metode, dreniranje trebušne votline, delež konverzij, način oskrbe krna in delež pooperativnih zapletov.Rezultati: Analiza rezultatov je pokazala strmo rast deleža zapletenih vnetij pri starejši populaciji, glede na mesec v letu pa ni bilo statistično pomembnih razlik (test hi-kvadrat, p = 0,158). Čas hospitalizacije je bil pri zapletenih vnetjih daljši (3,49 v. 5,94 dni). Pri tistih, ki so imeli pred operacijo opravljen CT, je bil delež zapletenih vnetij višji (CT 0,654, brez CT 0,229; test hi-kvadrat, p < 0,001). Delež dreniranj je bil pomembno višji (enostavno vnetje 0,223, zapleteno 0,855; test hi-kvadrat, p < 0,001). Delež enostavnega zapiranja krna s klipi je bil pri enostavnih vnetjih pomembno višji (enostavno vnetje 0,717, zapleteno 0,521; test hi-kvadrat, p = 0,005), pri deležu zgodnjih zapletov po operaciji in deležu konverzij pa ni bilo statistično pomembnih razlik.Zaključki: Z našo raziskavo smo ugotovili, da obstajajo razlike pri diagnosticiranju in zdravljenju glede na stopnjo vnetja slepiča, nismo pa ugotavljali statistično pomembne razlike v deležu konverzij ali zapletov po operaciji. Iz naših ugotovitev izhaja, da je laparoskopska apendektomija varna metoda pri vseh oblikah vnetja slepiča. AbstractBackground: Laparoscopic appendectomy has been gaining ground as a gold standard for the treatment of acute appendicitis. For complex inflammation there is no common opinion. A higher conversion rate, longer operative time, higher incidence of abscess formation and longer hospitalization are being reported. The aim of our study was to compare the diagnostic modalities, treatment and postoperative complications in uncomplicated and complicated appendicitis.

show abstract

Comparison of Outcomes of Laparoscopic and Open Appendectomy in Management of Uncomplicated and Complicated Appendicitis

Cited by 148 publications

References 27 publications

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

You must be the change you wish to see in the world

Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

Contact Info

Product

Resources

About