Effect of surgical timing and outcomes for appendicitis severity

Kim, Maru; Kim, Sung Jeep; Cho, Hang Joo

doi:10.4174/astr.2016.91.2.85

Cited by 43 publications

(37 citation statements)

References 21 publications

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“…Local hospital preparedness for surgical care may be a concern particularly for conditions in which patient outcomes depend on timely treatment. As complicated appendicitis has been associated with prehospital delay, it may be hypothesized that longer travel time to an adequate level of care would increase the risk of complicated disease. This study does not support such a hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Nationwide study of appendicitis in children

Omling

Salö

Saluja

et al. 2019

British Journal of Surgery

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Background: Paediatric surgical care is increasingly being centralized away from low-volume centres, and prehospital delay is considered a risk factor for more complicated appendicitis. The aim of this study was to determine the incidence of paediatric appendicitis in Sweden, and to assess whether distance to the hospital was a risk factor for complicated disease. Methods: A nationwide cohort study of all paediatric appendicitis cases in Sweden, 2001-2014, was undertaken, including incidence of disease in different population strata, with trends over time. The risk of complicated disease was determined by regression methods, with travel time as the primary exposure and individual-level socioeconomic determinants as independent variables. Results: Some 38 939 children with appendicitis were identified. Of these, 16⋅8 per cent had complicated disease, and the estimated risk of paediatric appendicitis by age 18 years was 2⋅5 per cent. Travel time to the treating hospital was not associated with complicated disease (adjusted odds ratio (OR) 1⋅00 (95 per cent c.i. 0⋅96 to 1⋅05) per 30-min increase; P = 0⋅934). Level of education (P = 0⋅177) and family income (P = 0⋅120) were not independently associated with increased risk of complicated disease. Parental unemployment (adjusted OR 1⋅17, 95 per cent c.i. 1⋅05 to 1⋅32; P = 0⋅006) and having parents born outside Sweden (1 parent born in Sweden: adjusted OR 1⋅12, 1⋅01 to 1⋅25; both parents born outside Sweden: adjusted OR 1⋅32, 1⋅18 to 1⋅47; P < 0⋅001) were associated with an increased risk of complicated appendicitis. Conclusion: Every sixth child diagnosed with appendicitis in Sweden has a more complicated course of disease. Geographical distance to the surgical facility was not a risk factor for complicated appendicitis.

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Section: Discussionmentioning

confidence: 99%

Nationwide study of appendicitis in children

Omling

Salö

Saluja

et al. 2019

British Journal of Surgery

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“…Certain patients with appendicitis, with a history of abdominal pain for less than 24 h, abdominal local pressure pain and hemodynamic stability, may be treated non-surgically ( 14 ). However, others with appendicitis are advised to undergo surgery within 24 h of symptom onset so as to reduce the risk of complications ( 15 ). With or without shock, patients with severe sepsis required treatment as early as possible ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Role of the Rho/ROCK signaling pathway in the protective effects of fasudil against acute lung injury in septic rats

2018

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Fasudil, which is primarily prescribed to treat cerebral vasospasm, may also inhibit systemic inflammation and prevent sepsis-induced acute lung injury (ALI) in rats, although the mechanisms remain elusive. The purpose of the present study was to investigate the role of the rhodopsin (Rho)/Rho-associated protein kinase (ROCK) signaling pathway in the protective effects of fasudil on ALI in septic rats. A total of 60 Wistar rats were pretreated with fasudil (30 mg/kg) through intraperitoneal injections 1 h prior to cecal ligation and puncture. Administration of fasudil led to reductions in polymorphonuclear neutrophil counts, and the protein concentrations of tumor necrosis factor-α, interleukin (IL)-1β and IL-6 in the bronchoalveolar lavage fluid of rats with sepsis-induced ALI. The results demonstrated that fasudil decreased sepsis-induced bacteremia. In addition, fasudil effectively reduced the Evans blue content, wet/dry lung weight ratio, lung injury score, and expression levels of malondialdehyde and myeloperoxidase. However, the superoxide dismutase activity in the lung tissue of the rats was increased. Activated caspase-3 activity in lung tissue was reduced to 29% by fasudil. Furthermore, the expression of Rho and ROCK1 was significantly downregulated, and the phosphorylation of myosin phosphatase-targeting subunit 1 in lung tissues was markedly decreased, whereas the protein expression levels of zonula occludens 1 were increased in fasudil-treated rats (P<0.05). In the in vitro experiments, vascular endothelial growth factor, intracellular adhesion molecule 1 and vascular cell adhesion molecule 1 secreted from human pulmonary microvascular endothelial cells treated with lipopolysaccharide (LPS) were attenuated by fasudil. Fasudil also reduced the fluorescence intensity of filamentous actin induced by LPS. Taken together, the results of the present study demonstrated that fasudil was able to improve endothelial permeability and inhibit inflammation, oxidative stress and cellular apoptosis in order to alleviate ALI in septic rats through inhibition of the Rho/ROCK signaling pathway.

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“…Maru Kim et al recommend that appendectomy be performed within 36 hours from symptom onset. 10 We find difficulty increases if laparoscopic appendectomy is performed after 24 hours of onset of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Preoperative predictive factors for difficult laparoscopic appendectomy

Goel

Bansal²,

Baliyan

2017

Int Surg J

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Background: An appendectomy is the surgical removal of the appendix. Appendectomy may be performed laparoscopically or as an open operation. Laparoscopy is now often used as patient resumed normal activity within a shorter period than had been experienced with open appendectomy. Patients had a superior cosmetic result and experienced significantly less postoperative discomfort. In this study, we attempted to determine the predictors for difficult appendectomy using history and clinical examinations, preoperative laboratory data, ultrasonography findings and intraoperative finding.Methods: The study was conducted in Sarojini Naidu Medical College, Agra. All patients who underwent laparoscopic appendectomy from 1st January 2016 to 30th June 2017 were included in the study. A detailed performa was developed to record information regarding patient history, physical examination, laboratory parameters, ultrasonography (USG) findings and intra-operative details. Laparoscopic appendectomy done in more than 120 minutes, converted into open due to difficulty in surgery and not due to complications, severe adhesions were considered to be a case of difficult appendectomy.Results: We found that the difficult laparoscopic appendectomy can be predicted preoperatively based on age >60 years, history of previous lower abdominal surgery, time of onset to surgery >24 hours, acute appendicitis and peri appendicular collection.Conclusions: There are very few reports to determine the predictors of difficult appendectomy and more research is required to establish it.

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Effect of surgical timing and outcomes for appendicitis severity

Cited by 43 publications

References 21 publications

Nationwide study of appendicitis in children

Nationwide study of appendicitis in children

Role of the Rho/ROCK signaling pathway in the protective effects of fasudil against acute lung injury in septic rats

Preoperative predictive factors for difficult laparoscopic appendectomy

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