Emergency appendicectomy in Australia: findings from a multicentre, prospective study

Arthur, Thomas; Gartrell, Richard; Manoharan, Bavahuna; Parker, David M.

doi:10.1111/ans.14088

Cited by 27 publications

(40 citation statements)

References 21 publications

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“…Data from our study also highlighted the increased utilization of imaging over the past 10 years for patients with suspected appendicitis prior to surgery, with a slight decrease in the negative appendicectomy rate from 17.3% to 14.4% that was not statistically significant. Our contemporary data are comparable to the results of a recent large Australian multicentre prospective cross‐sectional study, which showed an overall imaging utilization rate of 64.7% and negative appendicectomy rate of 19.0% . In contrast, recent nationwide data from the USA showed a computed tomography utilization rate of 86.1%, overall imaging utilization rate of 93.9% and a negative appendicectomy rate of 4.5% .…”

Section: Discussionsupporting

confidence: 84%

“…Our contemporary data are comparable to the results of a recent large Australian multicentre prospective cross-sectional study, which showed an overall imaging utilization rate of 64.7% and negative appendicectomy rate of 19.0%. 23 In contrast, recent nationwide data from the USA showed a computed tomography utilization rate of 86.1%, overall imaging utilization rate of 93.9% and a negative appendicectomy rate of 4.5%. 24 It is possible that clinical practice in Australia may follow suit, for better or worse.…”

Section: Discussionmentioning

confidence: 91%

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Outcomes of an acute care surgery model: a 10‐year follow‐up study

Kaya

Yang

Wong

et al. 2020

ANZ Journal of Surgery

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Background Many hospitals across Australia and New Zealand have implemented acute care surgery (ACS) models over the past decade, often with improved outcomes such as reductions in wait time to surgery, complications and length of stay. The aim of this study was to evaluate the outcomes of patients who underwent non‐elective appendicectomy and cholecystectomy and compare these with the results observed shortly after the implementation of an ACS model at our institution 10 years earlier. Methods A retrospective review of contemporary patients who underwent non‐elective appendicectomy and cholecystectomy compared with historical data was performed. Primary outcomes were wait time to surgery, surgical complications and length of stay. Results In the contemporary cohort, 263 patients underwent non‐elective appendicectomy over a 1‐year period compared with 226 patients in the historical cohort. The median wait time to surgery had increased (17.7 versus 9.6 h, P < 0.001). There was no significant difference in a composite end‐point of complications and readmissions (8.0% versus 9.3%, P = 0.61). The length of stay was unchanged. There was greater use of preoperative imaging and reduced overnight operating. For non‐elective cholecystectomies, 132 patients underwent this procedure in the contemporary cohort over a 2‐year period compared with 115 patients in the historical cohort. There were no significant differences in wait time to surgery (2 versus 1 day, P = 0.13) or complications (9.8% versus 8.7%, P = 0.75). The length of stay was unchanged. Conclusion The majority of improvements seen shortly following the implementation of an ACS model have been sustained after 10 years.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 91%

Outcomes of an acute care surgery model: a 10‐year follow‐up study

Kaya

Yang

Wong

et al. 2020

ANZ Journal of Surgery

View full text Add to dashboard Cite

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“…Various imaging modalities are increasingly being used in the investigation of abdominal pain and higher rates of pre-operative imaging is shown to reduce negative appendicectomy rates. 6 This case highlights the complexity of presentations of abdominal or scrotal pain, which is further compounded when multiple pathologies are present simultaneously. Clinical acumen plays an important role in diagnosis and decisions regarding potential surgical intervention, and when there are incongruities between the clinical picture and initial investigations, it is an important flagging point for further evaluation.…”

mentioning

confidence: 93%

“…Various imaging modalities are increasingly being used in the investigation of abdominal pain and higher rates of pre‐operative imaging is shown to reduce negative appendicectomy rates . This case highlights the complexity of presentations of abdominal or scrotal pain, which is further compounded when multiple pathologies are present simultaneously.…”

mentioning

confidence: 94%

Distracting diagnoses: a case report of a painless perforated appendix

Bierton

Murphy

2019

ANZ Journal of Surgery

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“…However, it does pose significant risks, with complications occurring in up to 10% of patients. 6 The prophylaxis use of antibiotics has been shown to reduce infective complications of appendicectomy. 3 The role of surgical prophylaxis antibiotics for appendicectomy is supported in national guidelines (Therapeutic Guidelines, 2015), which recommend antibiotic prophylaxis for patients undergoing open or laparoscopic appendicectomy, with cessation post-operatively if not perforated.…”

Section: Introductionmentioning

confidence: 99%

Variation in anti‐microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

Thong

Kim

Dobson

et al. 2019

ANZ Journal of Surgery

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Background This study aims to establish compliance levels to prescription guidelines among Australian surgeons in the use of antibiotics in the surgical management of appendicitis. The secondary outcomes are predictors of post‐operative infective complications; surgical site infection (SSI) and intra‐abdominal abscess (IAA) at 30 days. Methods A multi‐centre, prospective, observational study was conducted over a period of 2 months with a 30‐day follow‐up. Patients were eligible for recruitment if they underwent appendicectomy for suspected appendicitis. Antibiotics prescription practices were recorded and compared to national guidelines. Results A total of 1189 patients were recruited across 27 centres; 1081 (92.1%) patients were given prophylactic antibiotics at the time of appendicectomy. Patients with gangrenous appendicitis were more likely to receive prophylactic antibiotics (98.9%); lower rates of use were seen in the non‐appendicitis group (85.7%). A total of 619 (53.3%) patients received antibiotics in the post‐operative period. Despite recommendations, 300 (44.3%) patients with simple appendicitis received post‐operative antibiotics. Only six (2.9%) patients with complicated appendicitis did not receive antibiotics. Overall, SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islanders (P = 0.02) and patients with converted operations (P = 0.001) were more likely to have a SSI. Patients with complicated appendicitis and those operated on by a consultant were more likely to increase the odds of IAA (odds ratio 3.8 and 5.1, respectively). Conclusion This broad‐based study shows mixed compliance with antibiotic guidelines in the surgical management of appendicitis in Australia. The use of post‐operative antibiotics in patients with simple appendicitis should be a target for antimicrobial stewardship programmes to prevent antibiotic over‐utilization.

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Emergency appendicectomy in Australia: findings from a multicentre, prospective study

Abstract: The NAR found in this study is within the traditional measures of acceptance; however, this rate is high when measured against modern international benchmarks.

Cited by 27 publications

References 21 publications

Outcomes of an acute care surgery model: a 10‐year follow‐up study

Outcomes of an acute care surgery model: a 10‐year follow‐up study

Distracting diagnoses: a case report of a painless perforated appendix

Variation in anti‐microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

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