Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy

Sukmanee, Jarawee; Butchon, Rukmanee; Sarajan, Myka Harun; Saeraneesopon, Thanayut; Boonma, Chulathip; Karunayawong, Picharee; Teerawattananon, Yot; Isaranuwatchai, Wanrudee

doi:10.1371/journal.pone.0270241

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…Acute appendicitis is a common surgical emergency affecting people worldwide. In Thailand, the overall number of acute appendicitis cases was reduced by 13.4% [ 58 ]. This decline was primarily driven by a reduction in the incidence of simple acute appendicitis.…”

Section: Resultsmentioning

confidence: 99%

“…However, the pandemic had only a slight influence on the frequency at which generalized peritonitis was diagnosed. Since the frequency of generalized peritonitis and its sequelae remained stable despite fewer admissions during the COVID-19 lockdown, Sukmanee et al recommended that the prevalence of acute appendicitis in Thailand be overstated [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

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Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

Alzerwi,

Rayzah,

Alnemare

et al. 2023

Healthcare

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Background: The coronavirus disease (COVID-19) pandemic significantly disrupted surgical care worldwide, affecting different specialties in various ways. Lockdowns, surges in COVID-19 cases, and changes in hospital policies notably impacted patient attendance, management practices, and access to surgical services. This scoping review examines the adverse impacts of the COVID-19 pandemic on surgical services and the policies adopted to address these care barriers. Methods: We conducted a comprehensive literature review using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Our search, spanning 31 December 2019, to 29 January 2023, focused on understanding the multifaceted impacts of COVID-19 on surgical services, particularly across different specialties. Results: An analysis of 75 articles indicated that the pandemic challenged surgeons worldwide to maintain a balance between delivering emergency and elective surgical care, and implementing safety measures against viral transmission. There was a marked decline in the surgical volume, leading to extended waitlists and decreased operating theater usage. Strategies such as prioritizing medically necessary and time-sensitive surgeries and integrating telemedicine have emerged as pivotal for ensuring the continuity of urgent care. Despite the reduced rates, essential surgeries such as appendectomies and cancer-related operations continued, yet faced hurdles, including reduced staffing, limited operating theater capacity, and complications in patient transfers. Conclusions: This review emphasizes the steep reduction in surgical service utilization at the beginning of the pandemic and emergence of new compounded barriers. Policies that designated surgeries as essential, and focused on equitable and timely access, were effective. Incorporating these findings into post-pandemic assessments and future planning is crucial to sustain adequate surgical care during similar health emergencies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

Alzerwi,

Rayzah,

Alnemare

et al. 2023

Healthcare

View full text Add to dashboard Cite

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“…The rate of negative appendicitis diagnoses suggests potential over-diagnosis and unnecessary surgeries, a concern mirrored in other research. 17,18 This aspect of our study calls for more stringent diagnostic criteria and perhaps a more conservative approach to surgical intervention. Our laboratory findings, where 66% of participants exhibited leukocytosis and 71% had a neutrophil count of ≥70%, suggest the potential utility of these markers in predicting positive appendicitis findings.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic dilemma of right iliac fossa pain in females: a prospective study of 100 cases

Sayem,

Akter,

Karim

et al. 2024

Int Surg J

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Background: Right iliac fossa (RIF) pain in females presents a significant diagnostic challenge due to the wide range of potential underlying causes. This study aims to elucidate the complexities and diagnostic dilemmas associated with RIF pain in females, focusing on the prevalence of various conditions, the utility of laboratory markers, and the outcomes of surgical interventions. Methods: This prospective study was conducted at Shaheed Tajuddin Ahmed Medical College Hospital, Gazipur, Bangladesh and involved 100 female patients provisionally diagnosed with acute appendicitis. The study included females aged 12 years and above, presenting with symptoms suggestive of acute appendicitis and who were operable. Patients underwent clinical evaluations, laboratory testing, and, where indicated, surgical intervention, including appendectomy. Data were analyzed using SPSSV.19, with findings presented in table format. Results: The most common presenting symptoms were central abdominal pain shifting to RIF, nausea, vomiting, and pyrexia (45%). Laparotomy findings indicated acute suppurative appendicitis in 68% of cases. Appendicectomy results showed a 61% positive diagnosis rate for appendicitis, with 23% negative appendicitis findings. Laboratory results revealed leukocytosis (>11000/mm3) in 66% and a neutrophil count of ≥70% in 71% of the cases. Histopathological analysis post-appendectomy revealed 57.14% acute appendicitis, 15.48% gangrenous appendicitis, and 27.38% normal vermiform appendix. Conclusions: The study highlights the diagnostic challenges in females presenting with RIF pain, with a significant rate of negative appendicitis diagnoses post-appendectomy. The findings underscore the need for a comprehensive diagnostic approach and suggest the potential utility of laboratory markers in supporting diagnoses. The study advocates for improved diagnostic criteria and methods to enhance accuracy and patient outcomes.

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“…Furthermore, the case study of surgery for appendicitis in Thailand during COVID-19 (what type of RWD – hospitalisation due to appendicitis surgery; where were they collected from – national hospital database for patients enrolled under the universal coverage scheme, how were they translated into evidence – by conducting time series analysis of hospitalisation data before and during COVID-19) highlights the overuse of this service for several contextual reasons. 41 Collection and analysis of RWD enables us to identify such inefficiencies resulting from past decisions and offer opportunities to address them. However, implementing step 6 requires consideration around availability of resources and time for collecting RWD and conducting the re-evaluation, and the appropriate timeframe for re-evaluation.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

What, Where, and How to Collect Real-World Data and Generate Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia: A reflection into the Past and A Way Forward

Lin

Bayani

et al. 2023

Int J Health Policy Manag

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Background: Globally, there is increasing interest in the use of real-world data (RWD) and real-world evidence (RWE) to inform health technology assessment (HTA) and reimbursement decision-making. Using current practices and case studies shared by eleven health systems in Asia, a non-binding guidance that seeks to align practices for generating and using RWD/RWE for decision-making in Asia was developed by the REAL World Evidence In ASia for HEalth Technology Assessment in Reimbursement (REALISE) Working Group, addressing a current gap and needs among HTA users and generators. Methods: The guidance document was developed over two face-to-face workshops, in addition to an online survey, a face-to-face interview and pragmatic search of literature. The specific focus was on what, where and how to collect RWD/ RWE. Results: All 11 REALISE member jurisdictions participated in the online survey and the first in-person workshop, 10 participated in the second in-person workshop, and 8 participated in the in-depth face-to-face interviews. The guidance document was iteratively reviewed by all working group members and the International Advisory Panel. There was substantial variation in: (a) sources and types of RWD being used in HTA; and (b) the relative importance and prioritization of RWE being used for policymaking. A list of national-level databases and other sources of RWD available in each country was compiled. A list of useful guidance on data collection, quality assurance and study design were also compiled. Conclusion: The REALISE guidance document serves to align the collection of better quality RWD and generation of reliable RWE to ultimately inform HTA in Asia.

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Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy

Cited by 6 publications

References 22 publications

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

Diagnostic dilemma of right iliac fossa pain in females: a prospective study of 100 cases

What, Where, and How to Collect Real-World Data and Generate Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia: A reflection into the Past and A Way Forward

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