Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study

Collaborative, GlobalSurg

doi:10.1007/s00464-018-6064-9

Cited by 48 publications

(22 citation statements)

References 26 publications

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“…Female sex and open surgery were shown independently to increase the risk of SSI when treatment delays and severity of appendicitis were controlled for in multivariate logistic regression analysis. Our findings add to the growing evidence that laparoscopic appendicectomy reduces the risk of SSI, [26][27][28] but the reason for the increased risk of SSI in females is unclear and no similar observation has been made in other studies.…”

Section: Discussionsupporting

confidence: 46%

The role of treatment delays in surgical site infection after appendicectomy in a South African rural regional hospital

2021

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Surgical site infection (SSI), also known as surgical wound infection, is a major contributor to postoperative morbidity and mortality and is now the most common hospital-associated infection in the USA. [1,2] SSI is a major contributor to healthcare costs through increased length of hospital stay (LoS), antibiotic use, use of diagnostic modalities, surgical procedures and wound care consumables. [3,4] The presence of complicated appendicitis (gangrenous, perforated with local collection or perforated with general peritonism) is a major predictor for the development of SSI. [5-7] In high-income countries (HICs), the incidence of complicated appendicitis varies between 12.8% and 45%. [8,9] The reported risk of developing SSI is 0.6-3.2% for uncomplicated and 3.9-19% for complicated appendicitis. [6,9,10] In low-and middle-income countries (LMICs), barriers to quality surgical care profoundly affect outcomes of patients in need of emergency surgery. [11] Patients in these countries with acute appendicitis often present with significant delay and subsequently more advanced disease, such as general peritonitis or four-quadrant pus. [12] Rates of complicated appendicitis of >60% have been reported, leading to an increase in SSI, reoperation, critical care unit admission and mortality. [13] Determining the effect of time to treatment on the development of SSI in appendicitis is necessary, because time is a variable in the pathogenesis of appendicitis that can be addressed by healthcare providers and systems. Improved access to surgical care and better in-hospital logistics and patient flow may reduce the rate of SSI. Objectives The primary objective of this study was to assess the role that time to definitive surgery plays in the development of SSI in patients undergoing surgery for acute appendicitis. Secondary analyses assessed the effect of time to surgery on the development of complicated appendicitis, and the influence of surgical modality on the development of SSI. Methods A prospective cohort of consecutive patients undergoing surgery for acute appendicitis was recruited over a period of 1 calendar year (2017) at Worcester Regional Hospital, a rural referral centre in Western Cape Province, South Africa. The hospital functions as the primary referral centre for eight district (primary-level) hospitals and a local community health centre. The Department of General Surgery services a public healthcare population projected at ~850 000. [14] Data were prospectively captured for time to definitive operative management, in hours, from symptom onset and hospital admission. Data on age, sex, inflammatory markers, presence of complicated appendicitis and operative modality were collected on admission, together with in-hospital mortality, total length of stay (LoS), and duration of any readmission. The severity of the appendicitis found at operation was classified according to the American Association for the Surgery of Trauma (AAST) grading system for acute appendicitis. [5] This open-access article is distributed under ...

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Section: Discussionsupporting

confidence: 46%

The role of treatment delays in surgical site infection after appendicectomy in a South African rural regional hospital

2021

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“…Recent studies show that laparoscopic appendectomy provides considerable benefits over open appendectomy, including a lower complication rate, a shorter length of hospital stay (LOS), less postoperative pain and earlier postoperative recovery 5,6 . Laparoscopy also was associated with lower surgical site infection (SSI) rates 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Lasek

Wysocki

et al. 2019

Sci Rep

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<50 3269 (70.79%) First operator, n (%) Specialist 2589 (56.06%) Resident 2029 (43.94%) Median operative time, min (IQR) 55 (40-70) Technique, n (%) Clipping 2841 (61.64%) Suturing/ligature 453 (9.79%) Stapler 313 (6.75%) Endoloop 606 (13.11%) Röder loop 403 (8.71%) Complicated appendicitis, n (%) 1269 (27.48%) Uncomplicated appendicitis, n (%) 3349 (72.52%) Intraoperative adverse events, n (%) 104 (2.25%) Drainage, n (%) 3493 (75.64%) Postoperative morbidity, n (%) 310 (6.71%) Clavien-Dindo classification of surgical complications, n (%) I 146 (3.16%) II 80 (1.73%) III 77 (1.67%) IV 4 (0.09%) V 3 (0.06%) Conversions, n (%) 294 (6.37%) Reinterventions after primary procedure, n (%) 98 (2.12%) LOS 3 (2-4) Readmissions, n (%) 118 (2.56%)

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“…31 The percentage of laparoscopic appendectomy (58%) was slightly lower than that reported in high-income countries (67.7%). 32 However, this indicated that laparoscopic appendectomy remained a viable option despite the concerns of possible spread of the virus in the aerosol generated during laparoscopy which led many surgeons to abandon laparoscopy at the take-off of the pandemic. 33,34 This meta-analysis has a number of limitations.…”

Section: Discussionmentioning

confidence: 99%

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Emile

Hamid²,

Khan

et al. 2021

Journal of Gastrointestinal Surgery

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Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-021-04988-1.

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Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study

Cited by 48 publications

References 26 publications

The role of treatment delays in surgical site infection after appendicectomy in a South African rural regional hospital

The role of treatment delays in surgical site infection after appendicectomy in a South African rural regional hospital

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

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