Patient backgrounds and short‐term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis

Oba, Takuya; Yamada, Takeshi; Matsuda, Akihisa; Otani, Makoto; Matsuda, Shinya; Ohta, Ryo; Yoshida, Hiroshi; Sato, Norihiro; Hirata, Keiji

doi:10.1002/ags3.12523

Cited by 8 publications

(6 citation statements)

References 41 publications

(97 reference statements)

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“…All of these are, as demonstrated by the studies by Niikura et al [ 27 ] and Okamoto et al [ 28 ], independent predictors for the onset of diverticular complications. Furthermore, not to be underestimated is that tobacco smoking has been associated with an increased rate of perforations in acute appendicitis and colorectal anastomotic leak in patients who underwent resection for colon cancer [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Tobacco Smoking Is a Strong Predictor of Failure of Conservative Treatment in Hinchey IIa and IIb Acute Diverticulitis—A Retrospective Single-Center Cohort Study

Murzi,

Locci,

Carta

et al. 2023

Medicina

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Background and Objectives: Therapeutic management of patients with complicated acute diverticulitis remains debatable. The primary objective of this study is to identify predictive factors for the failure of conservative treatment of Hinchey IIa and IIb diverticular abscesses. Materials and Methods: This is a retrospective cohort study that included patients hospitalized from 1 January 2014 to 31 December 2022 at the Emergency Surgery Department of the Cagliari University Hospital (Italy), diagnosed with acute diverticulitis complicated by Hinchey grade IIa and IIb abscesses. The collected variables included the patient’s baseline characteristics, clinical variables on hospital admission, abscess characteristics at the contrast-enhanced CT scan, clinical outcomes of the conservative therapy, and follow-up results. Univariable and multivariable logistic regression models were used to identify prognostic factors of conservative treatment failure and success. Results: Two hundred and fifty-two patients diagnosed with acute diverticulitis were identified from the database search, and once the selection criteria were applied, 71 patients were considered eligible. Conservative treatment failed in 25 cases (35.2%). Univariable analysis showed that tobacco smoking was the most significant predictor of failure of conservative treatment (p = 0.007, OR 7.33, 95%CI 1.55; 34.70). Age (p = 0.056, MD 6.96, 95%CI −0.18; 0.99), alcohol drinking (p = 0.071, OR 4.770, 95%CI 0.79; 28.70), platelets level (p = 0.087, MD −32.11, 95%CI −0.93; 0.06), Hinchey stage IIa/IIb (p = 0.081, OR 0.376, 95%CI 0.12; 1.11), the presence of retroperitoneal air bubbles (p = 0.025, OR 13.300, 95%CI 1.61; 291.0), and the presence of extraluminal free air at a distance (p = 0.043, OR 4.480, 95%CI 1.96; 20.91) were the other variables possibly associated with the risk of failure. In the multivariable logistic regression analysis, only tobacco smoking was confirmed to be an independent predictor of conservative treatment failure (p = 0.006; adjusted OR 32.693; 95%CI 2.69; 397.27). Conclusion: The role of tobacco smoking as a predictor of failure of conservative therapy of diverticular abscess scenarios highlights the importance of prevention and the necessity to reduce exposure to modifiable risk factors.

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Section: Discussionmentioning

confidence: 99%

Tobacco Smoking Is a Strong Predictor of Failure of Conservative Treatment in Hinchey IIa and IIb Acute Diverticulitis—A Retrospective Single-Center Cohort Study

Murzi,

Locci,

Carta

et al. 2023

Medicina

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“…The treatment strategies for acute appendicitis are controversial [5][6][7][8]. EA has not been recommended for complicated appendicitis because it increases the incidence of extended resection and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Periappendiceal Fluid Collection on Preoperative Computed Tomography Can be an Indication for Interval Appendectomy: a Retrospective Study

Kanaka

Mizutani

Yokoyama

et al. 2022

Preprint

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Background: The treatment strategies for acute appendicitis, such as emergency appendectomy (EA), interval appendectomy (IA), and repeating nonoperative management (NOM), are controversial. In this study, we examined the preoperative factors that can be used to distinguish which patients should undergo IA.Methods: We retrospectively identified 902 patients who underwent surgery for appendicitis in our hospital from January 2010 to December 2021. Of these patients, 776 were included in this study. The patients were divided into two groups: those with a periappendiceal fluid collection (PAFC) on preoperative computed tomography (PAFC-positive group, n = 170) and those without a PAFC (PAFC-negative group, n = 606). In each group, we compared patients who underwent EA and IA.Results: In the PAFC-positive group, patients who underwent EA had a significantly higher postoperative complication rate than those who underwent IA (40.5% vs. 24.0%, p = 0.037). In the multivariate analysis, only the presence of PAFC was significantly associated with an increased risk of postoperative complications (odds ratio, 7.11; 95% confidence interval, 2.73–18.60; p < 0.001). The presence of PAFC alone was not significantly associated with an increased risk of IA or NOM failure (odds ratio, 1.48; 95% confidence interval, 0.19–11.7; p = 0.71). The rate of neoplasia on pathologic examination was significantly higher in the PAFC-positive than PAFC-negative group (7.6% vs. 1.5%, p < 0.001); the rate of carcinoma was also higher in the PAFC-positive group (2.4% vs. 0.17%, p = 0.02).Conclusions: The presence of PAFC on preoperative computed tomography was found to be a risk factor for postoperative complications but not IA or NOM failure. It was also correlated with neoplasia as the etiology of appendicitis. Therefore, PAFC positivity is useful as an indication for IA.

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“…The database includes the following data: disease names, hospitalization costs, comorbidities at admission and during hospitalization, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD‐10), age, sex, length of hospital stay, medical procedures including surgery, names and quantities of medicines administered, and discharge status (including in‐hospital deaths). 18 Medical procedures are indexed with a Japanese code (K‐code), 19 assigned by the Ministry of Health, Labor, and Welfare of Japan. This study was approved by the Ethics Committee for Medical Care and Research at the University of Occupational and Environmental Health Japan (R02‐007).…”

Section: Methodsmentioning

confidence: 99%

“…It contains discharge abstracts and administrative reimbursement claim data from inpatient cases collected at participating hospitals, and it has been used in various studies 16,17 The data were collected by the DPC Research Institute (a nonprofit organization) in collaboration with the Ministry of Health, Labor, and Welfare of Japan. The database includes the following data: disease names, hospitalization costs, comorbidities at admission and during hospitalization, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD‐10), age, sex, length of hospital stay, medical procedures including surgery, names and quantities of medicines administered, and discharge status (including in‐hospital deaths) 18 . Medical procedures are indexed with a Japanese code (K‐code), 19 assigned by the Ministry of Health, Labor, and Welfare of Japan.…”

Section: Methodsmentioning

confidence: 99%

Mechanical and oral antibiotics bowel preparation for elective rectal cancer surgery: A propensity score matching analysis using a nationwide inpatient database in Japan

Oba

Sato

Otani

et al. 2022

Annals of Gastroent Surgery

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Aim The best bowel preparation method for rectal surgery remains controversial. In this study we compared the efficacy and safety of mechanical bowel preparation (MBP) alone and MOABP (MBP combined with oral antibiotic bowel preparation [OABP]) for rectal cancer surgery. Methods In this retrospective study we analyzed data from the Japanese Diagnosis Procedure Combination (DPC) database on 37 291 patients who had undergone low anterior resection for rectal cancer from 2014 to 2017. Propensity score matching analysis was used to compare postoperative outcomes between MBP alone and MOABP. Results A total of 37 291 patients were divided into four groups: MBP alone: 77.7%, no bowel preparation (NBP): 16.9%, MOABP: 4.7%, and OABP alone: 0.7%. In propensity score matching analysis with 1756 pairs, anastomotic leakage (4.84% vs 7.86%, P < 0.001), small bowel obstruction (1.54% vs 3.08%, P = 0.002) and reoperation (3.76% vs 5.98%, P = 0.002) were less in the MOABP group than in the MBP group. The mean duration of postoperative antibiotics medication was shorter in the MOABP group (5.2 d vs 7.5 d, P < 0.001) than in the MBP group. There was no significant difference between the two groups in the incidence of Clostridium difficile (CD) colitis (0.40% vs 0.68%, P = 0.250) and methicillin‐resistant Staphylococcus aureus (MRSA) colitis (0.11% vs 0.17%, P = 0.654). There was no significant difference in in‐hospital mortality between the two groups (0.00% vs 0.11% respectively, P = 0.157). Conclusion MOABP for rectal surgery is associated with a decreased incidence of postoperative complications without increasing the incidence of CD colitis and MRSA colitis.

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Patient backgrounds and short‐term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 8 publications

References 41 publications

Tobacco Smoking Is a Strong Predictor of Failure of Conservative Treatment in Hinchey IIa and IIb Acute Diverticulitis—A Retrospective Single-Center Cohort Study

Tobacco Smoking Is a Strong Predictor of Failure of Conservative Treatment in Hinchey IIa and IIb Acute Diverticulitis—A Retrospective Single-Center Cohort Study

Periappendiceal Fluid Collection on Preoperative Computed Tomography Can be an Indication for Interval Appendectomy: a Retrospective Study

Mechanical and oral antibiotics bowel preparation for elective rectal cancer surgery: A propensity score matching analysis using a nationwide inpatient database in Japan

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