Predictors of appendiceal perforation in an equal access system

Walker, Avery S.; Hatch, Quinton; Drake, Frederick Thurston; Nelson, Daniel W.; Fitzpatrick, Emilie; Bingham, Jason; Black, George; Maykel, Justin A.; Steele, Scott R.

doi:10.1016/j.jss.2014.02.028

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…TRICARE is a UHC in the United States with almost full governmental coverage for all active-duty and retired military service personnel as well as their dependents. Previous reports studying the population under TRICARE [25], [26] have shown that even in the United States with a wide range of SES, UHC with high publicly funded coverage offered equal access to high-tech care. We suppose that this policy of keeping out-of-pocket payments affordable for a patient's household plays an important role in a patient choosing advanced care, such as cardiovascular interventions.…”

Section: Discussionmentioning

confidence: 99%

Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

Lee

Hashimoto²,

Kohro³

et al. 2014

PLoS ONE

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BackgroundUniversal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded.MethodsWe chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status.ResultsWe found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69–1.03) or in-hospital mortality (1.00; 0.68–1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34–0.71).ConclusionsUnder Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care.

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Section: Discussionmentioning

confidence: 99%

Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

Lee

Hashimoto²,

Kohro³

et al. 2014

PLoS ONE

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“…Appendicitis is defined as inflammation of the inner lining of the vermiform appendix that spreads to its other parts. Despite diagnostic and therapeutic advances in medicine, appendicitis remains a clinical emergency and according to some authors is the main cause of acute surgical abdomen [1,2]. Incident in all ages, the contemporary literature reports it to be more frequent in young adults, predominantly males [2][3][4].…”

Section: Original and Clinical Articlesmentioning

confidence: 99%

“…Despite diagnostic and therapeutic advances in medicine, appendicitis remains a clinical emergency and according to some authors is the main cause of acute surgical abdomen [1,2]. Incident in all ages, the contemporary literature reports it to be more frequent in young adults, predominantly males [2][3][4]. However, the alternative perception evaluated by a private care group working with acute care surgery and trauma in a city of three million people approximately of a specific region has led to the development of the hypothesis that a possible paradigm shift regarding the prevalence of acute appendicitis in this studied region could exist.…”

Section: Original and Clinical Articlesmentioning

confidence: 99%

Acute appendicitis may no longer be a predominant disease of the young population

Pereira¹,

Mendes²,

Ruano³

et al. 2019

ait

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Background: Some authors consider acute appendicitis as the main cause of acute surgical abdomen. Incident in all ages, contemporary literature suggests that is more frequent in children and young adults, male predominantly. This study aims to test the hypothesis that the disease in question is no longer prevalent in young adults (excluding children) in the surveyed region.Methods: 1150 cases of emergency surgery were performed and prospectively analyzed. 300 cases of appendicitis in adults were selected and variables studied. Patients under 13 years old were excluded.Results: 190 patients older than 60 years had a diagnosis of acute appendicitis confirmed by biopsy. There is a predominance of males. The elderly population takes less time to seek medical assistance and has fewer complications, despite being more often admitted to the ICU due to other comorbidities. Conclusions:A trend regarding acute appendicitis epidemiology may exist. In the specific studied region acute appendicitis is no longer a disease prevalent in young adults. Surgeons and emergency physicians must be aware that acute appendicitis may no longer be predominantly common in young adults in their own specific region. Multicenter studies are needed to determine whether these data are reproduced in a geographical area of greater extent.

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“…Therefore, differentiating perforated from non‐perforated appendicitis becomes very important. With regard to perforation rates, it has been reported that individuals aged 66–75 years have a higher perforation rates than the younger ones . Until now, the preoperative diagnosis of perforation is mainly based on clinical findings such as diffuse peritonitis and board‐like rigidity of the abdomen.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis

Zhao

Feng

Huang

et al. 2015

ANZ Journal of Surgery

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Predictors of appendiceal perforation in an equal access system

Cited by 13 publications

References 21 publications

Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

Acute appendicitis may no longer be a predominant disease of the young population

Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis

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