Prophylactic surgery prior to extended-duration space flight: Is the benefit worth the risk?

Ball, Chad G.; Kirkpatrick, Andrew W.; Williams, David R.; Jones, Jeffrey A.; Polk, J. D.; Vanderploeg, James M.; Talamini, Mark A.; Campbell, Mark; Broderick, Timothy J.

doi:10.1503/cjs.024610

Cited by 30 publications

(30 citation statements)

References 80 publications

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“…Nevertheless, it is unknown whether altered immunity and physiology during spaceflight increase susceptibility to both appendicitis or cholecystitis, rendering even healthy individuals prone to acute surgical pathologies. Prophylactic appendicectomy and cholecystectomy have been proposed for spaceflight candidates, as has conservative treatment of appendicitis in the absence of adequately trained crew or hardware for surgical management. These potentially life‐threatening conditions highlight the need for on‐board diagnostic and treatment solutions.…”

Section: Resultsmentioning

confidence: 99%

Surgery in space

Panesar

Ashkan

2018

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Surgery in space

Panesar

Ashkan

2018

British Journal of Surgery

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“…Patient autonomy may be limited owing to corporate, institutional or peer pressure to undergo the procedure, particularly if it is prerequisite for selection. 2 Furthermore, evidence suggests uncomplicated appendicitis can be managed conservatively with antibiotics. 7,23 It is acknowledged that surgical management of uncomplicated appendicitis has improved 30-day survival compared with conservative management.…”

Section: Discussionmentioning

confidence: 99%

“…1 Australian National Antarctic Research Expeditions have reported one mortality and a 40% complication rate after a diagnosis of acute appendicitis during field expeditions. 2 As a result, all expedition physicians undergo prophylactic appendicectomy prior to winter expeditions. 1 However, prophylactic practice remains controversial with many other Antarctic programmes, including that of the US, where prophylactic appendicectomy is not a mandatory prerequisite.…”

mentioning

confidence: 99%

Systematic review of clinical outcomes after prophylactic surgery

Davis

Trevatt

Dixit

et al. 2016

annals

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Introduction Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acute appendicitis in the field. However, the risk-benefit ratio of prophylactic surgery is controversial. This study aimed to systematically review the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgery resulting in life-threatening complications. Methods A systematic review was performed using MEDLINE(®) and the Cochrane Central Register of Controlled Trials. Keyword variants of 'prophylaxis' and 'appendicectomy' were combined to identify potential papers for inclusion. Papers related to prophylactic appendicectomy risks and benefits were reviewed. Results Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes after incidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomy in asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylactic appendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios such as polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations. Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when the short-term risk of acute appendicitis outweighs the long-term risks of surgery. Conclusions Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence of long-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis by balancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgical procedure in a healthy patient.

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“…The CMO decides that, clinically, Dr FH has acute appendicitis. We acknowledge that the benefits and risks prophylactic appendicectomy is currently being debated (11,12), but this topic will not be discussed here. Appendicitis occurs in healthy adults, with a lifetime risk of 8.6 percent in males, and 6.9 percent in females (13).…”

Section: A Hypothetical Casementioning

confidence: 99%

Challenges in Anaesthesia During Space Exploration Missions

Benson

Cable²,

Workman

2020

Journal of the Australasian Society of Aerospace Medicine

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Aim NASA and private spacefaring companies plan to send exploration missions to mars within the next two decades. The environment of space, duration of the mission, distance from earth, and limited available resources present significant challenges for the provision of health care. It has been estimated that at least one medical emergency is likely to occur during such a mission, which may necessitate surgical treatment, and therefore anaesthesia. The provision of safe anaesthesia faces challenges arising from physiological adaptations to space, difficulty achieving and maintaining personnel expertise, possible pharmacological changes in anaesthetic agents used, limited consumable shelf-life and provision of intravenous fluids and blood products. In this review article we discuss these challenges in the context of a hypothetical case.

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Prophylactic surgery prior to extended-duration space flight: Is the benefit worth the risk?

Cited by 30 publications

References 80 publications

Surgery in space

Surgery in space

Systematic review of clinical outcomes after prophylactic surgery

Challenges in Anaesthesia During Space Exploration Missions

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