Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients

Dahlberg, Martin; Boström, Lars

doi:10.1159/000477269

Cited by 25 publications

(21 citation statements)

References 28 publications

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“…Such comparison is important to improve patient care, as outcomes remain surprisingly varied between institutions . The perioperative mortality of appendicectomy has fallen dramatically likely due to advances in imaging, antibiotics and laparoscopic experience, but may still approximate 0.1–0.3% …”

Section: Introductionmentioning

confidence: 99%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

ANZ Journal of Surgery

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Background: Few large Australian studies have explored the impact of acute surgical unit (ASU) model in appendicitis.Methods: An ASU model commenced practice at our institution on 1 August 2012. In this retrospective cohort study, patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. Primary outcomes were median length of stay, median time from emergency department referral to theatre start and proportion of cases performed in-hours. Secondary outcomes were rates of complications, open appendicectomy, consultant scrubbed for procedure, intensive care unit admission and re-presentation to emergency department within 30 days. Results: After removing those with incomplete data, 1214 patients were enrolled; 465 in the Traditional group and 749 in the ASU group. There were no significant baseline differences between groups. Compared with the Traditional group, ASU patients had similar length of stay (1.81 versus 1.81 days; P = 0.54) and time to theatre (0.59 versus 0.56 days; P = 0.14), but a greater proportion of in-hours operation (72% versus 79%; P = 0.014). The ASU group also experienced fewer complications (9% versus 6%; P = 0.031), fewer primary open (4% versus 1%; P < 0.0001) or conversion-to-open appendicectomies (6% versus 2%; P < 0.0005) and had superior rates of consultant scrubbed in theatre (21% versus 56%; P < 0.00001). Rates of intensive care unit admission (1% versus 1%; P = 0.72) and re-presentation were unchanged (5% versus 5%; P = 0.46). Conclusion: In our institution, the introduction of an ASU model was associated with more in-hours operations and safer care for patients undergoing appendicectomy.

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Section: Introductionmentioning

confidence: 99%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

ANZ Journal of Surgery

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“…[2,3] The proportion of complicated AA varies, and it can reach up to 50% in some reports. [4][5][6][7][8] Presence of complicated appendicitis is an independent risk factor of developing intraabdominal abscesses after laparoscopic appendectomy (LA). [9] Several previously published studies showed that LAs are feasible and beneficial, producing a shorter length of stay (LOS), reduced pain, decreased surgical site infection rate, shorter postoperative ileus, and a better cosmetic effect.…”

Section: Introductionmentioning

confidence: 99%

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Pędziwiatr

Lasek

Wysocki

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA. METHODS: The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni-and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis. RESULTS: In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were:

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“…In order to reduce this exposure, the combination of US and low-dose CT scan is of the most value [21]. In a meta-analysis conducted by Dahlberg et al in 2014, it was stated that the NL rate declined from 10% to 1.7% within 10 years with the use of assistive radiological imaging methods in the diagnosis of AA [22]. In this study also, US examination was performed as the first step for diagnosing AA.…”

Section: Discussionmentioning

confidence: 81%

The Results of Abdominopelvic Computed Tomography Interpreted via Remote Access for the Diagnosis of Acute Appendicitis

Akalın¹,

Sasani²,

Ekmen³

2020

Cureus

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Introduction: Abdominal computed tomography (CT) is one of the imaging modalities for the diagnosis of acute appendicitis (AA). Today, CT scans can be interpreted via remote access called tele-radiology, besides conventional methods. The objective of this study was to evaluate the CT interpreted via tele-radiology for diagnosing AA. Methods: In this retrospective study, a total of 679 patients, who were interpreted via teleradiology of CT due to suspicion of AA, were evaluated. Age, gender, CT findings, pathology results and intra-operative diagnosis of those with normal CT results were analysed. A sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of CT in the diagnosis of AA were calculated. Results: 520 patients who were operated with pre-diagnosed AA were found. Of those, 441 patients (84.8%) were diagnosed with AA according to CT reports, out of which 368 (83.4%) were positive (true-positive) and 73 (16.6%) were negative (false-positive) in terms of pathology results. In the remaining operated 79 patients with normal CT results, 58 (73.4%) were positive for AA and 21 (26.6%) (negative laparotomy) were negative for AA in terms of pathological examination. The sensitivity, specificity, accuracy, PPV and NPV of CT in the diagnosis of AA were determined as 81.2%, 67.7%, 76.7%, 83.4% and 64.2%, respectively. Conclusion: The sensitivity and PPV rates were found similar in both conventional and teleradiological methods. However, specificity, accuracy and NPV rates were determined lower than in literature. Additionally, the negative laparotomy rate was higher than the conventional method.

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Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients

Cited by 25 publications

References 28 publications

Acute surgical unit improves outcomes in appendicectomy

Acute surgical unit improves outcomes in appendicectomy

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

The Results of Abdominopelvic Computed Tomography Interpreted via Remote Access for the Diagnosis of Acute Appendicitis

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