Appendicitis Research Articles

Mucinous carcinoma of the appendix: a case report

Mucinous carcinoma of the appendix is ​​​​a rare malignant tumor of the appendix. Incidence ranges about 0.01-0.2% in cases of malignancy in the gastrointestinal tract. Clinically, the symptoms appear to resemble acute appendicitis. The diagnosis was established at intraoperative time. Studies on this case are still few. A 69-year-old man complained of lower right abdominal pain since 6 days before going to Sanjiwani hospital. The patient also complained of fever, nausea, decreased appetite and constipation. Examination results temperature 37.6 0C, McBurney sign (+), rebound tenderness (+), localized defense on lower right abdomen. Ultrasound examination of the abdomen with an impression of the end tubular structure, a peristaltic diameter of 0.87 cm accompanied by a fluid collection, suspicious of appendicitis with perforation. Inflamed appendix and localized mucin were found at ileocaecal junction intraoperatively. The patient underwent a right hemicolectomy. Histopathological examination revealed a morphological picture suitable for mucinous carcinoma of the appendix. Mucinous carcinoma of the appendix is ​​​​a rare malignant tumor of appendix. Patients can have the same symptoms as appendicitis. Ultrasound investigations can find a picture like appendicitis. Mucinous carcinoma of the appendix is ​​more frequently found intraoperatively. Histopathological examination is necessary to determine a definitive diagnosis of mucinous carcinoma of the appendix. In high grade appendiceal mucinous neoplasm (HAMN) a right hemicolectomy can be performed and continued with adjuvant chemotherapy.

Understanding family-level decision-making when seeking access to acute surgical care for children: Protocol for a cross-sectional mixed methods study.

There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality). We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0-17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children's Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8-17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations. We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.

Surgical and Pre-surgical Factors Affecting Appendectomy Outcomes in Jeddah, Saudi Arabia: A Retrospective Record Review.

Appendectomy is the preferred treatment for acute uncomplicated appendicitis and the most common emergency abdominal surgery. While previous studies have investigated variables affecting post-appendectomy complications, local research is limited, and data on complication rates are scarce. Therefore, this study aimed to investigate appendectomy outcomes and the factors influencing them. This retrospective record review included all patients who underwent appendectomies at our center between 2013 and 2023, excluding those who underwent appendectomies as part of other procedures. Data were retrieved from the hospital database and recorded on predesigned Google Forms. A total of 556 patients were included. Complications occurred in 60 patients (10.8%); the most common included intra-abdominal collections (n=19, 3.4%), postoperative fever (n=13, 2.3%), and surgical site infections (n=11, 2.0%). The most frequently documented histopathological diagnoses included acute appendicitis (n=402, 72.3%), perforated appendicitis (n=109, 19.6%), and gangrenous appendicitis (n=19, 4.4%). Surgical site infection rates were higher after open appendectomies (6.0% vs. 0.9%, P=0.006), while intra-abdominal collections were more frequent after laparoscopic appendectomies (4.1% vs. 0.0%, P=0.095). Additionally, histopathology results showing complicated or chronic appendicitis were associated with higher complication rates (P<0.001, odds ratio=3.793, 95% confidence interval=1.957-7.350). To the best of our knowledge, this is the largest retrospective review of appendectomy cases in Saudi Arabia. However, this study was conducted in a tertiary care center, which may have caused the rates of complications to appear lower than those in primary centers. We recommend a multi-center study be conducted to establish more accurate results.

Multicenter validation of an artificial intelligence (AI)-based platform for the diagnosis of acute appendicitis

BackgroundThe current scores used to help diagnose acute appendicitis have a “gray” zone in which the diagnosis is usually inconclusive. Furthermore, the universal use of CT scanning is limited because of the radiation hazards and/or limited resources. Hence, it is imperative to have an accurate diagnostic tool to avoid unnecessary, negative appendectomies. MethodsThis was an international, multicenter, retrospective cohort study. The diagnostic accuracy of the artificial intelligence platform was assessed by sensitivity, specificity, negative predictive value, the area under the receiver curve, precision curve, F1 score, and Matthews correlation coefficient. Moreover, calibration curve, decision curve analysis, and clinical impact curve analysis were used to assess the clinical utility of the artificial intelligence platform. The accuracy of the artificial intelligence platform was also compared to that of CT scanning. ResultsTwo data sets were used to assess the artificial intelligence platform: a multicenter real data set (n = 2,579) and a well-qualified synthetic data set (n = 9736). The platform showed a sensitivity of 92.2%, specificity of 97.2%, and negative predictive value of 98.7%. The artificial intelligence had good area under the receiver curve, precision, F1 score, and Matthews correlation coefficient (0.97, 86.7, 0.89, 0.88, respectively). Compared to CT scanning, the artificial intelligence platform had a better area under the receiver curve (0.92 vs 0.76), specificity (90.9 vs 53.3), precision (99.8 vs 98.9), and Matthews correlation coefficient (0.77 vs 0.72), comparable sensitivity (99.2 vs 100), and lower negative predictive value (67.6 vs 99.5). Decision curve analysis and clinical impact curve analysis intuitively revealed that the platform had a substantial net benefit within a realistic probability range from 6% to 96%. ConclusionThe current artificial intelligence platform had excellent sensitivity, specificity, and accuracy exceeding 90% and may help clinicians in decision making on patients with suspected acute appendicitis, particularly when access to CT scanning is limited.

Observation on the Effect of Rapid Rehabilitation Nursing with Integrated Medical Care in Perioperative Period of Laparoscopic Appendicitis in Children.

Acute appendicitis is one of the most common causes of acute abdomen in pediatric surgery. The purpose of this study was to observe the effects of integrated rapid rehabilitation nursing in children with laparoscopic appendectomy (LA) during the perioperative period. A total of 200 children with appendicitis who underwent LA in our hospital from January 2022 to January 2023 were retrospectively selected as the study subjects. According to the nursing mode, they were divided into a control group (n = 100) and an observation group (n = 100). The control group was treated with routine nursing intervention, and the observation group was treated with an integrated rapid rehabilitation nursing intervention. Perioperative indices (operation time, first postoperative exhaust time, length of hospital stay) were recorded and compared between the two groups. The visual analog scale (VAS) was used to score the two groups at 6 h, 12 h, 24 h, and 48 h after surgery, and the pain degree of the children was quantitatively evaluated. The levels of serum stress response indices (cortisol (Cor), norepinephrine (NE), and adrenocorticotropic hormone (ACTH)) in the two groups were measured. The incidence of postoperative complications, improvement of postoperative quality of life, and nursing satisfaction were compared between the two groups. The operation time, first postoperative exhaust time, and hospitalization time in the observation group were significantly shorter than those in the control group (p < 0.05), and the VAS scores of the patients in the observation group were lower than those in the control group at each time point of 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.05). One hour after surgery, the serum Cor, NE, and ACTH levels of the two groups of patients were significantly higher than those before surgery, and the levels for the observation group were significantly lower than those of the control group (p < 0.05). After treatment, the quality of life scores of patients in both groups was significantly higher than before treatment, and the quality of life scores of patients in the observation group was significantly higher than that of the control group (p < 0.05). The postoperative complication rate of the observation group was 3.00% (3/100), which was significantly lower than that of the control group (13.00% (13/100)) (χ2 = 6.793, p = 0.009). The nursing satisfaction of the observation group was 95.00% (95/100), which was significantly higher than that of the control group (79.00% (79/100)) (χ2 = 11.317, p = 0.001). The integrated rapid rehabilitation nursing management mode is an intervention that can effectively alleviate the effects of LA on stress reactions and pain in children with appendicitis. It can effectively reduce the incidence of postoperative complications and improve the patient's nursing satisfaction, allowing children with appendicitis to recover as soon as possible after surgery, and can improve patients' quality of life. It helps to improve the overall clinical efficacy, and the treatment process is simple to operate, relatively safe and reliable, has high use value, and is worthy of further promotion in clinical treatment.

Early Surgical Management of Appendicular Mass: Evaluation of Surgical Outcome in Selected Private and Government Hospitals, Bangladesh

Background: Appendicular mass, a common occurrence in acute appendicitis (10% of cases), develops within 24-48 hours of symptom onset. Management strategies, including early appendectomy, non-operative management with or without drainage, and interval appendectomy, vary widely. This study aims to evaluate the outcomes of early surgical management and compare different surgical approaches. Methodology: This retroospective observational study was performed in different private and government hospital at Jamalpur, Manikgonj for a period of 8 years from January 2015 to December 2022. A total of 288 consecutive patients meeting eligibility criteria underwent open appendectomy within 24 hours of hospital admission due to appendicular lump diagnosis based on clinical or ultrasonographic findings. Two surgical techniques were employed: appendicectomy with generalized peritoneal toileting and appendicectomy with loco-regional peritoneal toileting All data were collected from hospital records. Follow-up records for a period of 2 weeks and at the end of 1 year were reviewed. Results: Patients had a mean age of 30.04 years, mostly male and under 30 years old. Appendicular lump with abscess was predominant (73.96%), along with perforated appendix and presence of pus (71.18% and 75.35% respectively). 68.75% underwent appendicectomy with loco-regional toileting, and 31.25% with generalized peritoneal toileting. Both groups were similar in demographics and perioperative findings, with common difficulties in localization and dissection (76.79% and 88.89% respectively). No bowel injuries occurred in the loco-regional toileting group. Postoperative complications were significantly lower in this group, especially superficial and deep wound infections (11.61% vs 16.67%, 2.53% vs 10%). Fecal fistula and incisional hernia were observed in the generalized peritoneal toileting group (1.11%, 2.22%). Operative time was notably shorter in the loco-regional peritoneal toileting group (92 minutes vs 65 minutes) Conclusion: Early appendicectomy allows for single-admission treatment, serving as an effective alternative to conservative therapy by significantly reducing hospital stays and expenses. Specifically, early appendicectomy with loco-regional peritoneal toileting demonstrates shorter operative times and lower post-operative complications compared to generalized peritoneal toileting, suggesting its favorable utility in managing appendicular mass and warranting further optimization in surgical strategies.

Schistosomal appendicitis: a case report

BackgroundSchistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition even in some endemic areas. Schistosomal appendicitis, an incidentally discovered appendicitis associated with schistosomiasis histological findings, affects young males predominantly. Timely diagnosis and treatment, including appendectomy and anti-helminthic therapy, are crucial.Case reportA 24-year-old Sudanese male patient presented with abdominal pain. Diagnosed with acute appendicitis, he underwent appendectomy, revealing appendix inflammation with Schistosoma ova in histopathology. Abdominal ultrasound detected no complications. Weakly positive Schistosoma serology was noted, but stool and urine analysis showed no infection evidence. Prescribed praziquantel, patient had 3-year post-op follow-up without complications.ConclusionsThis case report underscores the significance of including schistosomiasis in the differential diagnosis of appendicitis, particularly in regions where the disease is endemic. It underscores the necessity of histopathological evaluations for accurate diagnosis, emphasizing the potential implications for clinical practice in similar settings.

Gallbladder Volvulus: A Rare Case of Pre-operative Diagnostic Quandary

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Gallbladder volvulus (GBV) is a rare but critical condition characterized by torsion of the gallbladder on its mesentery. Prompt surgical intervention is crucial in preventing complications and improving patient outcomes. Despite advancements in imaging techniques, diagnosing GBV remains challenging due to its nonspecific clinical presentation and low preoperative detection rates.&amp;lt;i&amp;gt; Case Details: &amp;lt;/i&amp;gt;This paper presents the case of a 79-year-old female presenting with symptoms suggestive of acute appendicitis and urinary tract infection. Imaging, including Computed Tomography (CT), ultrasound, (US) and magnetic resonance cholangiopancreatography (MRCP), were indicative of acute acalculous cholecystitis. Intraoperatively, a necrotic gangrenous gallbladder was encountered, resulting from GBV. &amp;lt;i&amp;gt;Discussion: &amp;lt;/i&amp;gt;GBV poses diagnostic difficulties due to its variable presentation and low preoperative detection rates. Misdiagnoses poses significant risk of mismanagement, especially in the elderly and high risk populations, where non-operative management is attempted (antibiotics, percutaneous cholecystostomy, etc.) leading to increased morbidity and mortality. Therefore, high index of suspicion and correlation with imaging findings are crucial for accurate diagnosis. While various imaging modalities can assist in diagnosis, interpretation may be challenging, as demonstrated in this case. Surgical intervention, preferably through laparoscopy, is the cornerstone of treatment and offers favorable outcomes when performed promptly.&amp;lt;i&amp;gt; Conclusion: &amp;lt;/i&amp;gt;In conclusion, GBV is a rare but potentially life-threatening condition that necessitates early recognition and surgical intervention. Despite challenges in diagnosis, a comprehensive clinical and radiological approach is crucial for timely management and optimal patient outcomes. Further research and awareness are warranted to enhance early diagnosis of this uncommon entity.

Predicting severity of acute appendicitis with machine learning methods: a simple and promising approach for clinicians

BackgroundsAcute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA.MethodsData regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p < 0.05) in both univariate and multivariate analysis were included in the prediction models as input features. Five different error metrics and the area under the receiver operating characteristic curve (AUC) were used for model comparison.ResultsA total number of 1132 patients were included in the study. Patients were divided into training (932 samples), testing (100 samples), and validation (100 samples) sets. Age, gender, neutrophil count, lymphocyte count, Neutrophil to Lymphocyte ratio, total bilirubin, C-Reactive Protein (CRP), Appendix Diameter, and PeriAppendicular Liquid Collection (PALC) were significantly different between the two groups. In the multivariate analysis, age, CRP, and PALC continued to show a significant difference in the perforated AA group. According to univariate and multivariate analysis, two data sets were used in the prediction model. K-Nearest Neighbors and Logistic Regression algorithms achieved the best prediction performance in the validation group with an accuracy of 96%.ConclusionThe results showed that using only three input features (age, CRP, and PALC), the severity of AA can be predicted with high accuracy. The developed prediction model can be useful in clinical practice.

Review on Common Non-Obstetric Acute Abdominal Conditions in Pregnancy: An Update of Management

Non-obstetric acute abdominal conditions account for admission to the surgical ward, and it involves management by the surgeon and gynecologists. The common conditions are acute appendicitis, acute cholecystitis and acute pancreatitis. Acute appendicitis in pregnancy requires prompt diagnosis and the management has moved towards laparoscopic appendectomy. Acute cholecystitis in pregnancy has seen a trend from conservative management to laparoscopic cholecystectomy being performed during pregnancy to prevent recurrence. Acute pancreatitis in pregnancy is usually managed conservatively with endoscopic retrograde cholangiopancreatography being performed for gallstone pancreatitis. We have conducted this review article to investigate the current management of these conditions.

MAIT cell activation and recruitment in inflammation and tissue damage in acute appendicitis.

Mucosal-associated invariant T (MAIT) cells are antimicrobial T cells abundant in the gut, but mechanisms for their migration into tissues during inflammation are poorly understood. Here, we used acute pediatric appendicitis (APA), a model of acute intestinal inflammation, to examine these migration mechanisms. MAIT cells were lower in numbers in circulation of patients with APA but were enriched in the inflamed appendix with increased production of proinflammatory cytokines. Using the patient-derived appendix organoid (PDAO) model, we found that circulating MAIT cells treated with inflammatory cytokines elevated in APA up-regulated chemokine receptors, including CCR1, CCR3, and CCR4. They exhibited enhanced infiltration of Escherichia coli-pulsed PDAO in a CCR1-, CCR2-, and CCR4-dependent manner. Close interactions of MAIT cells with infected organoids led to the PDAO structural destruction and death. These findings reveal a previously unidentified mechanism of MAIT cell tissue homing, their participation in tissue damage in APA, and their intricate relationship with mucosal tissues during acute intestinal inflammation in humans.

The Role of Vascular Cell Adhesion Molecule-1 (VCAM-1) in Predicting Complicated Appendicitis in Children.

Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children. Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis. Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis (p < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all p < 0.001). Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation.

Ultrasonography (US) examination of acute appendicitis (AA): diagnosis of complicated and uncomplicated forms and when US is not enough

Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) have high diagnostic accuracy in the diagnosis of acute appendicitis. Nowadays imaging is part of the diagnostic algorithm of appendicitis and the advantages are demonstrated by the reduced negative appendectomies rates. US is the preferred first line imaging in acute appendicitis. The US diagnosis of complicated and uncomplicated appendicitis is well characterized by different signs but the paradigm of US to take in mind is that the non-visualization of the appendix cannot exclude acute appendicitis. In US, when the appendix is not visualized, or US is inconclusive, second-line imaging examination should be performed. The aims of this pictorial are 1. to illustrate the US signs of complicated and uncomplicated AA; 2. to describe the conditions in which other imaging modalities should be performed to reach a definitive diagnosis.

Modern Pathogenesis, Diagnosis and Management - Acute Appendicitis

Modern Pathogenesis, Diagnosis and Management - Acute Appendicitis

Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases

BackgroundNeoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal “stump”. Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal “tip” remnants.Case presentationThe first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively.ConclusionsIf appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.

Comparative Analysis of Acute Appendicitis Cases During and Prior to the Pandemic

Aim: This study aimed to compare the clinical characteristics, morbidity, and diagnostic accuracy of imaging modalities in acute appendicitis cases during the COVID-19 pandemic and the pre-pandemic period. Materials and Methods: We retrospectively analyzed the records of 898 patients who underwent surgery for acute appendicitis between April 2019 and April 2021. The study population was divided into two groups: pre-pandemic (n=508; April 2019 to April 2020) and pandemic (n=390; April 2020 to April 2021). We compared the socio-demographic characteristics, clinical features, morbidity rates, and the diagnostic accuracy of ultrasonography (USG) and computed tomography (CT) between the two periods. Results: The prevalence of complicated cases was significantly higher during the pre-pandemic period (29.3%) compared to the pandemic period (15.6%). The morbidity rate was also significantly higher in the pre-pandemic period. ( p= 0,004) The sensitivity of USG in diagnosing appendicitis decreased during the pandemic period, while CT scans remained more sensitive than USG in both periods. (sensitivity = 0.93, specificity = 0,67) The prevalence of chronic diseases was significantly higher during the pandemic period. Conclusion: Our study revealed that the prevalence of complicated appendicitis cases was significantly higher during the pre-pandemic period compared to the pandemic period. Additionally, the sensitivity of ultrasonography in diagnosing appendicitis decreased during the pandemic, while CT scans maintained their sensitivity across both periods. Based on our findings, we can confidently conclude that the pandemic does not exacerbate the severity of acute appendicitis cases.

Based on knowledge capital value for disease cost accounting of diagnosis related groups.

The National Health Commission and the other relevant departments in China have initiated testing of the Diagnosis Related Groups (DRGs) system in 30 pilot locations since 2019. In the process of DRG payment reform, accounting for the costs of diseases has become a highly challenging issue. The traditional method of disease accounting method overlooks the compensation for the knowledge capital value of medical personnel. The primary objective of this study is to analyze the cost accounting scheme of China's Diagnosis Related Groups (C-DRG), focusing on the value of knowledge capital. The study initially proposes a measurement index system for the value of knowledge-based capital, including the difficulty of disease treatment, labor intensity of disease treatment, risk of disease treatment, and operation/treatment time for diseases. The Analytic Hierarchy Process (AHP) is then utilized to weigh the features of medical workers' knowledge capital value. First, pairwise comparisons are conducted in this stage to develop a two-pair judgment matrix of the primary indicators. Second, the eigenvectors corresponding to the maximum eigenvalues of the matrix are calculated to generate the weight coefficient of each feature. The consistency test is carried out after this stage. An empirical analysis is conducted by collecting data, including the full costs of treating three types of diseases-hip replacement, acute simple appendicitis, and heart bypass surgery-from one public medical institution. The empirical analysis examines whether this DRG costing accounting can address the issue of neglecting the value of medical workers' knowledge capital. The methods reconfigure the positive incentive mechanism, stimulate the endogenous motivation of the medical service system, foster independent changes in medical behavior, and achieve the goals of reasonable cost control. In the cost accounting system of C-DRG, the value of medical workers' knowledge capital is acknowledged. This acknowledgment not only boosts the enthusiasm and creativity of medical workers in optimizing and standardizing the diagnosis and treatment process but also improves the transparency and authenticity of DRG pricing. This is particularly evident in the optimization and standardization of the diagnosis and treatment processes within medical institutions and in monitoring inadequate medical practices within these institutions.

Predictive Value of Neutrophil-to-Lymphocyte Ratio in Differentiating Perforated from Non-perforated Appendicitis: A Cross-Sectional Study in a Tertiary Care Hospital, Tamil Nadu.

Introduction Acute appendicitis is a common reason for acute abdominal pain.It has a high perforation rate of 20%. Diagnosis of acute appendicitis is usually through well-known clinical signs and symptoms.Radiologic imaging is by and large carried out in peculiar cases with indistinct signs and symptoms.Although various scoring methods are available for screening and diagnosis, those have inadequate validity to accurately predict the severity of acute appendicitis.From the differential counts, the neutrophil-to-lymphocyte ratio (NLR) is an economical and straightforward measure of subclinical inflammation. NLR may be a useful marker for predicting the onset and severity of appendicitis because of the insight it gives into immunological and inflammatory pathways. In this study, we aimed to determine the association between NLR and acute appendicitis among adult patients to differentiate between perforated and non-perforated appendicitis in a tertiary care hospital in Tamil Nadu, India. Methods This was a cross-sectional study conducted in the Department of General Surgery of a deemed university in Chennai, Tamil Nadu.The study was conducted from March 2022 to December 2022. Patients aged 18 years and above undergoing appendicectomy surgery were included in the study.Patients with hematology disorders, chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, asthma, cancer, or auto-immune diseases, and any viral, bacterial, or parasitic infections were excluded.Pregnant women were also excluded from the study.After obtaining informed consent from the patients, blood samples were collected as and when they were diagnosed as acute appendicitis.Laboratory analysis for complete hemogramincluding white blood cell (WBC) count, neutrophil, and lymphocyte count was carried out using an automated hematology analyzer.Prevalence of perforated appendicitis was reported as a percentage.The receiver-operating characteristic (ROC) curve was developed for NLR in differentiating perforated and non-perforated appendicitis.Data were entered in Microsoft Excel 2023.These analyses were carried out in STATA 12.0 (StataCorp, College Station, Texas, USA). Results A total of 212 patients aged 18 years and above were included in the study.Among them 93 (43.9%) were male and 119 (56.1%) were female.Prevalence of perforated appendicitis observed intra-operatively was 29.7% and non-perforated appendicitis was 70.3%. The mean (SD) of NLR among patients with perforated appendicitis was 8.8 (5.1) and non-perforated appendicitis was 3.2 (2.4) with a statistically significant difference (p-value < 0.0001).ROC curve with a cut-off value of 3.78 NLR, had sensitivity of 65.9% and specificity of 93.1% in differentiating perforated and non-perforated appendicitis.The positive predictive value (PPV) and negative predictive values (NPV) were reported as 85.7% and 81.2%, respectively. Conclusion NLR has a reasonable validity in differentiating perforated and non-perforated appendicitis.NLR may be useful in low-resource settings where routine confirmatory radiological procedures like computed tomography scans are not available.

Characteristics of and cost of care for children with impaired development and acute appendicitis: A study of two national databases

BackgroundCharacteristics of children with impaired development who have acute appendicitis are not well described in the literature. MethodsWe reviewed the National Surgical Quality Improvement Program-Pediatric and the multicenter Pediatric Health Information System for patients with acute appendicitis. Comparisons for demographics, clinical outcomes, and hospital charges between children with impaired development versus neurotypical children were made using independent t test or Wilcoxon rank sum tests. The multivariable logistic regression model estimated the odds of complicated acute appendicitis in impaired development patients. Based on correlation analyses, hierarchical linear modeling was used to examine the extent to which impaired development influenced resource use. ResultsPatients with impaired development were younger, had higher comorbidities, and were more commonly male sex. In the National Surgical Quality Improvement Program-Pediatric database, impaired development was associated with higher rates of complicated acute appendicitis (33.6% vs 27.5, P < .001), particularly in older children, and higher usage of computed tomography at National Surgical Quality Improvement Program-Pediatric hospitals (23.1% vs 15.1%, P < .001). In the Pediatric Health Information System database, the adjusted odds of complicated acute appendicitis were significantly higher in patients with impaired development (1.20 [1.09–1.31]), low childhood opportunity level (1.39 [95% confidence interval: 1.31–1.47]), and Black race (1.25 [1.17–1.33]). Hierarchical adjusted linear modeling showed that impaired development was associated with significantly higher hospital charges (9% increase). ConclusionManagement of acute appendicitis in children with impaired development remains a challenge to clinicians, as evidenced by the higher rate of perforated appendicitis in older children, diagnostic computed tomography use at National Surgical Quality Improvement Program-Pediatric hospitals, postoperative computed tomography use, and increased costs.

Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections

IntroductionThe purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis.Materials and methodsIn this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed.ResultsThe two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4–21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2–29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4–20.0), p = 0.016) were identified as independent risk factors for wound infections.ConclusionThe duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred.