Non-complicated Acute Appendicitis Research Articles

THE OUTCOME OF ANTIBIOTICS VS OPEN APPENDECTOMY FOR ACUTE NON-PERFORATED APPENDICITIS

Acute appendicitis is a common surgical emergency. While appendectomy has been the conventional treatment for this condition, recent advancements in antibiotic therapy have led to exploring the use of antibiotics as a non-surgical alternative for treating non-complicated acute appendicitis. Objective: The objective of the present study was to compare the outcomes of administering antibiotics and performing emergency appendicectomy in a cohort of individuals diagnosed with non-perforated acute appendicitis based on CT evaluation. Methods: After the ethical approval from the institutional review board, this randomised control trial was conducted at Combined Military Hospital Jhelum from July 2022 to December 2023. The patients were randomly assigned, using a closed envelope method, to either have open appendectomy (Group A, n=60) or receive antibiotic therapy (Group B, n=60) with intravenous ertapenem. Open appendectomy was conducted utilising the McBurney technique. The patient’s outcomes were assessed during their hospitalization period, specifically on days 0, 1, and 2, and by telephone interviews one week and two months following the intervention. Pain scores were collected at two specific time points, one week and two months after randomisation, utilising a visual analogue scale (VAS). Results: No significant differences were observed in the baseline characteristics in both groups. Mean± S.D of the pain experience of the study participants in both groups was 4.16±1.04 and 3.68±1.02 (days) (P value=0.008). Mean± S.D of the hospital stay of the study participants in both groups was 3.13±0.87 and 3.16±0.83 (days) (P value=0.843). A significant difference in the VAS score was observed (p <0.0001) in the participants of both groups at discharge and after a one-week follow-up period. Conclusion: The findings of the study indicate that a significant proportion of individuals who received antibiotic therapy for non-perforated acute appendicitis did not necessitate the surgical procedure of appendectomy within the two-month post-treatment observation period.

The Predictive Value of Plasma Sodium and Other Laboratory Parameters in Determining Complicating Appendicitis in Children

Objective: Finding a reliable preoperative predictor of complicated acute appendicitis (AA) has been a challenging diagnostic problem. The present study aimed to identify potential factors that may predict complicated AA in the pediatric emergency department (ED) based on routine, widely available laboratory tests on admission to the ED, including plasma sodium concentration. Methods: We retrospectively reviewed clinical and laboratory data of pediatric patients with AA who underwent emergency surgery at our department between January 2020 and December 2022. The patients were divided into two groups: histopathologically proven complicated AA (n = 80) and noncomplicated AA (n = 155). Results: Complicated AA was associated with reduced plasma sodium and chloride concentrations (p p = 0.002), elevated C-reactive protein (CRP) (p p = 0.012 and 0.001, respectively). In binomial logistic regression, increased levels of CRP and WBC and decreased levels of sodium were predictors of complicated AA. The area under the receiver operating characteristic curve was 0.825 (95% confidence interval: 0.764, 0.886). Conclusion: We identified mild hyponatremia and elevated CRP and WBC values as potential markers for distinguishing complicated from uncomplicated pediatric AA with implications for surgical approaches for treating complicated AA and conservative approaches for treating uncomplicated AA.

Hyperbilirubinemia is a Predictor of Gangrenous or Perforated Appendicitis

Introduction: Acute appendicitis is the most common acute abdominal condition that requires surgical intervention in childhood. Patients with complicated appendicitis (CA) were reported to have elevated serum bilirubin or reduced serum sodium levels in several studies. Aim of the study: The purpose of this study was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis. Methods: The present descriptive type observational study was accomplished in Department of Surgery, Faridpur Medical College Hospital, Bangladesh. Medical files of the patients, who underwent appendectomies between July 2015 and January 2016, were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU %), C-reactive protein (CRP), total/ direct/indirect bilirubin levels, and preoperative presentation & severity, complication of disease, outcome and postoperative hospital stay findings were recorded. The Fisher’s exact, Pearson’s χ2, ANOVA, and Kreskas–Wallis tests while logistic regression for multivariate analysis was performed. P value < 0.05 was accepted as statistically significant\ for this study. Result: 50 patients of more than 15 years old participated in this study. Histopathological examinations revealed normal appendix in 11 (22%) patients, non-complicated acute appendicitis in 18 (36%), and appendiceal gangrene/perforation in 21 (42 %) patients. WBC, NEU, NEU%, and CRP levels were found significantly elevated in cases of acute and gangrenous/perforated appendicitis (p < 0.01). Total and direct bilirubin levels were also significantly higher in patients with acute and gangrenous/perforated appendicitis (p < 0.01). Multivariate analysis, higher levels of CRP were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk ........

Value of total leucocytic count and pelvic-abdominal ultrasound in distinguishing complicated from noncomplicated acute appendicitis

Background Complicated appendicitis is associated with elevated rates of morbidity and mortality compared with noncomplicated appendicitis. In this study, we aimed to investigate the role of combining total leucocytic count (TLC) and abdominal ultrasound (US) in distinguishing simple from complicated appendicitis. Patients and methods This is a prospective study that included patients with acute appendicitis who underwent appendectomy. The patients’ data regarding demographic characteristics, clinical, laboratory, and US findings, as well as intraoperative findings and postoperative complications, were recorded and analyzed. Results This study included 80 patients. Overall, 48 (60%) patients had noncomplicated appendicitis, and 32 (40%) had complicated appendicitis. Patients with complicated appendicitis had significantly higher ages and TLC. Concerning the US findings, significantly higher cases of visualized blind-ended loop (P = 0.042), right iliac fossa fluid (P = 0.006), and pelvic collection (P < 0.001) were shown in the complicated group. Multiple regression analysis revealed that TLC and the presence of pelvic collection by the US were the only variables significantly predicting complicated appendicitis. Adopting either a TLC cut-off value of 12.95×109/l and/or the presence of pelvic collection for the diagnosis yielded a sensitivity of 90.6%, a specificity of 77.1%, and an accuracy of 82.5%. Conclusion The presence of a TLC cut-off value of 12.95×109/l and/or a pelvic collection in abdominal ultrasound seems to be reproducible for the preoperative prediction of complicated acute appendicitis.

Diagnostic performance of type I hypersensitivity-specific markers combined with CRP and IL-6 in complicated acute appendicitis in pediatric patients

ObjectiveIn this study, the diagnostic value of C-reactive protein (CRP), interleukin-6 (IL)-6, and specific markers for type I hypersensitivity were evaluated in pediatric patients with severe acute appendicitis. MethodsA total of 140 pediatric patients with “acute appendicitis” who underwent surgery at the Department of General Surgery of the Anhui Provincial Pediatric Patients' Hospital between December 2022 and April 2023 were studied retrospectively. The data collected included the gender, age, onset time, white blood cell count (WBC), CRP, procalcitonin (PCT), serum IgE, serum IL-4, serum IL-5, serum IL-6, serum IL-9, and serum IL-13 levels. The pediatric patients were divided into two groups based on the intraoperative situation and postoperative pathology: the non-complicated acute appendicitis group (NCAA) and the complicated acute appendicitis group (CAA). We analyzed the data from both groups using univariate and multivariate logistic regression models and constructed an ROC curve. ResultsThe CAA group outperformed the NCAA group in terms of onset time, WBC, CRP, PCT, IgE, IL-6, IL-9, and IL-13 levels (P < 0.05), but there was no statistically significant difference between the two groups in terms of gender, IL-4, or IL-5 levels (P > 0.05). Then, significant independent variables were incorporated into multivariate logistic regression. According to the results, CRP, IgE, IL-6, and IL-13 are all independent risk factors for CAA. The OR and 95% CI for each factor are as follows: CRP (OR = 1.073, 95%CI: 1.010–1.140, P = 0.022), IgE (OR = 0.975, 95%CI: 0.952–0.999, P = 0.038), IL-6 (OR = 1.494, 95%CI: 1.052–2.121, P = 0.025), and IL-13 (OR = 1.310, 95%CI: 1.036–1.657, P = 0.024). The receiving operator characteristics analysis yielded area under the curve (AUC) values of 0.8187, 0.9083, 0.8947, and 0.8394, respectively, for CRP, IgE, IL-6, and IL-13, confirming their significance in the diagnosis of CAA (P < 0.05). ConclusionRisk factors for CAA include CRP, IgE, IL-6, and IL-13. The combination of these serological markers can be used to diagnose CAA.

Utility of Ischemia-Modified Albumin as a Biomarker for Acute Appendicitis: A Systematic Review and Meta-Analysis.

Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help clinicians rapidly and accurately diagnose and prognosticate acute appendicitis with a high sensitivity and specificity. Although several markers have been evaluated, the pressing concern is still the low specificity of these markers. One such marker is serum ischemia-modified albumin (IMA), which can be a novel biomarker for accurately diagnosing and prognosticating acute appendicitis. The authors conducted a systematic search of the PubMed, EMBASE, Web of Science, and Scopus databases through February 2023 as per the PRISMA guidelines. The difference in the levels of IMA between patients with acute appendicitis vs. healthy controls, and the difference in the levels of IMA between patients with complicated vs. non-complicated acute appendicitis were taken as the outcome measures. Statistical analysis was performed using a random effects model and mean difference (MD) was calculated. The methodological quality of the studies was assessed by utilizing the Newcastle-Ottawa scale. A total of six prospective comparative studies were included in the meta-analysis. The analysis revealed that the mean level of serum IMA was significantly raised in the acute appendicitis group (MD 0.21, 95% CI 0.05 to 0.37, p = 0.01). Similarly, the mean serum IMA levels were also raised in the complicated appendicitis group compared to the non-complicated appendicitis group (MD 0.05, 95% CI 0.01 to 0.10, p = 0.02). Three of the studies included were, however, of poor methodological quality. Serum IMA is a viable potential marker for diagnosing and prognosticating acute appendicitis. However, due to the limited methodological quality of available studies, further prospectively designed and adequately powered studies are needed.

Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis.

Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1,minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation,postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.

Higher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis

IntroductionThe COVID-19 pandemic impacted presentation, management strategies, and patient outcomes of numerous medical conditions. The aim of this study is to perform a year-to-year comparison of clinical outcomes of patients with acute appendicitis (AA) before and during the pandemic. MethodsPatients treated for AA during the initial 12-mo period of the pandemic at our institute were compared to those treated for AA during the 12-mo period before. Clinical and laboratory parameters, treatment strategies, intraoperative findings, pathology reports, and postoperative outcomes were compared. ResultsDuring the study period, 541 patients presented with AA. The median (interquartile range) age was 28 (21-40) y and 292 (54%) were males. 262 (48%) patients presented during the pre-COVID-19 period, while 279 patients (52%) presented during the COVID 19 pandemic. The groups were comparable for baseline clinical data and imaging results upon index admission. There was no significant difference in rate of nonoperative treatment between the Pre-COVID-19 and During-COVID-19 eras (51% versus 53%, P = 0.6) as well as the success rate of such treatment (95.4% versus 96.4%, P = 0.3). Significantly more patients presented with a periappendicular abscess during COVID-19 (4.6% versus 1.1%, P = 0.01) and median (interquartile range) operative time was significantly longer (78 (61-90) versus 32.5 (27-45) min, P < 0.001). Pathology reports revealed a higher rate of perforated appendicitis during COVID-19 (27.4% versus 10.2%, P < 0.001). ConclusionsPatients with AA present with higher rates of perforated and complicated appendicitis during the COVID-19 pandemic. The success rates of nonoperative management in selected patients with noncomplicated AA did not change during the pandemic and is a safe, feasible, option.

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy

Objective: This manuscript is a mini review of the outpatient management of non-complicated acute appendicitis. We reviewed the literature supporting the safety and efficacy of outpatient management of laparoscopic appendectomy in adult patients with uncomplicated acute appendicitis. Background Data: Outpatient laparoscopic appendectomy is feasible and safe in selected patients in observational studies. Benefits include reduced length of stay (LOS) and postoperative complications. Data reported in 17 studies (mainly retrospective) suggested that outpatient appendectomy might be feasible. Several observational studies have shown that outpatient surgery is not associated with increased readmissions, increased morbidity rates, or reoperation. Until 2022, international guidelines supported the clinical efficacy and safety of outpatient appendectomy. However, the strength of the evidence is weak and recommendations cannot be given. In November 2022, the first randomized controlled trial (RCT) of outpatient treatment according to the ERAS protocol was published. In this study, the length of stay was significantly shorter. There were no differences in readmission rates. No further emergency consultations or complications were observed. The outpatient management had presented an economic saving. Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.

Diagnostic value of systemic immune inflammation index in acute appendicitis.

Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p<0.001). Receiver operating characteristic analysis revealed that the sensitivity and specificity of systemic immune inflammation index with a cutoff value of 840.13 was 82 and 66.7%, respectively, for the diagnosis of acute appendicitis. Correlation analysis revealed that systemic immune inflammation index, Alvarado score, and adult appendicitis score were positively correlated, and this correlation was statistically significant. Systemic immune inflammation index may be used to promote the diagnosis of acute appendicitis and may reduce the need for radiation exposure and diagnostic imaging tests such as contrast-enhanced abdominal computed tomography. It can also be used to differentiate between complicated and non-complicated acute appendicitis cases.

Same-Day Discharge after Laparoscopic Appendectomy for Simple Appendicitis in Pediatric Patients-Is It Possible?

(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents (n = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0–4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents (n = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.

Comparison of the RIPASA and Labeda Scoring Systems to Assess the Morphological Severity of Acute Appendicitis

BACKGROUND: Acute appendicitis is the most common emergency surgical case, leading to further complications if not treated immediately. Limited diagnostics infrastructure is an obstacle in developing countries, especially in the regions. Therefore, alternatives such as clinical scoring systems are required to assist in diagnosis. AIM: This study aimed to compare the use of the RIPASA and Labeda scores to assess the severity of acute appendicitis morphology by determining the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and negative appendectomy rate. METHODS: This was a cross-sectional study designed to assess the severity of morphology of intra-operative acute appendicitis in Dr. Chasan Boesoirie Hospital and network hospitals in Ternate, North Maluku, Indonesia. Data regarding patient characteristics, leukocytes, and acute appendicitis severity were collected and analyzed alongside RIPASA and Labeda scores using the Chi-square test. p &lt; 0.05 were considered statistically significant. RESULTS: Of 59 cases, 39 (66.1%) were complicated acute appendicitis and 20 (33.9%) were noncomplicated acute appendicitis. Chi-square test results showed that there was a significant relationship (p ≤ 0.001) between RIPASA/Labeda scores and the severity of acute appendicitis morphology. CONCLUSION: RIPASA and Labeda scores had the same accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for acute appendicitis severity. Thus, RIPASA and Labeda scores can be used by physicians to help establish a diagnosis of acute appendicitis and determine the need for emergency surgery, as well as predict the possibility of morbidity/complications in patients.

A new approach to the management of acute appendicitis: Decision tree method.

It is important to distinguish between complicated acute appendicitis (CAA) and noncomplicated acute appendicitis (NCAA) because the treatment methods are different. We aimed to create an algorithm that determines the severity of acute appendicitis (AA) without the need for imaging methods, using the decision tree method. The patients were analyzed retrospectively and divided into two groups as CAA and NCAA. Age, gender, Alvarado scores, white blood cell values (WBC), neutrophil/lymphocyte ratios (NLR), C-reactive protein value (CRP), albumin value and CRP/Albumin ratios of the patients were recorded. In the algorithm we created, the most important parameter in the distinction between CAA and NCAA is CRP. NLR is predictive in patients with a CRP value of ≤107.565 mg/L, and the critical value is NLR 2.165. In patients with a CRP value of >107.565 mg/L, albumin is the determinant and the critical value is 2.85 g/dL. Age, gender, alvarado score and CRP/albumin ratio have no significance in distinguishing between CAA and NCAA. In the statistical analysis, there were significant differences between NCAA and CAA groups in terms of age (39.56 years vs 13,675 years), gender (48.1% male vs 71.4% male), WBC (13,891.10/mL vs 11,614.76/mL), CRP (27 mg/L vs 127 mg/L), albumin (3 g/dL vs 3 g/dL) and CRP/albumin (9.50 vs. 41). Thanks to the algorithm we created, CAA and NCAA distinction can be made quickly. In addition, by avoiding unnecessary surgical procedures in NCAA cases, patients' quality of life can be increased and morbidity rates can be minimized.

Diagnostic performance of serum interleukin-6 in pediatric acute appendicitis: a systematic review.

Despite the radiological and analytical advances of the last decades, there is still a significant rate of diagnostic error in pediatric acute appendicitis. In recent years, multiple biomarkers have emerged as potential diagnostic tools. This study aimed to examine the diagnostic performance of serum interleukin-6 in pediatric acute appendicitis. We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography (Medline, PubMed, Web of Science and SciELO). Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the QUADAS2 index. Data extraction was performed by two independent reviewers. The research in the medical bibliography databases resulted in 68 articles. We removed 26 duplicates. Among the remaining 42 articles, we excluded 33 following the inclusion and exclusion criteria. Of the final 9 studies included in this review, 8 provided measured serum interleukin-6 values, and all of them reported significant differences between groups, but inconsistent results regarding sensitivity and specificity. The diagnostic performance of interleukine-6 alone for the diagnosis of acute appendicitis in children is limited. The sensitivity and specificity of interleukine-6 for the diagnosis of non-complicated acute appendicitis in the pediatric population are moderate but increased in complicated appendicitis. There seems to be a direct relationship between serum level of interleukin-6 and the hours of evolution of abdominal pain in children with acute appendicitis. The increasingly widespread use of non-operative management of acute appendicitis warrants further exploration of the classificatory potential of this marker between complicated and uncomplicated appendicitis. We consider that this may be an avenue of research to explore in the future.

Complicated or non-complicated appendicitis? That is the question.

Acute appendicitis (AA) is a common disease that includes all age groups and both genders in societies and is one of the most common causes of acute abdomen. It is important to distinguish between complicated and non-complicated appendicitis before surgery. This study aims to determine laboratory parameters that can be used to determine whether the disease is complicated or non-complicated in patients admitted to the emergency department with AA. Female and male patients admitted to the Emergency General Surgery Department between May 2019 and November 2020 and diagnosed with appendicitis were included in the study. Demographic data (age, gender, and protocol numbers), complete blood counts (Delta neutrophil index [DNI], hemoglobin, monocyte, neutrophil, eosinophil, basophil, platelet, platelet distribution width, mean platelet volume, reticulocyte distribution width), biochemical parameters (amylase, direct bilirubin, indirect bilirubin, albumin, calcium, and lactate dehydrogenase), and examination information were obtained from the hospital automation system and recorded via SPSS software. Parameters of patients were divided into two groups as complicated and non-complicated appendicitis groups were compared. White blood cell (WBC), monocyte, neutrophil, DNI, total bilirubin, and direct bilirubin values were found to be statisti-cally significantly higher in the complicated appendicitis group compared to the non-complicated appendicitis group (p-values; <0.001, 0.003, <0.001, <0.001 and 0.008, respectively). DNI, bilirubin values, WBC, monocyte, neutrophil, and eosinophil can be used as laboratory parameters to distin-guish between complicated and non-complicated AA.

Accuracy of C-reactive protein and procalcitonin in differentiating between complicated and non-complicated acute appendicitis patients in Babylon province

Accuracy of C-reactive protein and procalcitonin in differentiating between complicated and non-complicated acute appendicitis patients in Babylon province

The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis.

Background: Laboratory tests of inflammatory mediators are routinely used in the diagnosis of acute appendicitis (AA). The aim of this study was to evaluate the differences of dynamics of inflammatory markers of the blood in patients with suspected acute appendicitis between complicated AA (CAA), non-complicated AA (NAA), and when AA was excluded (No-AA). Methods: This was a retrospective analysis of prospectively collected data of patients presented to the Emergency Department (ER) of a tertiary hospital center during a three-year period. All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. The dynamics of inflammatory markers of the blood between different types of AA (No-AA, NAA or CAA) during different periods of time are presented. Results: A total of 453 patients were included in the study, with 297 patients in the No-AA group, 99 in the NAA group, and 57 in the CAA group. White blood cell (WBC) count in the No-AA decreased with time, with a statistically significant difference between the <8 h and 25–72 h group. The neutrophils (NEU) percentage decreased in the No-AA group and was statistically significantly different between the <8 h and 25–72 h and <8 h and >72 h groups. C-reactive protein (CRP) increased significantly in the No-AA group throughout all time intervals, and from the first 24 h to the 25–72 h in the NAA and CAA groups. There was a statistically significant difference between the WBC count between No-AA, NAA, and No-AA and CAA groups during the first 24 and 24–48 h. There was a statistically significant difference between NEU percentage and LYMP percentage and in the NEU/LYMP ratio between No-AA and CAA groups through all time periods. CRP was significantly higher in the first 24 h in the CAA than in the No-AA group, and in the 24–48 h in the CAA group than in the No-AA and NAA groups. The linear logistic regression model, involving inflammatory mediators and clinical characteristics, showed mediocre diagnostic accuracy for diagnosing AA with an AUC of 0.737 (0.671–0.802). Conclusions: Increasing concentrations of inflammatory markers are more characteristic in CAA patients than in No-AA during the first 48 h after onset of the disease. A combination of laboratory tests with clinical signs and symptoms has a mediocre diagnostic accuracy in suspecting AA.

Current Practice of Acute Appendicitis Diagnosis and Management in China (PANDA-C): A National Cross-Sectional Survey.

Background: The aim of this study was to describe and analyze the current status of the diagnosis and management of acute appendicitis in China. Patients and Methods: An online record system was used to collect data retrospectively from 52 medical centers in mainland China. All patients with acute appendicitis who were first treated at the hospital in 2017 were included and followed up for one year. Propensity score matching (PSM) was used to exclude the potential confounders and analyze the difference in outcomes between the non-operative management (NOM) and surgical groups. Results: A total of 10,187 patients were enrolled, of whom 5,517 (54.2%) were males. A total of 2,056 (20.2%) cases received NOM. The one-year recurrence rate of appendicitis in the NOM group was 19.3%. On PSM analysis, we found that the NOM group had a lower complication rate (2% vs. 4.2%; p = 0.001) and an acceptable success rate (96.8% vs. 100%; p < 0.001) compared with the operative group in patients with non-complicated acute appendicitis. However, in the complicated acute appendicitis population, the in-hospital complication rate in the NOM group was higher (10.8% vs. 5.8%; p = 0.048) and the success rate was lower (95.4% vs. 100%; p < 0.001) than the operative group. The recurrence rate was lower in patients with non-complicated acute appendicitis than in those with complicated acute appendicitis (17.3% vs. 30.8%; p = 0.010). In the operative group, pre-operative antimicrobial prophylaxis-covered anaerobes could reduce the surgical site infection (SSI) rate compared with that in the non-covered anaerobes group in non-complicated patients (0.9% vs. 1.9%; p = 0.020). Conclusions: Appendectomy is currently the most effective treatment for acute appendicitis. However, NOM is an alternative treatment for non-complicated acute appendicitis but not for complicated acute appendicitis because of the lower complication rate, considerable success rate, and recurrence rate.

Comparison of Antibiotic treatment and Appendectomy for non-complicated Acute Appendicitis during Covid-19 pandemic

Aim: To evaluate the efficacy of antibiotic treatment as the primary option for non-complicated acute appendicitis in pandemic situation. Study Design: Prospective interventional study. Setting &amp; Duration of Study: CMH Lahore, a 700 bedded tertiary care hospital, for 4 months from 15th April 2020 to 15th august 2020. Methodology: A total of 110 cases meeting inclusion criteria, aged 13-65 years of both genders with suspicion of non-complicated appendicitis were included in the study, using probability sampling. They were divided in two groups on randomization basis. Group A for antibiotic therapy and Group B for appendectomy. Group A patients admitted in the ward 48 hours for IV antibiotics, were re-evaluated after 24 hours. If condition improves, the patient was discharged on oral antibiotics for next 10 days &amp; if condition does not improve, antibiotics were prolonged for 48 hours. If deteriorating or patient. .chooses to change group, they underwent appendectomy. If condition improved, they were discharged on oral antibiotics for next 10 days. Group B patient were discharged after 2 post-operative doses of I/V antibiotics. Post-operative I/V antibiotics for 48 hours &amp; 3 days oral antibiotics were given when appendix was gangrenous or perforated. Results: In a population of 110 patients, we studied the comparison of the groups having antibiotics and appendectomy as treatment for acute appendicitis. There is no significant difference in outcomes on basis of mean pain score and mean duration of hospital stay. Both ways of treatment can be adapted accordingly. Conclusion: Non-complicated acute appendicitis can be managed non-operatively in crisis situations like COVID-19 pandemic causing overburdening of hospitals. Keywords: Acute appendicitis, antibiotic therapy, appendectomy, pandemic.

Composite Criteria for Non‐Operative Management of Acute Non‐Complicated Appendicitis Result in Low Failure Rates

The aim of this study is to investigate the outcomes of conservative management of non-complicated acute appendicitis (AA) using our unique institutional protocol, and to compare between these and the outcomes of operative management. Patients admitted to our institution between March 2016 and October 2019 with non-complicated AA were grouped according to their initial management: non-operative versus surgical. Our unique protocol for non-operative management includes: pain< 3days; afebrile upon admission; non-gravid; WBC<15,000 (× 109/L); CRP< 5mg/dl; appendix diameter < 1cm; no appendicolith on imaging; no prior episode of AA; no history of Inflammatory Bowel Disease; no evidence of peritonitis on physical examination. The primary outcome measured was failure of non-surgical management during the index admission. Secondary outcomes included recurrence rate, readmissions, complications, length of antibiotic treatment and length of stay (LOS). A total of 695 patients were included, 436 in the operative group and 259 in the non-surgical treatment group. The mean follow-up time was 1004.9 ± 205.7days. Patients initially treated conservatively rarely required surgery during their index admission (6.9%). Recurrence rate was 19.1% after a mean follow up of 33.4months. The overall failure rate of conservative management was documented in 20.8% of the patients. The complication rate was higher in those treated with upfront surgery (1.6% vs. 0.4%, p < 0.001). The overall LOS was not statistically different between the groups. Our composite protocol for non-surgical management of non-complicated AA results in a low failure rate. A well calculated patient treatment allocation in non-complicated AA can advocate for wide-spread use of the conservative approach.