Patients Undergoing Emergency Appendicectomy Research Articles

Enhanced recovery through fast-track pathway for patients undergoing emergency appendectomy: a quality improvement study

Introduction: Acute appendicitis is a highly prevalent condition, with an incidence ranging from 5.7 to 57 cases per 100,000 inhabitants per year. The average hospitalization duration for patients undergoing laparoscopic appendectomy is 2.08 days and 2.88 days for open appendectomy cases. The implementation of Enhanced Recovery After Surgery (ERAS) protocols for early patient recovery reduces hospital stay without an increase in complications or readmissions. The main objective of the study is to analyze the postoperative hospital stay in patients undergoing urgent appendectomy (open or laparoscopic) who follow the clinical pathway included in the ERAS bundle.
 Materials and methods: Prospective observational study conducted at the Hospital Universitari Parc Taulí, in Sabadell (Barcelona). The results of the patients included in the study were compared with the historical cohort of the hospital with inclusion criteria identical to the study.
 Results: Between May 2021 and February 2022, 50 patients (24 men and 26 women) were included. Laparoscopic appendectomy was performed in 47 patients and open appendectomy in 3 cases. The mean postoperative stay in the group that followed the clinical pathway was 23 hours, compared to 38 hours in the historical control group, with this difference being statistically significant (p 0.03), without observing an increase in morbidity.
 Conclusion: The use of clinical pathways in patients undergoing urgent surgery for acute appendicitis reduces the average hospital stay without increasing the risk of complications or readmissions.

Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy.

Appendiceal neoplasms (ANs) are rare, with an estimated incidence of around 1%: neuroendocrine tumours (NETs) and low-grade appendiceal mucinous neoplasms (LAMNs) comprise most cases. Most tumours are cured by appendectomy alone, although some require right hemicolectomy and intra-operative chemotherapy. The aim of the present study is to evaluate our institution's experience in terms of the prevalence of AN, their histological types, treatment and outcomes in adult patients undergoing emergency appendectomy. Single-centre retrospective cohort analysis of patients treated for acute appendicitis at a large academic medical centre. Patients with a diagnosis of acute appendicitis (AA) where further compared with patients with acute appendicitis and a histologically confirmed diagnosis of appendiceal neoplasm (AN). A diagnosis of acute appendicitis was made in 1200 patients. Of these, 989 patients underwent emergency appendectomy. The overall incidence of appendiceal neoplasm was 9.3% (92 patients). AN rate increased with increasing age. Patients under the age of 30 had a 3.8% (14/367 patients) rate of occult neoplasm, whereas patients between 40 and 89years and older had a 13.0% rate of neoplasm. No difference was found in clinical presentations and type of approach while we found a lower complicated appendicitis rate in the AN group. ANs are less rare with respect to the literature; however, clinically, there are no specific signs of suspicious and simple appendicectomy appears to be curative in most cases. However, age plays an important role; older patients are at higher risk for AN. ANs still challenge the non-operative management concept introduced into the surgical literature.

Improving access to patient information leaflets in patients undergoing emergency appendicectomy

Background
 Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles.
 Methods
 The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods.
 Results
 Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim.
 Conclusion
 The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.

A prospective study of relevance of interval appendicectomy in treatment of appendicular lump

Appendicitis is one of the most common diseases that a surgeon faces in practice. Sometimes patients may present a few days after the onset of acute appendicitis with a palpable mass a phlegmon is a type of inflammatory tumour that consists of an inflamed appendix, as well as the larger omentum and associated viscera.To evaluate the need for interval appendicectomy in patients with appendicular lump. The study included all patients with an appendicular mass and was put on conservative management. . Failures of resolution of mass with conservative management were taken up for appendicectomy. The patients were discharged on successful conservative management and followed up at regular intervals for 12 months. Any patient with features suggesting recurrence of acute appendicitis on follow up was admitted and taken up for appendicectomy. All of the above information was gathered and statistically evaluated.Out of 58 cases of appendicular mass, 3 (5.17%) were operated due to failure of resolution of mass. The remaining 55 (94.83%) cases were successfully treated conservatively and followed up regularly for 12 months. 4 (7.27%) patients were lost to follow up. 1 (1.81%) patient revealed carcinoma of caecum and underwent right hemicolectomy. The remaining 50 (86.2%) cases, from which 42 (84%) patients remained recurrence free. 8 patients (16%) had recurrent appendicitis, out of which 7 (14%) patients underwent emergency appendicectomy, 1(2%) patient developed appendicular lump and was treated non operatively. In our study recurrence rate of acute appendicitis following resolution of appendicular mass is low (16%). So interval appendicectomy have to no longer be the rule in all patients after resolution of mass and should be reserved for patients with recurrences or with increased risk factors for recurrence.

Improving access to patient information leaflets utilising QR codes in patients undergoing emergency appendicectomy.

Abstract Background Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles. Methods The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods. Results Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim. Conclusion The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.

Association of Total Leucocyte Count and Acute Appendicitis Among Young Patients Undergoing Emergency Appendectomy

Objective: To study the association of total leucocyte count and acute appendicitis among young patients undergoing emergency appendectomy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Quetta Pakistan, from Mar to Oct 2021. Methodology: The study included one hundred patients diagnosed with acute appendicitis by a consultant surgeon undergoing an emergency appendectomy. The total leucocyte count was calculated for all the patients at the time of diagnosis. The treating surgeon confirmed acute appendicitis findings based on gross examination of the appendix at the time of surgery. The presence of acute appendicitis and other factors was associated with raised total leucocyte count in all the patients. Results: Out of 100 patients diagnosed with acute appendicitis, 59 were male, while 41 were female. The mean age of the study participants was 28.33±3.673 years. On gross examination, 79 had a confirmed diagnosis of acute appendicitis, while 21 did not have an inflamed appendix. 85 had raised total leucocyte count, while 15 patients had total leucocyte count in the normal range. Statistical analysis revealed that acute appendicitis on gross examination and raised C-reactive protein had a statistically significant correlation with raised total leucocyte count (p-value: 0.001). Conclusion: Total leucocyte count was significantly raised in patients who had confirmation of inflammation of the appendix at gross examination during the surgery. Raised total leucocyte count and C reactive protein should be given more weightage in diagnosing acute appendicitis and planning for an emergency appendectomy.

Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England

IntroductionThe mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis.MethodsAdult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink and hospital episode statistics data. Length of stay, re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression.ResultsA total of 40,353 patients underwent appendicectomy and of these 75 (0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p < 0.0001) and have comorbidities (p < 0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90 days (20% vs 11%, p = 0.019). Most importantly, their odds of death at 90 days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49).ConclusionPatients with cirrhosis have a threefold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis.

Appendiceal tumours as incidental findings in patients undergoing emergency appendicectomy: A retrospective, single-center study and a brief overview of current practice standards

Introduction: Primary cancers of the appendix are very rare and most of them are usually found accidentally on appendectomies performed for appendicitis. Although these tumours are rare, there is a diverse histology. Methods: We conducted a single-center retrospective study of patients undergoing appendectomy at our institution for the suspended diagnosis of appendicitis. From January 2003 to December 2018 a total of 1809 patients underwent appendectomy under general anaesthesia. Patient demographics, type of procedure, and tumour histology were recorded. Results: The mean age of patients was 32 years (range, 14 to 85). Of these patients, 821 (45.38%) were female, and 988 (54.62%) were male. In total 959 (53.01%) underwent laparoscopic appendectomy and 850 (46.99%) underwent open appendectomy. An appendiceal neoplasm was found in 17 patients (0.94%). Of these 17 patients, four (23.53%) were reported to have benign tumours, while 13 (76.47%) were reported to have malignancies. The most frequent appendiceal tumour was carcinoid, which was detected in 10 patients (58.82%). Conclusion: Tumours of the appendix are very rare and the majority of them are malignancies. Early recognition is very important. There is no standard of care due to the rare frequency of these tumours.

Comparison of Effects of Nalbuphine and Tramadol on Cardiovascular Response to Tracheal Intubation in Patients Undergoing Emergency Appendectomy

Objectives: To compare the effects of Nalbuphine with Tramadol on cardiovascular response (change in heart rate and blood pressure) to tracheal intubation in patients undergoing emergency appendectomy. Material and methods: This randomized controlled trial was conducted at the Department of Anaesthesiology, CMH Mardan from January 1, 2022, to June 30, 2022. A total of 100 patients who were undergoing emergency appendectomy under general anaesthesia, with ASA grade I, aged between 30-50 years, and weighing between 50-80 kg were selected. Patients were either male or female and had normal blood pressure. They were divided into two groups: the Nalbuphine group and the Tramadol group. The study focused on analyzing the cardiovascular response (changes in heart rate and blood pressure) to tracheal intubation in both groups. Results: Most of the patients in both Group A and Group B were females, with a female to male ratio of 3.54:1 and 2.57:1, respectively. The mean age of patients in Group A was 37.90±5.41, while in Group B it was 40.10±6.39. After laryngoscopy and tracheal intubation, patients in Group A had a significantly less increase in heart rate and blood pressure as compared to those in Group B. Conclusion: The Nalbuphine is better than Tramadol in attenuating the cardiovascular response to laryngoscopy and tracheal intubation. Keywords: Nalbuphine, Tramadol, Cardiovascular Response, Tracheal Intubation, Laryngoscopy, Heart Rate and Blood Pressure.

Paediatric negative appendicectomy rates at a regional Western Australian Centre: a five-year cohort study.

In acute appendicitis, decision-making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross-sectional imaging. In regional settings, non-paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres. A retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length-of-stay and post-operative complication rates. Four hundred and twenty-one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 109 , neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re-admission or complications compared with appendicectomy for appendicitis. Our centre's NA rate is higher than that observed in the literature at both non-paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign.

Frequency of Hyperbilirubinemia in Perforated Appendicitis - A Current Update on Diagnostics and Management.

Background: Perforated appendix can be detected earlier by chemically with the aid of hyperbilirubinemia. It is a simple non-invasive modality that can aid to detecting complicated appendicitis and avoid morbidity. Aim: To assess frequency of hyperbilirubinemia in patients undergoing appendectomy due to perforated appendicitis. Methods: A descriptive cross-sectional study was conducted in which a total of 75 patients undergoing emergency appendectomy due to perforated appendicitis and age 15-70 years were recruited. Patients with CLD, pregnancy, Congenital or acquired biliary disease, alcoholism and hemolytic disease were excluded. Blood sample was obtained and was sent to the hospital histopathology laboratory and it was reported by consultant pathologist for assessment of hyperbilirubinemia. Results: Age range in this study was from 15-70 years with mean age of 30.69±14.37 years. Majority of the patients 56(74.67%) were 15-40 years of age. Out of these 75 patients, 43(57.33%) were male and 32(42.67%) were females. Mean hyperbilirubinemia was 1.67±0.87 mg/dl. Frequency of hyperbilirubinemia in patients undergoing appendectomy due to perforated appendicitis was found in 63 (84.0%) patients. Practical implication: This will aid in prompt diagnosis and early management of perforated appendix, and serum bilirubin can be used as modality for diagnosis in the absence of ultrasound facility. Conclusion: Frequency of hyperbilirubinemia in patients undergoing appendectomy due to perforated appendicitis is very high. Keywords: perforated appendicitis, hyperbilirubinemia, appendectomy, bilirubin level, perforation, sensitivity.

Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil.

the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.

Hyperbilirubinemia as a diagnostic marker in gangrene or perforation of acute appendicitis

Background. Although several scoring systems are available for the diagnosis of acute appendicitis, there is no one specific for the diagnosis of gangrenous or perforated appendicitis. This study aims to evaluate the sensitivity and specificity of serum total bilirubin in gangrene or perforated appendicitis. Materials and Methods. A prospective study was conducted on 55 patients undergoing emergency appendectomy, in whom total serum bilirubin was determined for statistical analysis. Results. In our study, out of 55 patients with a perforated or non-perforated appendix, the mean total serum total bilirubin was 2.34 and 1.27, respectively. The cut-off value of serum total bilirubin in this study was calculated using the ROC curve and found to be 1.75. Hyperbilirubinemia is 92.7% sensitive and 96.4% specific in perforation or gangrene of acute appendicitis. The positive predictive value was 96.2% and the negative predictive value was 93%. Conclusions. Patients with acute appendicitis and increased bilirubin levels have a higher chance of gangrene or perforation than those with normal bilirubin levels. Estimation of total serum bilirubin is available in most centers at minimal cost, and can therefore be used in conjunction with clinical and laboratory investigations for the diagnosis of gangrenous or perforated appendicitis.

How Can Laparoscopic Appendectomy Become the First-Line Treatment for Acute Appendicitis in Lower-Income Countries: A 15-Year Experience

Introduction: The barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource cost and availability. The present study evaluates the impact of actions took over 15 years in a single academic center aiming to implement the routine use of laparoscopy for acute appendicitis. Methods: Retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared with 4 major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. Results: We identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p < 0.001). Since 2016 the standard of care in our institution is appendiceal stump closure with polymeric clips, even in complicated acute appendicitis. Conclusion: The development of a feasible, reproducible, and safe technical standardization is one of the cornerstones for a consistent and viable change in the current practice for appendectomies in lower-income countries.

TH5.2 Gender differences in patients undergoing emergency appendicectomy

Abstract Aims Although appendicectomy is common, there exists minimal published literature exploring whether there are differences between adult males and females undergoing appendicectomy. This study aimed to investigate the demographics, pre-operative investigation, intra-operative findings and clinical outcomes between both genders having an emergency appendicectomy (EA). Methods A multicentre retrospective observational study was carried out across four hospitals who had an EA between August 2018 and November 2020. Patients were identified through pathology records. Data was extracted from electronic records for demographics, pre-operative (peak) blood results, pre and post-operative imaging, operative details, and the clinical outcomes. Patients were dichotomised by gender and results compared. Data was analysed using unpaired Student t test or Chi-squared test as appropriate with p &amp;lt; 0.05 considered statistically significant. Results 1,128 emergency appendicectomies (57.5% male) were included. Males undergoing EA were younger (median age: 34 vs 40 years, p&amp;lt;0.001). There was no difference in peak pre-operative white cell or neutrophil count; however, C-reactive protein was lower in male patients (median 72 vs 97, p&amp;lt;0.001). Pre-operative imaging was performed more often in females: ultrasound (20.7 vs 1.5%, p&amp;lt;0.001) and CT scan (61.8 vs 54.9%, p=0.020). Male patients underwent more open surgery (14.0 vs 6.5%, p&amp;lt;0.001). There was no difference in the severity of appendicitis, rate of negative appendicectomy, median total hospital stay, post-operative complication or 30-day readmission rates. Conclusions This study demonstrates that differences exist between males and females who have EA in terms of age, use of pre-operative imaging and operative approach, however, clinical outcomes are similar.

O043 The outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England

Abstract Introduction The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections, and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis. Methods Adult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink, and hospital episode statistics data. Length of stay, re-admission, Case fatality, and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex, and co-morbidity using logistic regression. Results A total of 40353 patients underwent appendicectomy and of these 75(0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p &amp;lt;0.0001) and have comorbidities (p&amp;lt;0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90-days (20% vs 11%, p=0.019). Most importantly, their odds of death at 90-days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49) Conclusion Patients with cirrhosis have a 3-fold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis. Take-home message Patients with cirrhosis have a 3-fold increased mortality risk than those without cirrhosis. They also have longer hospital stays and higher risk of readmissions.

Implementing a surgical site infection prevention bundle for emergency appendectomy: Worth the effort or waste of time?

BackgroundThe aim of this study was to evaluate feasibility and impact of an intraoperative surgical site infection prevention bundle for emergency appendectomy. MethodsConsecutive adult patients undergoing emergency appendectomy were prospectively included during a 10-year study period (2011−2020). The care bundle was implemented as of November 1, 2018, and focused on 4 intraoperative items (disinfection, antibiotic prophylaxis, induction temperature control >36.5°C, and intracavity lavage). The primary outcome was the compliance to bundle items. Thirty-day surgical site infections were assessed by the independent Swiss National SSI Surveillance Program (2011 to October 2018) and by an institutional audit (November 2018−2020). Independent risk factors for surgical site infection were identified through multinominal logistic regression analysis. ResultsOf 1,901 patients, 449 (23.6%) were included after bundle implementation. Overall surgical site infection rate was 111 (5.8%). In 42 patients with surgical site infection (37.8%), antibiotic treatment alone was done, and additional surgical management was necessary in 31 patients (27.9%), computed tomography-guided drainage in 30 patients (27%), and bedside wound opening in 9 cases (8.1%). Overall compliance to the bundle was 79.9%. Overall surgical site infection rates were decreased after bundle implementation (17/449 [3.8%] vs 94/1,452 [6.5%], P = .038), mainly due to a decrease in superficial incisional infections (P = .014). Independent risk factors for surgical site infection were surgical duration ≥60 minutes (odds ratio: 1.66, P = .018), contamination class IV (odds ratio: 2.64, P < .001), and open or converted approach (odds ratio: 4.0, P < .001), and the bundle was an independent protective factor (odds ratio: 0.58, P = .048). ConclusionImplementation of an intraoperative surgical site infection prevention bundle was feasible and might have a beneficial impact on surgical site infection rates after emergency appendectomy.

Burden of negative appendectomy at a District General Hospital: a two-year cross-sectional review

INTRODUCTION: The average negative appendectomy rate (NAR) in the UK is relatively high when compared to other high-income countries. Associated factors and complications following NAR defer in literature. The main objective of this paper is to report the short and long-term re-admission following a NAR, secondary objectives were to assess the characteristics of NAR patients and their Alvarado’s score. METHODS: A two-year retrospective observational study was performed on patients undergoing emergency appendectomy. Patient demography, data and follow-up records were extracted from electronic patient records. RESULTS: Four hundred and seventy-eight (478) patients underwent emergency appendectomy over the study period. 7 patients were excluded due to incomplete patient records. 471 patients met the study criteria; median age at presentation was 27 (IQR 19 - 39) years, mean age of 32 (SD 16.3) years. 245 (52%) were male. Among this cohort, 355 patients (75.4%) underwent appendectomy for histologically proven appendicitis, while 12 patients (2.5%) and 19 patients (4%) were diagnosed via histology to have appendicular faecolith without inflammatory change and lymphoid hyperplasia respectively, an additional 12 patients (2.5%) had unexpected histological findings. Conversely, 73 patients (15.5%) underwent negative appendectomy. Re-presentation within thirty-days was 5.5% vs. 11% (p=0.2001) while re-presentation beyond thirty-days was 21.9% vs. 4.2% (p

Diagnostic test evaluation of Raja Isteri Pengiran Anak Saleha appendicitis score in patients with acute appendicitis

Introduction: The diagnosis of acute appendicitis is still heavy reliant on clinical judgement as the availability and quality of imaging studies are quite variable. The Alvarado score and newer scores have been proposed in recent times, one of which is the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score. It has been developed for a better diagnosis of acute appendicitis; the score includes 14 clinical parameters, which have higher sensitivity, specificity and diagnostic accuracy than Alvarado scoring, especially in the Asian population. Methodology: The objective was to evaluate the diagnostic accuracy of the RIPASA score with respect to histopathologically proven appendicitis. A diagnostic test evaluation was conducted in the surgical wards of a tertiary care centre for 1 year on patients undergoing emergency appendicectomy for acute appendicitis. Consecutive sampling was done on 132 participants. After administering the RIPASA score questionnaire to the patients, the histopathological reports were collected and the scoring system was compared to obtain sensitivity, specificity, predictive values, likelihood ratios and area under curve (AUC). Results: Of the 132 patients, 50.8% were male and 49.2% were female, with the majority of patients <40 years. Among components of the RIPASA score other than age, sex, anorexia, duration of symptoms and Rovsing's sign, all other components had an independent statistically significant association to histologically proven appendicitis. The receiver operating characteristic curve analysis of the RIPASA score showed an AUC of 0.915 (P < 0.0001). The negative appendicectomy rate was about 19.6%. Conclusion: The RIPASA score is a simple scoring system with high sensitivity and specificity for the diagnosis of acute appendicitis. The 14 clinical parameters are easily obtained from a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early and complications can be prevented.

P-O08 Effect of socioeconomic deprivation on clinical characteristics and outcomes of patients undergoing an emergency appendectomy

Abstract Background Appendicectomy is one of the commonest emergency general surgical operations performed. Previous studies have shown that socioeconomic status (SES) impact outcomes in a number of diseases. Currently, there is no study analysing the impact of SES on the outcome of appendectomy. Our aim was to compare the clinical characteristics and outcomes of adults having an emergency appendectomy between deprived and less deprived SES groups. Methods A multicentre retrospective observational study of all adult patients who had an emergency appendectomy across four hospitals (two district general and two tertiary care hospitals) between August 2018 and November 2020 was performed. Patients were identified through pathology records. Data was extracted from electronic records for demographics, pre-operative (peak) blood results, pre and post-operative imaging, operative details and the clinical outcomes. Patient’s residential address was used to calculate Scottish Index of Multiple Deprivation (SIMD). The patients were grouped by SIMD into a more deprived SES group (SIMD 1-5) and a less deprived SES group (SIMD 6-10) and results compared. Results A total of 1,105 patients (57.5% male) were included. Median age was lower in the more deprived group (35 vs 40 years, p &amp;lt; 0.001). The less deprived group were more likely to be fitter: ASA-1 grade 51.6% vs 43.5%, p = 0.008. There were fewer appendectomies in most deprived decile compared to the least deprived decile (5.2 vs 11.3 per 10,000 population per year, p &amp;lt; 0.001). There was no difference in inflammatory markers, pre-operative imaging, surgical approach, severity of appendicitis and the median length of stay (3 days). However, there were more surgical site infection in the more deprived group (3.4% vs 0.9%, p = 0.006). Conclusions This study demonstrates that SES does impact on the age of presentation and incidence of appendectomy. Surgical site infection were seen more frequently in the more deprived patients undergoing emergency appendectomy. This may be a reflection of the underlying comorbidities.