Perforated Appendicitis Patients Research Articles

Influence of the urgency of the time of surgery on the rate of perforated appendicitis in patients with acute appendicitis : Results of the randomized PERFECT study

Influence of the urgency of the time of surgery on the rate of perforated appendicitis in patients with acute appendicitis : Results of the randomized PERFECT study

Perbandingan Suhu dan Kadar Leukosit Pada Pasien Appendisitis Akut dengan Pasien Appendisitis Perforasi

Late diagnosing appendicitis will increase the incidence of perforation of the appendix which causes dangerous complications. In diagnosing appendicitis, temperature assessment and leukocyte count can be carried out which is useful for indicating the presence or absence of an inflammatory/infectious reaction. This test is used to support the diagnosis of patients with acute appendicitis and perforated appendicitis. If the difference between the two patients is immediately known, this can be used as additional information in strengthening the diagnosis so that it can be determine the management quickly, precisely and increase awareness of complications. This study was conducted to compare the temperature and leukocyte levels of acute appendicitis patients with perforated appendicitis patients at Arun Lhokseumawe Hospital in 2019–2020. This study was an observational analytic study with a cross sectional approach. It was conducted on 45 patients with acute appendicitis and 45 patients with perforated appendicitis. The data were obtained from medical records and analyzed using the Mann Whitney test. The results showed that the average temperature of patients with acute appendicitis was 36,766 ± 0,083?C and patients with perforated appendicitis was 37,237 ± 0,146?C with p value = 0,040. The cut off point of temperature between acute appendicitis patients and perforated appendicitis patients was 37,8?C with sensitivity 22,22%, specificity 97,78% and AUC 62,3%. The average leukocyte level in patients with acute appendicitis was 9.989.67 ± 236,058 cells/mm3 and patients with perforated appendicitis was 16.808.89 ± 713,356 cells/mm3 with p value < 0,001. The cut off point of leukocytes between patients with acute appendicitis and patients with perforated appendicitis was 12,200 cells/mm3 with sensitivity 91,11%, specificity 88,89% and AUC 98,3%. The conclusion of the study stated that there were differences in body temperature values and blood leukocyte levels between patients with acute appendicitis and perforated appendicitis at Arun Lhokseumawe Hospital.

Perbandingan Suhu dan Kadar Leukosit Pada Pasien Appendisitis Akut dengan Pasien Appendisitis Perforasi

Late diagnosing appendicitis will increase the incidence of perforation of the appendix which causes dangerous complications. In diagnosing appendicitis, temperature assessment and leukocyte count can be carried out which is useful for indicating the presence or absence of an inflammatory/infectious reaction. This test is used to support the diagnosis of patients with acute appendicitis and perforated appendicitis. If the difference between the two patients is immediately known, this can be used as additional information in strengthening the diagnosis so that it can be determine the management quickly, precisely and increase awareness of complications. This study was conducted to compare the temperature and leukocyte levels of acute appendicitis patients with perforated appendicitis patients at Arun Lhokseumawe Hospital in 2019–2020. This study was an observational analytic study with a cross sectional approach. It was conducted on 45 patients with acute appendicitis and 45 patients with perforated appendicitis. The data were obtained from medical records and analyzed using the Mann Whitney test. The results showed that the average temperature of patients with acute appendicitis was 36,766 ± 0,083⁰C and patients with perforated appendicitis was 37,237 ± 0,146⁰C with p value = 0,040. The cut off point of temperature between acute appendicitis patients and perforated appendicitis patients was 37,8⁰C with sensitivity 22,22%, specificity 97,78% and AUC 62,3%. The average leukocyte level in patients with acute appendicitis was 9.989.67 ± 236,058 cells/mm3 and patients with perforated appendicitis was 16.808.89 ± 713,356 cells/mm3 with p value < 0,001. The cut off point of leukocytes between patients with acute appendicitis and patients with perforated appendicitis was 12,200 cells/mm3 with sensitivity 91,11%, specificity 88,89% and AUC 98,3%. The conclusion of the study stated that there were differences in body temperature values and blood leukocyte levels between patients with acute appendicitis and perforated appendicitis at Arun Lhokseumawe Hospital.

Role of immature granulocytes and total bilirubin values in the diagnosis of perforated appendicitis in patients over 65 years.

The aim of this study was to investigate the effectiveness of immature granulocyte count, immature granulocyte percentage, and total bilirubin value in predicting complicated and perforated appendicitis in patients aged 65 years and older with a diagnosis of appendicitis. In this study, 84 patients, aged 65 years and older, who had appendectomy demographic information, preoperative white blood cell count, neutrophil/lymphocyte ratio, immature granulocyte count and immature granulocyte percentage, operation findings, and pathology results were collected retrospectively. They were grouped into 4 categories: complicated, non-complicated, perforated, and non-perforated, according to the data and surgical findings. Total bilirubin and immature granulocyte count were found to be statistically significant in predicting complicated and perforated appendicitis in patients aged 65 years and older with a diagnosis of appendicitis. The total bilirubin was found to have the following values in differentiating complicated appendicitis: area under the curve=0.883, sensitivity=78.3%, and specificity=88.5%. Total bilirubin had the highest discrimination power with area under the curve=0.804 in differentiating perforation. The immature granulocyte percentage and total bilirubin count are the fast, inexpensive, and reliable parameters that can be used to predict complicated and perforated appendicitis in patients aged 65 years and older.

HUBUNGAN ANTARA LAMA NYERI PRA OPERASI DENGAN LAMA PERAWATAN POST OPERASI PADA PASIEN APENDISITIS PERFORASI YANG DILAKUKAN LAPAROTOMI APENDEKTOMI DI RSUD DR M HAULUSSY AMBON TAHUN 2018-2019

Perforated appendicitis is a rupture of the appendix which can cause pus to enter the abdominal cavity, causing complications of peritonitis. The delay in establishing a diagnosis has an impact on less than optimal management which in to complications in the form of perforation. This study aims to determine the correlation between the length of preoperative pain and the length of postoperative pain in perforated appendicitis patients who underwent appendectomy laparotomy in RSUD Dr. M. Haulussy Ambon in 2018-2019. The design of this research used an observational analytic method with a cross sectional approach. The research using total sampling technique obtained 42 samples according to the inclusion criteria. Data analysis used univariate analysis and bivariate analysis. The statistical test used was the chi-square test and the alternative test used the fisher's exact test. The results of the chi-square test between the length of preoperative pain and the length of treatment obtained p = 0.041. The conclusion of this study is that there is a significant relationship between the length of preoperative pain and the length of postoperative care in appendicitis patients who underwent appendectomy laparotomy at Dr. M. Haulussy Ambon in 2018-2019.

Predictive value of serum sodium level in determining perforated appendicitis.

The aim of the study was to investigate the predictive value of hyponatremia as a new biochemical marker for the early and accurate preoperative diagnosis of complicated appendicitis in the adult population. 732 patients who were operated for acute appendicitis (AA) and diagnosed as perforation intraoperatively were evaluated retrospectively. Serum sodium, C-reactive protein (CRP), and leukocyte levels of patients with perforated and nonperforated appendicitis were compared. Perforated appendicitis patients had statistically lower serum Na values (p<0.001). Similarly, patients without perforated appendicitis had higher serum CRP values (p<0.001). In patients diagnosed with perforated AA, the sensitivity of plasma sodium concentration was 63%, and the specificity was 66%. The threshold value of plasma sodium concentration ≤137.5 mEq/L had the best possible sensitivity and specificity. Hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium level measurement should be considered in patients with a clinical presentation consistent with appendicitis if complications are suspected.

A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS ROLE OF ISOLATED HYPERBILIRUBINEMIA TO PREDICT GANGRENOUS/PERFORATED APPENDICITIS

Aim:Theaimof studywas toassess theroleofhyperbilirubinemiaasapredictorofgangrenousorperforated appendicitis. Introduction: Appendicitis is characterised by means of infection and inflammation of the appendix. It was hypothesized that an association exists between the presence of appendiceal perforation and hyperbilirubinemia.The present study has been designed to evaluate the association between hyperbilirubinemia in cases of acute appendicitis and its complications. Methods: This study was conducted at SMS hospital Jaipur as a prospective observational study. One hundred twenty patients of appendicitis were enrolled from 1 March 2017 to 30 November 2018 according sample size. Patients underwent appendectomy after confirmation of diagnosis by USG and other investigations and biopsy was sent for histopathological examination. Results: Total 120 patients were analysed In our study as per inclusion criteria. Hyperbilirubinemia (&gt;1.2 mg/dL) was found in gangrenous appendicitis and perforated appendicitis (91.67% and 100% respectively) as compared to in acute appendicitis (15.63%) cases (P&lt;0.001). most of the acute (84.37%) and some gangrenous appendicitis (8.33%) patients had normal TSB but all perforated appendicitis patients had hyperbilirubinemia (&gt;1.2 mg/dL). Liver enzymes were normal in most of cases or slightly elevated in some cases.Alvarado Score and CRP were also significantly elevated in complicated appendicitis than acute appendicitis. Conclusion: Our study concluded that isolated hyperbilirubinemia is a predictor of perforated or gangrenous appendicitis.High Alvarado Score and CRP level are also indicating complicated appendicitis.

Laboratory markers used in the prediction of perforation in acute appendicitis.

In this study, we aimed to evaluate the laboratory markers used in the diagnosis of acute appendicitis (AA) and present the parameters that can be used to predict acute perforated appendicitis. The cases who underwent an appendectomy in our clinic between September 2018 and March 2020 were evaluated retrospectively. A total of 530 patients who met the study criteria were included in the study. Patients were divided into two groups according to the presence of an intraoperative perforation. Non-complicated appendicitis patients formed Group-1, and perforated appendicitis patients formed Group-2. The demographic, clinical, and laboratory characteristics of the patients were compared. The number of non-complicated patients in Group 1 was 443, while there were 87 (16.4%) patients in Group 2 who had perforated appendicitis. The mean age of the patients in the normal appendicitis group was 29.90±10.51 years, and the mean age of the patients in the perforated appendicitis group was 36.32±14.58 years. In the normal appendicitis group, 257 (58%) of the patients were male, 186 (42%) were female, while in the perforated appendicitis group, 38 (43.7%) were male, 49 (56.3%) were female. In the perfo-rated appendicitis group, white blood cell (WBC) value was 16.19±4.71 (p<0.001), C-reactive protein (CRP) value was 146.28±113.59 (p<0.001), total bilirubin value was 0.71±0.36 (p<0.001), and neutrophil-lymphocyte ratio (NLR) was 10.85±6.25 (p<0.001). We believe that the WBC, total bilirubin, CRP, and NLR values obtained within this study, which is tested in the rapid and easily accessible blood tests in routine examinations that can contribute to the prediction of perforation.

Did the COVID-19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis?

BackgroundAppendectomy for acute appendicitis remains one of the most common surgical procedures. This study aims to assess the clinical presentation and delays in diagnosing acute appendicitis during the COVID-19 pandemic.MethodsWe evaluated data of all adult patients who underwent an appendectomy at our hospital between June 1, 2019 and June 1, 2020. Demographic data, admission type to the emergency room, radiological findings, pathological findings, and hospitalization time were noted. Patients were divided into four groups of 3-month periods, pre (Groups 5, 4, 3, 2) and during the pandemic (Group 1). Hospitalization time and perforation status of each group were compared. The hospital admission type and their effect on perforation were also evaluated.ResultsTwo hundred and fourteen patients were included; 135 patients were male, and 57 were female. The median age was 39 years. In Group 1 (pandemic period), 28.8% of patients were referred to us from pandemic hospitals. The median hospitalization time was 7.3 h before pandemics (Group 2–5), 5 h in the pandemic period (Group 1). Perforation rates were 27.8% in Group 1, 23.3% in Group 2, 16.3% in Group 3, 14.0% in Group 4, and 18.6% in Group 5 (0 = 0.58). There was no difference in the patients in Group 1 in the rate of perforated appendicitis in patients who were referred from other pandemic hospitals (29.4) and those admitted via our own emergency room (16.6%) (p = 0.27) during the pandemic period.ConclusionWe did not observe any clear increase in the diagnosis of perforated appendicitis during the pandemic period, even in patients who were transferred from other hospitals.

Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China.

BACKGROUNDCoronavirus disease 19 (COVID-19) is a global pandemic and has had a profound impact on our routine surgical activities. Acute appendicitis is the most common abdominal emergency worldwide. Therefore, it is highly essential to assess the influence the pandemic has on acute appendicitis.AIMTo assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODSWe retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing, China. Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019. Preoperative management, intraoperative protective measures, and postoperative management were conducted.RESULTSAfter screening, six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group. The results of the nucleic acid test were negative. Of the 76 patients enrolled in the simple group, nine patients received medication therapy, and all others underwent surgery. From this same group, 66 patients were diagnosed with suppurative appendicitis, and one patient was diagnosed with perforated appendicitis after surgery. There were 14 patients in the complex group, for which the postoperative diagnosis indicated perforated appendicitis. The proportion of men with perforated appendicitis was higher than that in 2019 (P < 0.05). The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019 (P < 0.05). The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019 (P < 0.05). The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019 (P < 0.05). Online consultation after discharge was selected in 59 cases (65.6%). No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSIONThe management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.

Diagnostic value of laboratory results in children with acute appendicitis

Abstract Background The correct diagnosis rate in acute appendicitis (AA) is between 72 and 94% despite advanced laboratory and radiologic examinations. This study was conducted to determine the effectiveness of laboratory parameters in the diagnosis of children with appendicitis. Materials and methods Patients who underwent appendectomy were divided as AA (subdivided into two groups as perforated and non-perforated) and without appendicitis. White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), red cell distribution (RDW), mean platelet volume (MPV), C-reactive protein (CRP), procalcitonin levels and Alvarado score were recorded. Results WBC, NLR and CRP levels were higher in patients with AA (p&lt;0.05). According to the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), p values and 95% confidence interval in predicting patients with and without appendicitis were NLR: 0.703, 0.025, 0.523–0.884; CRP: 0.822, &lt;0.001, 0.725–0.919; procalcitonin: 0.631, 0.150, 506–0.755 and Alvarado score: 0.754, 0.05, 0.578–0.930, respectively. RDW, CRP and procalcitonin values of perforated appendicitis patients were higher compared with those of the non-perforated ones (p&lt;0.05). According to the ROC curve, AUC, p values and 95%CI were NLR: 0.583, 0.094, 0.488–0.678; RDW: 0.715, &lt;0.001, 0.628–0.802; CRP: 0.900, &lt;0.001, 0.842–0.958; procalcitonin: 0.865, &lt;0.001, 0.799–0.930 and Alvarado score: 0.727, &lt;0.001, 0.641–0.812, respectively. Conclusions CRP is the most effective bioindicator in the diagnosis of AA, the detection of perforated cases. It was revealed that NLR is effective in the diagnosis of AA, procalcitonin and RDW values are effective in the separation of perforated cases.

Prophylactic intraabdominal drains do not confer benefit in pediatric perforated appendicitis: Results from a quality improvement initiative

Background/purposeProphylactic, intraabdominal drains have been used to prevent intraabdominal abscess (IAA) after perforated appendicitis. We hypothesized that routine drain placement would reduce the IAA rate in pediatric perforated appendicitis. MethodsA 27-month quality improvement (QI) initiative was conducted: closed-suction, intraabdominal drains were placed intraoperatively in pediatric (age < 18) perforated appendicitis patients. QI patients were compared to controls admitted during the preceding 8 months and following 4 months.The primary outcome was 30-day IAA rate. Univariate and multivariate analyses were performed. ResultsTwo hundred seventy QI patients were compared to 109 controls. There was 100% compliance during 21 of 27 months of the QI initiative; only 7 QI patients did not receive drains. IAA occurred in 20.0% of QI patients and 22.9% of control (p = 0.52). After adjustment, the QI initiative was not associated with reduced odds of IAA (OR 0.83, 95% CI 0.48–1.44). Median length of stay was longer in QI patients during the index admission (p = 0.03) and over 30 postoperative days (p = 0.03), but these relationships did not persist after adjustment. ConclusionsA QI initiative investigating prophylactic, intraabdominal drain placement in perforated appendicitis did not reduce the IAA rate. We recommend against routine drain placement in pediatric perforated appendicitis. Level of evidenceLevel III.

Accuracy of D-Dimer Levels and C-reactive Protein in Predicting Perforation of Acute Appendicitis

Introduction: D-Dimer as the primary product of fibrin degradation, was found to be increased in appendicitis patients. CRP still gives different results in predicting perforated appendicitis. The purpose of this study is to find out the accuracy of D-Dimer and CRP in predicting appendicitis perforation at the Central General Hospital Dr. Hasan Sadikin Bandung 2019.&#x0D; Method: This study used prospective observational design with cross-sectional approach. The subject were taken from the Emergency Department (ED) patient between September 2018-September 2019 who met the inclusion criteria. Preoperative D-Dimer and CRP serum were measured and the results of the surgery were noted. Chi-Square test was conducted and the data were analyzed using SPSS Version 22.0 for windows at a 95% confidence level. The value is significant if p &lt;0.05.&#x0D; Results: The sample included in this study were 41 patients, with 24 perforated appendicitis patients. The average age of patients was 34.8 ± 13.8. The majority of patients were male, 24 patients ( 58.5%). Area for ROC curve for D-Dimer is 0.929, with a cut-off point of 0.51 mg / l for sensitivity perforation appendicitis 95.8%, specificity 76.5%, positive predictive value (PPV) 85.2%, negative predictive value (NPV) 92.9% and accuracy 87.8%. For CRP with a cut-off point at 18.84 for sensitivity perforation appendicitis 58.3%, specificity 94.1%, positive predictive value (PPV) 93.3%, negative predictive value (NPV) 61.5% with an accuracy of 73.2%.&#x0D; Conclusion: D-dimer and CRP level can be used in predicting perforation of appendicitis.&#x0D; (ISSN 2723-7494 J Bedah Indonesia. 2020;48:3-14)

Increased risk of perforated appendicitis in patients with schizophrenia and dementia: A population-based case-control study.

Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19–3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62–14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.

The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis.

This study aimed to investigate the superiority of C-reactive protein (CRP) lymphocyte ratio (CLR) in acute appendicitis (AA) and perforated appendicitis (PA) compared to routine laboratory parameters in patients where radiological tests were insufficient to clarify the diagnosis. In this cross-sectional and retrospective study, the patients were divided into two groups as PA and AA. Age, sex, length of hospital stay, leukocytes, neutrophil, lymphocyte, CRP, and CLR were recorded at the time of diagnosis. Regression analyses were performed for the parameters, which were found to be statistically significant in univariate analysis. One hundred thirty-one patients were included in this study (111 patients in the AA group, and 20 patients in the PA group). Age (p=0.03), gender (p<0.001), length of hospital stay (p<0.001), CRP (p<0.001), NLR (p=0.004) and CLR (p<0.001) were significantly different between both groups. However, only CLR was found as a significant risk factor in PA cases (p=0.016). The ROC analysis showed the highest AUC value in CLR (0.83). The cut-off value for predicting PA was found 0.45. This study provided that the CLR is an important parameter for the differentiation of AA and PA patients. Besides, it is a valuable predictor in the preoperative risk classification of these patients.

Non-Operative Management is More Cost-Effective than Immediate Operation in Perforated Appendicitis Patients with Seven or More Days of Symptoms

BackgroundManagement of perforated appendicitis in children remains controversial. Nonoperative (NO) and immediate operative (IO) strategies are used with varying outcomes. We hypothesized that IO intervention for patients with perforated appendicitis would be more cost-effective than NO management. MethodsA retrospective chart review of all patients with appendicitis from 2012 to 2015 was performed. Patients with perforated appendicitis were defined by evidence of perforation on imaging. We excluded patients who presented with sepsis, organ failure, and ventriculoperitoneal shunts. NO management was determined by surgeon preference. Univariate and multivariate analyses were performed. ResultsIO was performed on 145 patients with perforated appendicitis, whereas 83 were treated with NO management. Compared to IO patients, NO patients incurred higher overall costs, greater length of stay, more readmissions, complications, peripherally inserted central venous catheter lines, interventional radiology drains, and unplanned clinic and emergency department visits (P < 0.0001 for all). Multivariate analysis adjusting for age, days of symptoms, admission C-reactive protein and white blood cell count revealed that NO management was independently associated with increased costs (OR 1.35, 1.12-1.62, 95% CI). Cost curves demonstrated that total cost for IO surpasses that of NO management when patients present with greater than 6.3 d of symptoms (P = 0.01). ConclusionsOur data suggest that IO is more cost-effective than NO management for patients with perforated appendicitis who present with less than 6.3 d of symptoms, after which point, NO management is more cost-effective. Level of EvidenceIV.

The risk factors for infected and perforated appendicitis

It is believed that the appendix will be perforated if the surgery of an acute appendicitis is delayed. However, some of the recent studies, contested this hypothesis and shown that only a delay in the treatment cannot fully explain perforated appendicitis. This study aimed to examine the prevalence and risk factors for perforated appendicitis in patients with acute appendicitis. A cross-sectional study was conducted in Shahid Beheshti Medical center. Data from 526 patients diagnosed with acute appendicitis were extracted from file related to the patients who undergone appendectomy since 2011 till the end of 2015. Performing an appendectomy after more than 48 hours from the onset of symptoms was defined as a delayed appendectomy. Data related to the patients’ age, gender, type of appendicitis, and the delay in appendectomy were gathered using a checklist. Descriptive statistics (frequency, percentage) were used to describe the data. Chi-square and Fisher's exact tests were used to analyze the data. Among the 526 patients with a diagnosis of acute appendicitis, 24.3% were perforated while 75.7% were non-perforated appendicitis. Of the total patients, 72.2% were referred to the hospital and were operated in less than 48 hours while 27.8% were referred and operated with a delay more than 48 hours. The rate of septic appendicitis was 55.5% and 72.6% in patients without and with delayed appendectomy, respectively but the rate of perforated appendicitis was 28.9% and 12.3% in patients without and with delayed appendectomy, respectively (P value < 0.05). The majority of cases of perforated appendicitis were occurred males (73.4%) and in the age range of 15 to 34 years (33.8%). Physiopathology of perforated appendicitis is very complex and a delay in appendectomy cannot fully justify the physiopathology of perforated appendicitis. The fact that perforation cannot fully explained be a delay in appendectomy may prevent many cases of unnecessary surgeries in patients with acute appendicitis. Further studies are recommended to confirm the findings of the present study. Keywords: Acute appendicitis, perforated appendicitis, infected appendix.

Advanced Practice Nurse Phone Follow-Up Initiative to Reduce Unplanned Returns for Perforated Appendicitis Patients

Introduction: Perforated appendicitis is a high-volume diagnosis managed by advanced practice nurses (APNs) in the general pediatric surgery department at an urban hospital in the northeast. This APN-led quality improvement project aimed to determine the impact of APN phone follow-up to prevent unplanned return visits and readmission. Methods: Before June 2015, all patients with perforated appendicitis discharged home on antibiotic therapy were provided with APN phone follow-up. The patients were followed for 30-day outcomes regarding unplanned returns to care. The goal was to attempt to identify patients at a higher risk for returns based on symptom analysis so that preventative measures may be instituted. The process of phone follow-up for patients with perforated appendicitis changed in June 2015 because of the decreased number of patients discharged home on intravenous antibiotic therapy, and therefore the phone follow-up was discontinued. This allowed the data from the first cohort (December 2014 to May 2015) to be reviewed by a retrospective chart review and analyzed. Outcomes: The preliminary data between the two cohorts, which have comparable patient volumes and return rates, have revealed that the APN phone follow-up did not necessarily change the rate of unplanned return-to-care visits after patient discharge, perhaps because of the call being conducted too soon after discharge. Our findings suggested that the APN phone follow-up call may have been more impactful in reducing unplanned return-to-care visits if completed after the 48-hour time frame.

Perforated appendicitis in patients with schizophrenia: a retrospective cohort study

ObjectiveAltered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.DesignRetrospective cohort...

A call for a standardized definition of perforated appendicitis

BackgroundAbscess rates have been reported to be as low as 1% and as high as 50% following perforated appendicitis (PA). This range may be because of lack of universal definition for PA. An evidence-based definition (EBD) is crucial for accurate wound classification, risk-stratification, and subsequent process optimization. ACS NSQIP-Pediatric guidelines do not specify a definition of PA. We hypothesize that reported postoperative abscess rates underrepresent true incidence, as they may include low-risk cases in final calculations. MethodsLocal institutional records of PA patients were reviewed to calculate the postoperative abscess rate. The ACS NSQIP-Pediatric participant use file (PUF) was used to determine cross-institutional postoperative abscess rates. A PubMed literature review was performed to identify trials reporting PA abscess rates, and definitions and rates were recorded. Results20.9% of our patients with PA developed a postoperative abscess. The ACS NSQIP-Pediatric abscess rate was significantly lower (7.61%, p<0.001). In the eighteen published studies analyzed, average abscess rate (14.49%) was significantly higher than ACS NSQIP-Pediatric (p<0.001). There was significantly more variation in trials that do not employ an EBD of perforation (Levene's test F-value =6.980, p=0.018). ConclusionsA standard EBD of perforation leads to lower variability in reported postoperative abscess rates following PA. Nonstandard definitions may be significantly altering the aggregate rate of postoperative abscess formation. We advocate for adoption of a standard definition by all institutions participating in ACS NSQIP-Pediatric data submission. Level of evidenceIII.