Surgical Treatment Of Appendicitis Research Articles

WP5.14 - Cost of conservative management of acute appendicitis: a cohort study

Abstract Aims Potential benefits of non surgical treatment of appendicitis: low risk treatment, suitable for older patients, avoids negative appendicectomy & lower healthcare costs. It is associated with recurrent appendicitis, prolonged hospitization, antibiotic related complications, prolonged follow up. Aim of study is to assess costs of conservative management. Methods Cohort study was carried out from Mar'2020 to Dec'2023 at single centre. Descriptive demography & outcomes were evaluated for non surgical management. Appendicectomy (acute & interval) were used as controls. Costing was calculated using the standardised NHS cost ledger for resources, procurement and services. Results Conservative (n = 235) Appendicectomy (n = 518) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 39.0 35.9 47.9 <0.0001 Sex(M : F) 121 : 114 251 : 267 19 : 26 NS BMI(kg/m2) 26.0 25.5 26.5 NS GP(n) 69 143 NS A&E(n) 166 375 NS WCC(x109/L) 12.0 13.2 6.5 <0.0001 CRP(mg/L) 76.3 66.3 3.4 <0.0001 Open(n) 11 0 NS Lap(n) 507 45 NS ASA(med) 1 2 NS Appendgrade(n) Uncomplicated 161 186 42 <0.0001 Complicated 74 332 3 <0.0001 Diagnostic (n) Clinical 9 34 USS scan 65 138 CT scan 161 346 Op time(mins) 74.9 74.4 NS LOS(days)(med) 2 2 0 <0.0001 IP AB(days) 2 2 0 <0.0001 Post-op AB(days) 7 0 0 <0.0001 App HPA(mm) Length 66.6 55.7 <0.001 Diameter 11.2 9.9 NS Normal(HPA)(n) 41 Appendicitis (HPA)(n) 477 Cost(£) 1529 4269 1046 <0.0001 Conclusions Appendicitis grading clinically & radiologically has facilitated safe conservative management. Costs is lower for index admission, but is associated with additional costs & workload.

Acute Appendicitis: Trends in Surgical Treatment—A Population-Based Study of Over 800 000 Patients.

Appendectomy is the gold standard for treatment of acute appendicitis. However, recent studies favor primary antibiotic therapy. The aim of this observational study was to explore changes in the numbers of operations for acute appendicitis in the period 2010-2017, paying special attention to disease severity. Data from diagnosis-related group statistics were used to analyze the trends, mortality, and complication rates in the surgical treatment of appendicitis in Germany between 2010 and 2017. All cases of appendectomy after a diagnosis of appendicitis were included. Altogether, 865 688 inpatient cases were analyzed. The number of appendectomies went down by 9,8%, from 113 614 in 2010 to 102 464 in 2017, while the incidence fell from 139/100 000 in 2010 to 123/100 000 in 2017 (standardized by age group). This decrease is due to the lower number of operations for uncomplicated appendicitis (79 906 in 2017 versus 93 135 in 2010). Hospital mortality decreased both in patients who underwent surgical treatment of complicated appendicitis (0.62% in 2010 versus 0.42% in 2017) and in those with a complicated clinical course (5.4% in 2010 versus 3.4% in 2017). Decisions on the treatment of acute appendicitis in German hospitals follow the current trend towards non-surgical management in selected patients. At the same time, the care of acute appendicitis has improved with regard to overall hospital morbidity and hospital mortality.

Our experience with the surgical treatment of appendicitis

Acute appendicitis is the most common surgical disease in the pathology of the population. Incidence in the general population is 6%. In the period from 15.01.2002 to 08.16.2014 as any 627 appendix which je12,4% of the 5055 total patients. Prevalent patients males 55.5% compared to 44.5% female. According to the age of the children present in 393 (68.47%) and 181 adults (31.53%). The greatest incidence is in children aged age group of 15-20 years, 131 (23.06%). In the adult group the highest incidence is represented in the third decade of 21-30 years, with 77 (13.4%). The most common disease of acute appendicitis is in the second decade of the 258 cases (44.9%). Intraoperative pathomorphologically highest incidence wearing Appendicitis phlegmonosa with 317 (52.1%). Peritonitis acuta is the most common complication of severe forms of appendicitis acuta 231 (71.96%). Anterograde apendectomia was performed in 532 (87.5%) patients and retrograde in 76 (12.5%). Abdominal drainage procedures were performed in 145 (23.85%) patients. Postoperative complications 6 (4.68%). Surgical wound infection 4. Fistula appendicularis 1 (3.12%). Mortality 1 (0.16%).

Lateral pouch appendix associated with retroperitoneal terminal part of the ileum: a potential diagnostic and surgical challenge.

Knowledge of development and various possible positions of the appendix is important in understanding the pathophysiology of appendicitis. In the present case, we report on a lateral pouch type of appendix in a formalin-embalmed male cadaver. The appendix was found to be situated in a space between the caecum and the lateral abdominal wall. A short band of peritoneum extended from the right iliac fossa to the base of the appendix. The terminal part of the ileum was retroperitoneal and it was vertically situated in the right iliac fossa. Both the ileocaecal junction and the base of the appendix were located at the posterolateral wall of the caecum. The mesoappendix was unusual in position, and it extended from the appendix to the anterolateral wall of the caecum and commencement of the ascending colon. Documentation of rare anatomical variants of the appendix may hold significant clinical importance in diagnosis as well as surgical treatment of appendicitis.

Discriminating Between Simple and Perforated Appendicitis

Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. All consecutive patients who have undergone an appendectomy in the Reinier de Graaf hospital between January 1, 2007 and July 31, 2009, were included in a retrospective cohort study. Baseline patient characteristics, history and laboratory data were collected. Variables discriminating perforated from non-perforated appendicitis were identified using univariate and multivariable analyses. A total of 498 patients were included in the study. In the univariate analysis leukocyte count, C-Reactive Protein levels, Erythrocyte Sedimentation Rate levels, days of symptoms and temperature were identified as predictors of perforated appendicitis. The predicted probability (P) of a perforated appendicitis can be calculated from the following model: (P)=1/(1+e(-(-2.788+0.012 * CRP+0.207 * days with complaints))). Perforation of appendicitis can be predicted from the CRP level and the duration of abdominal pain. These findings might influence the choice between conservative or surgical treatment of appendicitis, and could provide guidance in the early start of antibiotics.

Correlation between the Duration of Right Lower Quadrant Abdominal Pain and Clinical Stage Of Acute Appendicitis Among Patients Who Underwent Appendectomy at MCU-FDTMF Hospital

Right lower quadrant abdominal pain is the prime symptom of acute appendicitis. The surgical treatment of appendicitis is one of the great public health advancement of the last 150 years. The objective of this study is to correlate the duration of right lower quadrant abdominal pain with the clinical stage (Pathologic diagnosis) on patients who underwent appendectomy at MCU-FDTMF Hospital from January 2006 to December 2006. This is a cross-sectional study. There were one hundred and ninety four (194) patients who presented with right lower quadrant abdominal pain and underwent appendectomy. One hundred and eighty six (186/194) had acute appendicitis during surgery and eight (8/194) patients with normal appendix. The 3 most common diagnoses on patients with normal appendices were pelvic inflammatory disease, ovarian torsion and urinary tract infection. The total number of patients who underwent appendectomy surpassed the required sample size of at least 130 observations. A Chi-square test was used for univirate analysis of data. The study revealed that right lower quadrant abdominal pain of acute appendicitis 24 hours increased the likelihood of a ruptured appendicitis (98.5%).

Fatores de risco para as complicações após apendicectomias em adultos

OBJETIVO: Definir os fatores de risco para as complicações após as apendicectomias em adultos. INTRODUÇÃO: os fatores de risco que levam as complicações após as apendicectomias são ainda pouco conhecidos. Sua definição pré-operatória é importante na diminuição da morbi-mortalidade pós-operatória. MÉTODOS: Estudo retrospectivo de 500 pacientes submetidos à apendicectomia no Hospital Regional da Asa Norte entre os anos de 2003 e 2004. Estes foram avaliados quanto à idade, sexo, duração dos sintomas até a procura por assistência médica, presença de febre, características da dor abdominal, hemograma, tempo de admissão até a operação, co-morbidades, incisões utilizadas nas operações, achados operatórios, utilização de drenos, complicações pós-operatórias e dias de internação hospitalar. Foram utilizadas análises de regressões logísticas para predizer e quantificar os fatores de risco para as complicações após as operações. RESULTADOS: As chances de complicações foram maiores no gênero feminino (OR=1,97, 95%, IC-1,19-3,13), na apendicite perfurada (OR=4,67, 95%, IC-2,43-8,94), na apendicite sem perfuração (OR=3,32, 95%, IC-1,72-6,38), naqueles pacientes submetidos à drenagem abdominal (OR=17,54, 95%,IC-4,83-63,77) ou com ASA II (OR=1,53, 95%, IC 2,52-15,89). As infecções do sítio cirúrgico e os abscessos intra-abdominais foram os principais fatores de morbidade. A mortalidade foi nula. CONCLUSÕES: A análise de regressão logística multivariável demonstrou que o gênero, a necrose apendicular, a drenagem da cavidade abdominal e a classificação de ASA contribuíram para o aumento das complicações pós-operatórias dos pacientes submetidos às apendicectomias.

Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults.

To define risk factors that predict adverse outcomes after the surgical treatment of appendicitis in Department of Veterans Affairs Medical Centers. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults are poorly defined. Accurate presurgical assessment of the risk of perioperative complications and death is important in planning surgical therapy. The VA National Surgical Quality Improvement Program contains prospectively collected and extensively validated data on approximately 1,000,000 major surgical operations. All patients undergoing surgical intervention for appendicitis from 1991 to 1999 registered in this database were selected for study. Independent variables examined included 68 putative preoperative risk factors and 12 intraoperative process measures. Dependent variables were 21 specific adverse outcomes, including death. Stepwise logistic regression analysis was used to construct models predicting 30-day morbidity rate and the 30-day postoperative mortality rate. There were 4163 patients identified. The mean age was 50 years; 96% were male. Sixteen percent of patients had 1 or more complications after surgical intervention. Prolonged ileus, failure to wean from the ventilator, pneumonia, and both superficial and deep wound infection were the most frequently reported complications, accounting for the majority of the morbidity. The 30-day mortality rate was 1.8% (74 deaths). For >50% of the complications reported, the 30-day mortality rates were significantly higher (P < 0.01) for patients with complications than for those without. Thirty-day mortality rates for several complications exceeded 30%, including cardiac arrest, coma >24 hours, myocardial infarction, acute renal failure, bleeding requiring >4 units of red cells, and systemic sepsis. Four preoperative factors predicted a high risk of 30-day mortality in the logistic regression analysis: "completely dependent" functional status, bleeding disorder, steroid usage, and current pneumonia. "Threat to life" or "moribund" American Society of Anesthesiologists classification and more than a 10% weight loss in the 6 months before surgery were associated with a high risk of complications. Morbidity and mortality rates after the surgical treatment of appendicitis in VA hospitals are comparable with those reported in other large series. Most postsurgical complications are associated with an increased 30-day mortality rate. The models presented here are the most robust available in predicting 30-day morbidity and mortality for VA patients with appendicitis. Furthermore, they provide a starting point for the design of similar models to evaluate non-VA patients with appendicitis using the data the National Surgical Quality Improvement Program is currently gathering from private hospitals.

The consequences of current constraints on surgical treatment of appendicitis

In this study, we sought to identify changes in the picture of a selected surgical condition during an interval of time that has brought about radical departures from previously established policies and programs. As a direct consequence, the patients take a more circuitous route to the surgeon. A significant number of patients with acute appendicitis in 1986 (37 percent) and 1987 (29 percent) suffered a prolonged delay in hospitalization or surgical referral compared with patients in 1980. This delay was accompanied by a more advanced stage of disease that ultimately caused a markedly increased morbidity (13 percent in 1986 and 24 percent in 1987, compared with 5 percent in 1980) and subsequent extended length of stay. This deterioration in patient care and failure at cost containment had previously been examined for conditions that can be operated electively. This study documents that the constraints also affect the treatment of patients whose initial condition requires urgent operative treatment. With specific relation to patients with acute appendicitis, surgeons recognize the value of the negative appendectomy. It appears the so-called gatekeepers must find a way to accept a certain negative hospitalization to referral rate. If current constraints will not allow this, the policies and programs behind the constraints should be changed.

A STATISTICAL STUDY OF 2,921 CASES OF APPENDICITIS

From a study of a series of 842 cases admitted to the Cincinnati General Hospital from Jan. 1, 1915, to Jan. 1, 1924, reported in 1926, it was deduced that (1) an unusually high percentage of cases entered the hospital presenting perforative appendicitis and its complications, abscess or peritonitis, and (2) there still was some belief among our hospital staff that surgical treatment of appendicitis should be deferred for an interval rather than resorted to in the acute stage of the disease. This statistical study has been continued to include the years of 1924 through 1933 inclusive to determine whether the adoption in 1922 of immediate operation for acute appendicitis has changed in any way either of these deductions. We also present at this time our total statistics of this series of cases of appendicitis. The series includes 2,921 cases of appendicitis admitted to the Cincinnati General Hospital between Jan.

Radical surgical treatment of appendicitis in the period of calm

Abstracts. Surgery.R.R.Vreden. Depressive operative treatment of appendicitis in the period of calm. Lѣt. Rus. Heer. 1901, book. 3.A radical operation of appendicitis to the froid should answer, according to the author, the following basic requirements: i) free access to the small intestine and the appendix during the operation, 2) prevention of eventration in the aftermath.

Medical and Surgical Treatment of Appendicitis.

Winterset, Iowa, March 14, 1899. <h3>To the Editor:</h3> —An article published in theJournalof Dec. 18, 1897, written by me was later very favorably commented upon and sustained throughout by a more lengthy article from the pen of Dr. Haughton of Richmond, Ind., in theJournal. One great, and I trust general, good has been accomplished through the controversy elicited by the article mentioned, however, and that is the expression of the profession as a whole, as well as the medical press of this country, sustaining conservatism and common sense against radicalism and the lack of it. The constant aim of every member of the medical profession should be the welfare of humanity at large, and the greatest good to the greatest number. Taking into consideration the fact that autopsies held for the purpose "have demonstrated the existence of some pathologic condition of the appendix in over 30 per

PERINEAL OPERATION FOR PERFORATIVE APPENDICITIS WITH ABSCESS IN THE CUL-DE-SAC.

The literature on the surgical treatment of appendicitis is replete, and it is the consensus of opinion that, for ordinary cases of perforative appendicitis with abscess formation the incision over McBurney's point, or the extra-peritoneal operation from the side, reaching the abscess without entering the peritoneal cavity, with simple evacuation and drainage, only removing the appendix when possible to do so without causing general infection, are the best methods of procedure. In looking over the reports of cases it has not come to my knowledge that an operation reaching the appendix abscess, when located back of the bladder, below the small intestine, and in front of the rectum, has been operated on from the perineum. The difficulties of draining these cases through the abdominal incision and the avoidance of soiling the peritoneum are barriers which render the operation useless and fatal when attempted above, except when the operation is made

Medical Treatment of Appendicitis.

Oneida, N. Y., Jan 10, 1898. <h3>To the Editor:</h3> —Much has been written of late years on the surgical treatment of appendicitis, but very little on the medical treatment. In a practice of nearly forty years I have had my share of cases, ranging from five to twenty yearly, and thus far have had no case that I have found it necessary to operate more than to aspirate in case of abscess. I have had only one death, a boy 15 years of age, who was hurt while playing at school, and this case, in my opinion, died from lack of good nursing. My treatment can be given in brief. Although adopted more than thirty-five years ago, I have never witnessed another line of treatment that has caused me to change my own. Unfortunately, many physicians are not correct in their diagnosis, and frequently call peritonitis (especially if pelvic) appendicitis.

Remarks on the Surgical Treatment of Appendicitis

Remarks on the Surgical Treatment of Appendicitis

The Massachusetts Health Report — Mortality vs. Immortality — Physical Training in the Boston Public Schools — Surgical Treatment of Appendicitis — Medical Notes

The Massachusetts Health Report — Mortality vs. Immortality — Physical Training in the Boston Public Schools — Surgical Treatment of Appendicitis — Medical Notes