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Malbul K, Katwal S, Maharjan S, Shrestha S, Dhital R, Rajbhandari AP. Appendicitis as a presentation of COVID-19: A case report. Ann Med Surg (Lond) 2021; 69:102719. [PMID: 34422263 PMCID: PMC8372448 DOI: 10.1016/j.amsu.2021.102719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/06/2023] Open
Abstract
Background Coronavirus disease-19 (COVID-19) is an infectious respiratory disease caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Respiratory symptoms and flu-like presentation are the most defined clinical manifestations. However, gastrointestinal symptoms with acute abdomen have been reported in a small percentage, occasionally mimicking acute appendicitis. Hence, the diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen in the present situation. Case presentation We report a case of a 25-year-old male who presented with features of acute appendicitis. Despite the equivocal ultrasound results, he was scheduled for an emergency appendectomy for Alvarado's score 7 out of 10, who underwent a successful appendectomy. The patient had initially tested negative on an upper respiratory COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) with normal chest X-ray but few hours after the surgery patient developed a high-grade fever. An RT-PCR for COVID-19 was resent following a suspicion that came out to be positive. Clinical discussion Several case reports have suggested a probable association between COVID-19 and appendicitis. This case shows the limited effectiveness of clinical diagnosis for the surgical abdomen in COVID-19 patients as these two conditions share similar symptoms often needing a clinical vigilance. Conclusion This case reports acute appendicitis in a patient who tested positive for SARS-CoV-2 subsequently following emergency appendectomy highlighting the acute gastrointestinal presentation of COVID-19. This case exemplifies the necessity to be familiar with the gastrointestinal symptoms of COVID-19 and maintain a high level of suspicion for COVID-19 infection in cases of abdominal pain. Acute appendicitis can be one of the presentation of COVID-19. Clinicians need to be familiar with the gastrointestinal symptoms of COVID-19. Rapid diagnosis of COVID-19 in patients with acute abdominal pain should be done to prevent the virus from spreading. A negative RT-PCR for COVID-19 can't totally exclude COVID-19.
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Affiliation(s)
- Kiran Malbul
- Nepalese Army Institute of Health Sciences College of Medicine, Sanobharyang, Kathmandu, Nepal
| | - Srijana Katwal
- Nepalese Army Institute of Health Sciences College of Medicine, Sanobharyang, Kathmandu, Nepal
| | - Swojay Maharjan
- Nepalese Army Institute of Health Sciences College of Medicine, Sanobharyang, Kathmandu, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Roman Dhital
- Nepal National Hospital, Kalanki, Kathmandu, Nepal
| | - Ashish Prasad Rajbhandari
- Department of GI and General Surgery, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal
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152
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Lee S, Jang EJ, Jo J, Park SJ, Ryu HG. Long-term impacts of appendectomy associated with increased incidence of inflammatory bowel disease, infection, and colorectal cancer. Int J Colorectal Dis 2021; 36:1643-1652. [PMID: 33594506 DOI: 10.1007/s00384-021-03886-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Although the appendix has been suggested to play a role in maintaining the gut microbiome and immune system, the ramifications of appendectomy on the development inflammatory bowel disease, sepsis, and colorectal cancer are yet to be determined. The purpose of this study was to evaluate the potential long-term impacts of appendectomy, with a focus on inflammatory bowel disease, infection, and colorectal cancer, using the National Healthcare Insurance Service (NHIS) database of Korea. METHODS The National Healthcare Insurance Service database in Korea was used for analysis. Adult patients who received appendectomy between 2005 and 2013 were identified. The control group consisted of patients who did not receive appendectomy were matched by baseline characteristics including comorbidities and frequency of healthcare resource utilization. The primary outcome was the incidence-rate ratio (IRR) of Crohn's disease, ulcerative colitis, Clostridium difficile infection, sepsis, and colorectal cancer after appendectomy or the index date. RESULTS We identified 914,208 patients who underwent appendectomy, and after matching with control patients, a total of 486,844 patients were included for analysis. Patients who underwent appendectomy showed a significantly higher incidence of Crohn's disease (IRR 4.40, 95% confidence interval (CI) 3.78-5.13) and ulcerative colitis (IRR 1.78, 95% CI 1.63-1.93) compared to the control group during the 5-year follow-up period. The associations between appendectomy and Clostridium difficile infection, sepsis, and colorectal cancer were all found to be significant. CONCLUSION Patients who underwent appendectomy may be at increased risk for developing Crohn's disease, ulcerative colitis, Clostridium difficile infection, sepsis, and colorectal cancer.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea, 03080
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, 1375 Gyeongdong-Ro, Andong, Gyeongsangbuk-do, 36729, South Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea
| | - So Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea, 03080
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea, 03080.
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153
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Creamer M, Trinkman H, Hamby T, Williams L, Carroll M, Gandhi A. Impact of an opioid stewardship program on opioid exposure for pediatric appendectomy postsurgical pain. J Pediatr Surg 2021; 56:1421-1424. [PMID: 33190814 DOI: 10.1016/j.jpedsurg.2020.09.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE This study aimed to evaluate the impact of a Pediatric Acute Pain Guideline on postsurgical pain scores, opioid exposure, and discharge opioid prescribing habits in postappendectomy patients. METHODS This was a retrospective single-center quality improvement project, including patients admitted for an appendectomy at a pediatric medical center between April 1 and December 31, 2018. Patients 0-17 years of age, who underwent a laparoscopic appendectomy without complications, were inpatient for at least 1 calendar day, and designated as presurgical American Society of Anesthesiologists (ASA) category 1 or 2 were included. RESULTS Two hundred fifty-eight patients met inclusion criteria (n = 92 pre-, n = 166 post-guideline implementation). There was a decrease in the number of as needed opioid doses used (p = 0.014) and length of hospitalization (p = 0.003) post-guideline implementation compared to pre-guideline implementation. A decrease in the number of as needed doses of opioids used (p < 0.001) and in opioid exposure (p = 0.038) during hospitalization was also seen when the nonopioid pain agent was scheduled. CONCLUSIONS The implementation of the Pediatric Acute Pain Guideline was associated with a decrease in the number of as needed opioid doses used during hospitalization, which may have contributed to a decreased length of hospitalization. Scheduling nonopioid pain medications decreased opioid exposure. LEVEL OF EVIDENCE Treatment study level III.
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Affiliation(s)
- Mackenzie Creamer
- Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104.
| | - Heidi Trinkman
- Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104
| | - Tyler Hamby
- Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104
| | | | - Matthew Carroll
- Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104
| | - Artee Gandhi
- Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104
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154
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Alganabi M, Biouss G, Pierro A. Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis. Pediatr Surg Int 2021; 37:973-981. [PMID: 33934183 DOI: 10.1007/s00383-021-04911-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.
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Affiliation(s)
- Mashriq Alganabi
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - George Biouss
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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155
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Cho HW, Cho GJ, Noh E, Hong JH, Kim M, Lee JK. Pregnancy Outcomes Following Laparoscopic and Open Surgery in Pelvis during Pregnancy: a Nationwide Population-based Study in Korea. J Korean Med Sci 2021; 36:e192. [PMID: 34313034 PMCID: PMC8313397 DOI: 10.3346/jkms.2021.36.e192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery. METHODS Study data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. We identified pregnant women who underwent abdominal non-obstetric pelvic surgery by laparoscopy or laparotomy from the database. Pregnancy outcomes including preterm birth, low birth weight (LBW), cesarean section (C/S), gestational hypertension, gestational diabetes, and postpartum hemorrhage were identified. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the pregnancy outcomes were estimated by multivariate regression models. RESULTS Data from 4,439,778 women were collected for this study. From 2006-2016, 9,417 women from the initial cohort underwent non-obstetric pelvic surgery (adnexal mass resection, appendectomy) during pregnancy. Multivariate logistic regression analysis indicated that preterm birth (HR, 2.01; 95% CI, 1.81-2.23), LBW (HR, 1.62; 95% CI, 1.46-1.79), C/S (HR, 1.13; 95% CI, 1.08-1.18), and gestational hypertension (HR, 1.35; 95% CI, 1.18-1.55) were significantly more frequent in women who underwent non-obstetric surgery during pregnancy compared to pregnant women who did not undergo surgery. When the laparoscopic and laparotomy groups were compared for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (odds ratio, 0.62; 95% CI, 0.40-0.95). CONCLUSION Non-obstetric pelvic surgery during pregnancy was associated with a higher risk of preterm birth, LBW, gestational hypertension, placenta previa, placental abruption, and C/S. Although the benefits and safety of laparoscopy during pregnancy appear similar to those of laparotomy in regard to pregnancy outcomes, laparoscopic adnexal mass resection was associated with a lower risk of LBW.
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Affiliation(s)
- Hyun Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
| | - Minjeong Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea.
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156
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Abstract
PURPOSE Amyand's hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand's hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand's hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia. METHODS Six patients diagnosed with Amyand's hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes. RESULTS The diagnosis of six cases with Amyand's hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had appendicitis. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8 ± 6.1 days. One patient suffered from a wound infection. No additional postoperative complications were detected. CONCLUSIONS Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand's hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.
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Affiliation(s)
- Yijie Gao
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou District, Dalian, 116033, People's Republic of China
- Dalian Medical University, Dalian, 116044, Liaoning, People's Republic of China
| | - Taotao Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou District, Dalian, 116033, People's Republic of China
| | - Min Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou District, Dalian, 116033, People's Republic of China
- Dalian Medical University, Dalian, 116044, Liaoning, People's Republic of China
| | - Zhengxu Hu
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou District, Dalian, 116033, People's Republic of China
- Dalian Medical University, Dalian, 116044, Liaoning, People's Republic of China
| | - Qiao Li
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou District, Dalian, 116033, People's Republic of China
- Dalian Medical University, Dalian, 116044, Liaoning, People's Republic of China
| | - Xiangwen Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou District, Dalian, 116033, People's Republic of China.
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157
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Abstract
Acute appendicitis (AA) is the most common acute abdomen, and appendectomy is the most common nonelective surgery performed worldwide. Despite the long history of understanding this disease and enhancements to medical care, many challenges remain in the diagnosis and treatment of AA. One of these challenges is the timing of appendectomy. In recent decades, extensive studies focused on this topic have been conducted, but there have been no conclusive answers. From the onset of symptoms to appendectomy, many factors can cause delay in the surgical intervention. Some are inevitable, and some can be modified and improved. The favorable and unfavorable results of these factors vary according to different situations. The purpose of this review is to discuss the causes of appendectomy delay and its risk-related costs. This review also explores strategies to balance the positive and negative effects of delayed appendectomy.
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Affiliation(s)
- Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan Province, China
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158
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Liang CS, Bai YM, Hsu JW, Huang KL, Chu CS, Yeh TC, Tsai SJ, Chen TJ, Chen MH. The Risk of Alzheimer's Disease After Acute Appendicitis With or Without Appendectomy. J Am Med Dir Assoc 2021; 23:601-607.e2. [PMID: 34265267 DOI: 10.1016/j.jamda.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous epidemiologic studies have suggested an association between appendectomy and Parkinson's disease. The aim of the current study was to examine the risk of Alzheimer's disease (AD) and other types of dementia following appendicitis or appendectomy for appendicitis. DESIGN Population-based cohort study. SETTING AND PARTICIPANTS We used claims data from the Taiwan National Health Insurance Research Database. Participants aged ≥45 years with acute appendicitis or who received appendectomy for appendicitis were enrolled and followed up for more than 15 years. Cases and controls underwent 1:1 matching by age, sex, index date, and dementia-related comorbidities. METHODS The primary outcome was AD, and secondary outcomes included other dementia types. Adjusted hazard ratios (aHRs) were calculated, and a competing risk regression model was created. The E value for causality of evidence was calculated. RESULTS Patients developing appendicitis (0.6% vs 0.1%, P = .005) and those receiving appendectomy for appendicitis (0.4% vs 0.1%, P = .003) had higher incidences of AD than the controls during the follow-up period. A Cox regression analysis with adjustment for potential confounders showed that patients with appendicitis [aHR 6.68, 95% confidence interval (CI) 1.84-24.48] and those receiving appendectomy for appendicitis (aHR 5.01, 95% CI 1.33-18.85) were more likely to develop AD than the controls. These 2 groups also had higher risks for unspecified dementia and all types of dementia but not for vascular dementia than the controls. The age at dementia diagnosis was 88.51 years in the controls; however, among people who developed dementia following appendicitis, the mean age at diagnosis was 70.18 years, and dementia occurred 5.84 years after appendicitis. The competing risk regression models and the E values support the study findings. CONCLUSIONS AND IMPLICATIONS After recovery from appendicitis, these patients should be followed up for signs of AD.
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Affiliation(s)
- Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
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159
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Patel PP, Weller JH, Westermann CR, Cappiello C, Garcia AV, Rhee DS. Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-pediatric Study. J Surg Res 2021; 267:556-562. [PMID: 34261006 DOI: 10.1016/j.jss.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with cancer often develop leukopenia which may impair wound healing and increase surgical complication rates. When leukopenic children with cancer develop an acute surgical condition, the optimal management strategy remains unclear. This study examined the effect of preoperative leukopenia on postoperative outcomes in children with cancer who underwent an appendectomy or cholecystectomy. METHODS We retrospectively identified cancer patients undergoing an appendectomy or cholecystectomy from the National Surgical Quality Improvement Program-Pediatric database from 2012-2018. Demographics and perioperative characteristics were compared by leukopenia status (WBC <4 vs. ≥4 × 10^3/mL). Postoperative length of stay (LOS) and 30-day composite complications, including infections, reoperations, and readmissions, were analyzed for each procedure using multivariate regression. RESULTS There were 227 children who underwent an appendectomy and 101 children who underwent a cholecystectomy. Leukopenia was seen in 93 (41.0%) appendectomy and 57 (56.4%) cholecystectomy cases. Nineteen (8.4%) appendectomy patients and six (5.9%) cholecystectomy patients developed a postoperative complication. The median postoperative LOS was 2 days (IQR 1-6 days) for appendectomy and 1 day (IQR 1-2.5 days) for cholecystectomy cases. After multivariate analyses, leukopenia was not associated with increased postoperative complications after an appendectomy (OR 0.55, P = 0.36) or cholecystectomy (OR 0.39, P = 0.37). There was no significant difference in postoperative LOS based on leukopenia status for children who underwent an appendectomy (P = 0.82) or cholecystectomy (P = 0.37). CONCLUSION In pediatric cancer patients, leukopenia was not associated with increased short-term postoperative complications or longer postoperative LOS after either an appendectomy or cholecystectomy. These results support that operative management can be performed safely in pediatric appendicitis and cholecystitis in leukopenic cancer patients.
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Affiliation(s)
- Palak P Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennine H Weller
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Carly R Westermann
- Virginia Polytechnic State Institution and University, Blacksburg, Virginia
| | - Clint Cappiello
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland.
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160
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Affiliation(s)
- Katherine He
- Department of General Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street CA-034, Boston, MA 02115, USA
| | - Shawn J Rangel
- Department of Pediatric & Thoracic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue - Fegan 3, Boston, MA 02115, USA.
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161
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Abstract
Objectives: To determine the prevalence of appendiceal histopathology in patients with confirmed endometriosis following minimally invasive surgery (MIS) for endometriosis. To determine whether pre-operative symptoms, age, intra-operative appendiceal appearance, or endometrioma laterality were associated with appendix histopathology in patients with suspected endometriosis. Methods: One hundred thirty-five patients ages 16–52 with suspected endometriosis undergoing MIS for endometriosis with concomitant appendectomy at two metropolitan academic hospitals from January 1, 2012 to June 30, 2017 were included in this retrospective chart-review study. Medical records were reviewed for pre-operative symptoms, age, intraoperative appendix appearance, appendix histopathology, histopathologically-confirmed endometriosis, and endometriomas. Results: In patients with confirmed endometriosis, the prevalence of all appendiceal histopathology was 25%, which included appendiceal endometriosis (18%), appendiceal tumors (2%), and inflammation (5%). Dyspareunia was the only pre-operative symptom significantly associated with appendiceal histopathology (p = 0.04). The presence of a right endometrioma was associated with appendiceal histopathology (p = 0.009). Additionally, appendiceal histopathology was not significantly associated with age nor intra-operative appendiceal characteristics. Conclusion: This manuscript adds to the limited pool of studies regarding appendiceal histopathology and appendiceal tumors in patients with suspected and confirmed endometriosis. On the basis of the high rate of histopathological appendices found in this population; the lack of association with possible diagnostic factors such as age, most pre-operative symptoms, and intra-operative appendiceal characteristics; and the relatively low risks of concomitant appendectomy, we suggest that surgeons consider concomitant appendectomies at the time of MIS for endometriosis.
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Affiliation(s)
| | - Nicole Sara Tenzel
- Obstetrics, Gynecology, and Reproductive Science, Mt Sinai Health System, New York, NY
| | - Peiying Hua
- Population Health Science and Policy, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Laurence Orbuch
- Obstetrics, Gynecology, and Reproductive Science, Mt Sinai Health System, New York, NY
| | - Iris Kerin Orbuch
- Obstetrics, Gynecology, and Reproductive Science, Mt Sinai Health System, New York, NY
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162
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Gumuşoglu AY, Donmez T, Kabuli HA, Onur ND, Ferahman S, Sakiz D, Karabulut M. Management of appendiceal neuroendocrine tumors in the light of new guidelines. Ir J Med Sci 2021. [PMID: 34218410 DOI: 10.1007/s11845-021-02707-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Appendiceal neuroendocrine tumors (ANETs) are the most common in the appendix, detected in histopathological appendectomy specimens, which are resected for acute appendicitis. If tumor detection does not show signs of metastatic disease or obvious features of carcinoid syndrome, preoperative diagnosis remains a challenge. However, the treatment and follow-up algorithm change over time. In our study, we aimed to present 10 years of diagnostic and management experience. MATERIAL AND METHODS A retrospective study of all patients who underwent emergency appendectomy, with the intention to treat clinically acute appendicitis at Bakirkoy Dr. Sadi Konuk Hospital (Istanbul, Turkey), was undertaken. Patients with diagnoses other than ANETs were excluded. Age, gender, preoperative clinical findings, operative procedure, and histopathological results identified as ANETs were evaluated. RESULTS ANETs were detected in 24 patients (0.42%) in the histopathological examination of 5720 appendectomy specimens between December 2011 and October 2020. Mean age of patients was 30 years, with 58.3% female. The majority were located at the tip of appendix (62.5%). Eleven patients (45.83%) were graded as T1, one patient (4.16%) as T2, 11 (41.83%) as T3, and one patient (4.16%) as T4. Secondary hemicolectomy was performed in four patients. Median postoperative follow-up was 43 (17-108) months. CONCLUSION In addition, ANETs are rare and largely detected by chance; therefore, precise examination of routine appendectomy specimens is essential for diagnosis. Accurate tumor staging, in light of new algorithms, has an important place in follow-up and treatment management.
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Nijssen DJ, van Amstel P, van Schuppen J, Eeftinck Schattenkerk LD, Gorter RR, Bakx R. Accuracy of ultrasonography for differentiating between simple and complex appendicitis in children. Pediatr Surg Int 2021; 37:843-9. [PMID: 33677613 DOI: 10.1007/s00383-021-04872-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Accurate differentiation between simple and complex appendicitis is important since differences in treatment exist. This study aimed to assess the accuracy of ultrasonography in differentiating between simple and complex appendicitis. METHODS Data from children aged < 18 years who underwent appendectomy between the 1st of January 2013 and the 1st of January 2018 were analyzed retrospectively. Ultrasonography reports of eligible children were divided into simple (test negative) and complex appendicitis (test positive) based on predefined criteria and compared to a gold standard (a combination of predefined perioperative and histopathological criteria). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated to measure ultrasonographic accuracy in differentiating between simple and complex appendicitis. RESULTS 176 children were eligible for inclusion. The mean age at the time of operation was 10.1 ± SD 4.6 years. 84 (47.7%) children had simple appendicitis and 92 (52.3%) had complex appendicitis. The use of ultrasonography yielded a sensitivity: 46%, specificity: 90%, PPV: 84%, and NPV: 60%. CONCLUSION Ultrasonography as standalone modality is not suitable for differentiating between simple and complex appendicitis in children. To improve preoperative differentiation, other variables such as clinical signs and laboratory data are necessary in conjunction with ultrasonography findings.
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164
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Adhikari AB, Acharya K, Kathayat K, Bhatta NC, Koirala DP, Dahal GR. Forshal type IE appendiceal intussusception: A case report. Int J Surg Case Rep 2021; 84:106151. [PMID: 34218021 PMCID: PMC8258857 DOI: 10.1016/j.ijscr.2021.106151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Appendiceal intussusception is a rare condition. Clinical features are not specific for it. Patients may present with abdominal pain and vomiting. These symptoms represent a variety of abdominal pathology. Preoperative diagnosis is difficult because of the non-specific clinical features. We present a case report of a child who initially presented with ileocolic intussusception. Case presentation This is a case report of a 5-years-old boy with abdominal pain and vomiting. He had an ileocolic intussusception 2 days back, and was successfully managed by hydrostatic reduction and discharged. On ultrasonography, an intussusception was identified in the ileocaecal region. Hydrostatic reduction failed this time and laparotomy was performed. On laparotomy, there was complete intussusception of the appendix with normal ileocaecal junction. Appendectomy was performed. Post-operative period was uneventful. Discussion Appendiceal intussusceptions are mostly diagnosed intra-operatively. The clinical features may mimic various other acute and chronic abdominal conditions. Type IE appendiceal intussusception, as described by Forshal, is a rare condition. Appendectomy with a rim of the caecum is the procedure of choice. Conclusion Though ileocaecal intussusceptions are common in children, appendiceal intussusceptions are rare and are usually diagnosed during the operative procedure. Radiologists and pediatric surgeons should be aware of this rare entity. Appendectomy is the treatment of choice in most of the appendiceal intussusceptions. Appendiceal intussusception is a rare cause of sudden onset, colicky intermittent abdominal pain in children. Appendiceal intussusceptions are diagnosed by surgical exploration. On imaging, appendiceal intussusceptions may mimic cecal mass/tumor or ileocolic intussusceptions. Appendectomy is the choice of treatment in appendiceal intussusceptions.
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Affiliation(s)
- Aramva Bikram Adhikari
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal.
| | - Kshitiz Acharya
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | | | - Naveen C Bhatta
- Department of Surgery, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Dinesh Prasad Koirala
- Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Nepal
| | - Geha Raj Dahal
- Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Nepal
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Abstract
Objective This study aimed to determine the frequency of Enterobius vermicularis in appendectomy specimens and evaluate the histopathological characteristics of adult and pediatric cases with E. vermicularis infection. Methods Appendectomies examined from 1 January 2010, to 1 December 2020, were analysed retrospectively. Cases were divided into two groups: under 18 years (children) and 18 and over (adults). Demographic and histopathological characteristics of patients were also examined. Results Out of 14.797 patients that underwent appendectomy, 6.130 were children and 8.667 were adults. E. vermicularis was detected in 268 patients, wherein 64.2% were children and 35.8% were adults. In the detection of E. vermicularis in appendectomy specimens, the frequency was higher in children compared to that in adults (2.85%, 1.1%, respectively) (p<0.001). Histopathologically, acute appendicitis was defined in 31.7% (n=85) of 268 cases, and E. vermicularis was found to cause a higher rate of acute appendicitis in adults (p<0.001). Conclusion The frequency of E. vermicularis in appendectomy specimens is higher in children. However, E. vermicularis causes acute appendicitis more frequently in adults.
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Affiliation(s)
- Serdar Gümüş
- Çukurova University Faculty of Medicine, Department of General Surgery and Surgical Oncology, Adana, Turkey
| | - Nilgün Söğütçü
- University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Clinic of Pathology, Diyarbakır, Turkey
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Maeda Y, Saito S, Ohuchi M, Tamaoki Y, Nasu J, Baba H. Appendiceal bleeding in an elderly male: a case report and a review of the literature. Surg Case Rep 2021; 7:147. [PMID: 34160703 PMCID: PMC8222427 DOI: 10.1186/s40792-021-01234-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of acute lower gastrointestinal bleeding has been increased including colonic diverticulitis and angioplasty. However, appendiceal bleeding is extremely rare. CASE PRESENTATION We present a case of lower gastrointestinal bleeding from the appendix in an elderly male who presented with melena. Appendiceal bleeding was diagnosed using lower gastrointestinal endoscopy, and laparoscopic appendectomy was performed. The patient did not have melena postoperatively, and was discharged 6 days after the surgery. CONCLUSION It is important to distinguish appendiceal bleeding from lower gastrointestinal bleeding and to treat it as soon as possible with less invasiveness.
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Affiliation(s)
- Yuto Maeda
- grid.274841.c0000 0001 0660 6749Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan
- grid.415530.60000 0004 0407 1623Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto, 862-0965 Japan
| | - Seiya Saito
- grid.415530.60000 0004 0407 1623Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto, 862-0965 Japan
| | - Mayuko Ohuchi
- grid.415530.60000 0004 0407 1623Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto, 862-0965 Japan
| | - Yuka Tamaoki
- grid.415530.60000 0004 0407 1623Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto, 862-0965 Japan
| | - Jiro Nasu
- grid.415530.60000 0004 0407 1623Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto, 862-0965 Japan
| | - Hideo Baba
- grid.274841.c0000 0001 0660 6749Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan
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167
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Theodorou CM, Beres AL, Nguyen M, Castle SL, Faltermeier C, Shekherdimian S, Tung C, DeUgarte DA, Brown EG. Statewide impact of the COVID pandemic on pediatric appendicitis in California: A multicenter study. J Surg Res 2021; 267:132-142. [PMID: 34147003 PMCID: PMC8674370 DOI: 10.1016/j.jss.2021.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has resulted in delays in presentation for other urgent medical conditions, including pediatric appendicitis. Several single-center studies have reported worse outcomes, but no state-level data is available. We aimed to determine the statewide effect of the COVID-19 pandemic on the presentation and management of pediatric appendicitis patients. MATERIALS AND METHODS Patients < 18 years old with acute appendicitis at four tertiary pediatric hospitals in California between March 19, 2020 to September 19, 2020 (COVID-era) were compared to a pre-COVID cohort (March 19, 2019 to September 19, 2019). The primary outcome was the rate of perforated appendicitis. Secondary outcomes were symptom duration prior to presentation, and rates of non-operative management. RESULTS Rates of perforated appendicitis were unchanged (40.4% of 592 patients pre-COVID versus 42.1% of 606 patients COVID-era, P = 0.17). The median symptom duration was 2 days in both cohorts (P = 0.90). Computed tomography (CT) use rose from 39.8% pre-COVID to 49.4% during COVID (P = 0.002). Non-operative management increased during the pandemic (8.8% pre-COVID versus 16.2% COVID-era, P < 0.0001). Hospital length of stay (LOS) was longer (2 days pre-COVID versus 3 days during COVID, P < 0.0001). CONCLUSIONS Pediatric perforated appendicitis rates did not rise during the first six months of the COVID-19 pandemic in California in this multicenter study, and there were no delays in presentation noted. There was a higher rate of CT scans, non-operative management, and longer hospital lengths of stay.
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Affiliation(s)
- Christina M Theodorou
- University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California.
| | - Alana L Beres
- University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California
| | - Michelle Nguyen
- Valley Children's Hospital, Department of Pediatrics, Madera, California
| | - Shannon L Castle
- Valley Children's Hospital, Division of Pediatric Surgery, Madera, Madera, California
| | - Claire Faltermeier
- University of California, Los Angeles, Division of Pediatric Surgery, Los Angeles, Los Angeles, California
| | - Shant Shekherdimian
- University of California, Los Angeles, Division of Pediatric Surgery, Los Angeles, Los Angeles, California
| | - Christine Tung
- Harbor-UCLA Medical Center, Division of Pediatric Surgery, Torrance, California
| | - Daniel A DeUgarte
- Harbor-UCLA Medical Center, Division of Pediatric Surgery, Torrance, California
| | - Erin G Brown
- University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California
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168
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Marison SR, Pati B, Laferriere NR, Woo RK, Ha A. Unexpected diagnosis of acute lymphoblastic leukemia in a 2-year-old with acute appendicitis - Case report. Int J Surg Case Rep 2021; 84:106077. [PMID: 34167071 PMCID: PMC8227831 DOI: 10.1016/j.ijscr.2021.106077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Appendicitis is an extremely common surgical problem, especially in the pediatric population. However, leukemic infiltration of the appendix is rare and even more so is having acute appendicitis as the initial manifestation. CASE PRESENTATION The patient is a 2-year-old female with multiple febrile illnesses since birth, who presented to the emergency department with a 3-day history of abdominal pain, fever, and decreased appetite. Ultrasound of her right lower quadrant was consistent with acute appendicitis. A laparoscopic appendectomy was performed successfully without complication. However, pathological examination of the specimen revealed an appendix with partial involvement of B-lymphoblastic lymphoma/leukemia in a background of lymphoid hyperplasia. This prompted referral to a pediatric hematologist/oncologist. Further workup revealed abnormal immature cells on peripheral blood flow cytometry. Bone marrow biopsy confirmed a diagnosis of B-cell acute lymphoblastic leukemia. CLINICAL DISCUSSION Though acute appendicitis is very common and management is well documented, it is rare for pathological examination to uncover leukemia as an underlying etiology and to have acute appendicitis as the initial manifestation of hematologic malignancy. To our knowledge, very few similar events have occurred and been documented in the medical literature. CONCLUSION Physicians and surgeons should be aware that, though quite rare, leukemic infiltration of the appendix can occur and should be considered in the differential diagnosis of acute appendicitis. Notably, pathologic examination of the appendix may be particularly informative. Diligent follow-up of abnormal pathology is crucial in cases suggestive of underlying hematologic malignancy.
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Affiliation(s)
- Scott R Marison
- The Queens Medical Center, Department of Surgery, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813, United States of America.
| | - Brooke Pati
- Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America
| | - Nicole R Laferriere
- Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America
| | - Russell K Woo
- Kapiolani Medical Center for Women and Children, Department of Pediatric Surgery, 1319 Punahou St, Honolulu, HI 96826, United States of America
| | - Ally Ha
- Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America
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Degrate L, Chiappetta MF, Nigro A, Fattori L, Perrone S, Garancini M, Romano F, Braga M. The uncharted severity of complications after appendectomy for acute appendicitis in children: results from 348 consecutive patients. Updates Surg 2021; 74:667-673. [PMID: 34095965 DOI: 10.1007/s13304-021-01101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
Appendectomy is the most frequently performed emergent procedure in paediatric patients. However, there is a wide heterogeneity in outcome definitions and, conversely, a lack of information about complications' severity. This study aims to analyse the outcome of children operated for acute appendicitis, with reference to complications' severity grading. This is a retrospective analysis of a prospectively collected database including all children who underwent emergent appendectomy between September 2013 and March 2020. Postoperative complications were defined according to standardized definitions and graded following Clavien-Dindo classification (CDC). The outcome was analysed in terms of postoperative morbidity, severity of complications, hospital readmission and length of hospital stay (LOS). 348 patients were analysed. Postoperative complications occurred in 18 (5.2%) patients; superficial and organ/space surgical site infections represented the most frequent complications (1.7% and 2.9%, respectively). Major complications (CDC ≥ IIIa) were seen in 4 (1.1%) patients. Median postoperative LOS was 4 (iqr 3-5) days, while hospital readmission was 1.1%. Postoperative complications, preoperative C-reactive protein values and presence of drainage were significantly associated with longer LOS at multivariate analysis. No difference in incidence and severity of complications was found in relation to children's adolescent age. Major complications among paediatric patients undergoing appendectomy for acute appendicitis in a general surgery department are rare. The application of standardized definitions and severity-based grading of complications is crucial for outcome analysis: our results are a useful reference for comparison between forthcoming studies.
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Affiliation(s)
- Luca Degrate
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
| | | | - Alice Nigro
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Luca Fattori
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Stefano Perrone
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Braga
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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170
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Feng W, Du XB, Zhao XF, Li MM, Cui HL. Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis. Pediatr Surg Int 2021; 37:745-754. [PMID: 33538868 DOI: 10.1007/s00383-021-04862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction. METHODS From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction. RESULTS Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6 years, overweight and obesity, duration of symptoms ≥ 36 h, C-reactive protein ≥ 99 mg/L, duration of operation ≥ 60 min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913-0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9. CONCLUSION Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.
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Affiliation(s)
- Wei Feng
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Xiao-Bing Du
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Xu-Feng Zhao
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Miao-Miao Li
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Hua-Lei Cui
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China.
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Steffani M, Merz C, Stöß C, Landau L, Hüser N, Hartmann D, Friess H, Theisen J, Novotny A. [Effects of the first COVID-19 wave on visceral surgery : A retrospective comparison of case numbers from a university hospital and a primary care hospital]. Chirurg 2021; 92:559-566. [PMID: 34009441 PMCID: PMC8132278 DOI: 10.1007/s00104-021-01434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 11/07/2022]
Abstract
Hintergrund Während der ersten COVID-19-Pandemiewelle führte die Aussetzung aller elektiven Eingriffe im Zeitraum vom 15.03. bis 15.05.2020 in Deutschland zu einem Rückgang an Operationen. Die Auswirkungen auf die Zahl spezifischer Operationen in der Viszeralchirurgie sind bislang nicht bekannt. Methoden In diese retrospektive Studie wurden 301 Patienten eingeschlossen, die eine Cholezystektomie bzw. Appendektomie an einem Universitätsklinikum oder Krankenhaus der Grund- und Regelversorgung zwischen dem 15.03.2020 und 05.05.2020 (vs. 2018 und 2019) erhielten. Analysiert wurden die Fallzahlen und der klinische Verlauf. Ergebnisse Die Aussetzung des Elektivprogramms führte zu einer signifikanten Reduktion elektiver Cholezystektomien und notfallmäßiger Appendektomien. Am Universitätsklinikum reduzierte sich die Anzahl der Appendektomien von 24 im Jahr 2018 um 33 % auf 16 im Jahr 2020, die Zahl der Cholezystektomien sank von 30 um 57 % auf 13. Am Grundversorger reduzierte sich die Zahl der Appendektomiepatienten von 23 im Jahr 2018 um 48 % auf 12 im Jahr 2020, die Zahl der Cholezystektomien stieg im Jahr 2018 auf 2019 an und sank anschließend um 30 % im Jahr 2020. Die Operationsdauer, Krankenhausverweildauer und der klinische Verlauf der Patienten unterschied sich nicht signifikant zu den Vorjahreszeiträumen. Diskussion Der Lockdown während der ersten COVID-19-Pandemiewelle führte zu einer deutlichen Reduktion häufiger viszeralchirurgischer Eingriffe. Um die medizinische Versorgung der gesamten Bevölkerung während einer Pandemie möglichst auf hohem Niveau zu erhalten, müssen aktuelle Möglichkeiten der operativen und konservativen Therapie, unter anderem abhängig von lokalen Infektionszahlen und den individuellen Komorbiditäten der Patienten, gegeneinander abgewogen werden.
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Affiliation(s)
- Marcella Steffani
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Constanze Merz
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Christian Stöß
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Lars Landau
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Norbert Hüser
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Daniel Hartmann
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Helmut Friess
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Jörg Theisen
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Alexander Novotny
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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172
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Lee KY, Lee J, Park YY, Oh ST. Effect of the COVID-19 pandemic on surgical treatment of acute appendicitis: A single-center retrospective study. Asian J Surg 2021; 44:800-801. [PMID: 33863628 PMCID: PMC8081671 DOI: 10.1016/j.asjsur.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kil-Yong Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Jaeim Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
| | - Youn Young Park
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Seong Taek Oh
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
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173
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Abstract
OBJETIVO La apendicitis aguda es uno de los procedimientos quirúrgicos más aplicados en todo el mundo. Una de las complicaciones de la apendicectomía es la apendicitis del muñón. El diagnóstico de apendicitis del muñón suele retrasarse. MÉTODOS En nuestro estudio recopilamos casos de apendicitis del muñón tras apendicectomía. Todos los casos con apendicectomía abierta y laparoscópica fueron incluidos en nuestro estudio. RESULTADOS Entre 2008 y 2020 se examinaron 5620 pacientes apendicectomizados que fueron operados en la clínica de cirugía general. Se realizó apendicectomía en 5 pacientes por apendicitis del muñón. Uno de los pacientes con apendicitis del muñón presentó síntomas de peritonitis generalizada, otro con síntomas de íleo, el otro con síntomas de hernia de incisión encarcelada en la incisión de Mc Burney y los otros dos pacientes con síntomas de apendicitis aguda. CONCLUSIONES Como se desprende de nuestro estudio, si bien la apendicectomía es el procedimiento quirúrgico más común y fácil de ver en la práctica quirúrgica general, es un procedimiento que aumenta la morbilidad como vemos en los pacientes con apendicitis del muñón. La tomografía abdominal parece ser el estándar de oro en el diagnóstico de la apendicitis del muñón. Los cirujanos definitivamente deben sospechar apendicitis del muñón en pacientes cuyos síntomas han mejorado, incluso con cicatrices de apendicectomía abierta. OBJECTIVE Acute appendicitis is among the most applied surgical procedures around the world. One of the complications of appendectomy is stump appendicitis. The diagnosis of stump appendicitis is usually delayed. MATERIAL AND METHOD In our study, we compiled cases with stump appendicitis after appendectomy. All cases with open and laparoscopic appendectomy were included in our study. RESULTS Between 2008 and 2020, 5620 appendectomy patients who were operated in the general surgery clinic were examined. Appendectomy was performed in five patients due to stump appendicitis. One of the patients with stump appendicitis presented with symptoms of generalized peritonitis, another with symptoms of ileus, the other with symptoms of incarcerated incision hernia at the McBurney incision, and the other two patients with symptoms of acute appendicitis. CONCLUSION As it can be understood from our study, although appendectomy is the most common and easily seen surgical procedure in general surgical practice, it is a procedure that increases morbidity as we see in patients with stump appendicitis. Abdominal tomography appears to be the gold standard in diagnosis in stump appendicitis. Surgeons should definitely suspect stump appendicitis in patients whose symptoms have improved, even with open appendectomy scarring.
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Affiliation(s)
- Oguz Catal
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Bahri Ozer
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Mustafa Sit
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Hayri Erkol
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
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174
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Cabrera LF, Mendoza-Zuchini A, Bernal F, Pedraza M, Martínez JS, Olarte CE. Evaluación de factores asociados a formación de colecciones intraabdominales en apendicectomía monopuerto para apendicitis aguda complicada. CIR CIR 2021; 89:384-389. [PMID: 34037621 DOI: 10.24875/ciru.20000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJETIVO Comparar los desenlaces entre la apendicectomía por laparoscopia por puerto único y multipuerto, y establecer si existe diferencia en el riesgo de colección intraabdominal posoperatoria. MÉTODO Se realizó un estudio retrospectivo, observacional, mediante 116 historias clínicas de pacientes llevados a apendicectomía laparoscópica por único puerto y multipuerto en dos centros médicos. RESULTADOS Desarrollaron colección intraabdominal 12 (10.3%) pacientes. No se encontraron diferencias entre ambas técnicas en cuanto al desarrollo de colección intraabdominal (p = 0.242), no hubo diferencia entre ambas técnicas en cuanto a sangrado intraoperatorio (p = 0.012) y el tiempo quirúrgico fue mayor en el grupo de puerto único (17.4 minutos en promedio). El 62.5% de los pacientes con sangrado > 50 ml desarrollaron colección intraabdominal. CONCLUSIONES No se evidenció superioridad de ninguna de las dos intervenciones en apendicitis complicada, pero sí se confirma que la apendicectomía laparoscópica por puerto único es un procedimiento seguro, factible, no inferior y con tasas similares de complicaciones en comparación con la técnica convencional de apendicectomía laparoscópica. OBJECTIVE To compare the decreases between the appendectomy by single port vs. multiport laparoscopy and to establish if there is a difference in the risk of postoperative intra-abdominal collection. METHOD Retrospective study was carried out using 116 medical records of patients undergoing laparoscopic appendectomy through a single port and multiport in two medical centers. RESULTS 12 (10.3%) patients developed an abdominal collection. No differences were found between the two techniques in terms of intra-abdominal collection development (p = 0.242), there was no difference between the two techniques in terms of intraoperative bleeding (p = 0.012), the surgical time was greater in the single-port group (17.4 min on average). 62.5% of patients with bleeding > 50 mL developed intra-abdominal collection. CONCLUSIONS There was no evidence of superiority of either of the two interventions in complicated appendicitis, but it does confirm that single-port laparoscopic appendectomy is a safe, feasible, noninferior procedure and with similar complication rates compared to the conventional laparoscopic appendectomy technique.
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Affiliation(s)
- Luis F Cabrera
- Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia.,Departamento de Cirugía General, Fundación Santa Fe de Bogotá. Bogotá, Colombia.,Departamento de Cirugía General, Cobos Medical Center. Bogotá, Colombia
| | - Andrés Mendoza-Zuchini
- Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia.,Departamento de Cirugía General, Cobos Medical Center. Bogotá, Colombia
| | - Felipe Bernal
- Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia.,Departamento de Cirugía General, Cobos Medical Center. Bogotá, Colombia
| | - Mauricio Pedraza
- Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
| | - Juan S Martínez
- Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
| | - Carlos E Olarte
- Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
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175
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Naya I, Adachi K, Takeuchi K, Ariyama Y, Hosaka A, Imamura K, Morita Y, Matsubara S, Lefor AK, Horie H. Clinical predictors of gangrenous appendicitis: elevated total bilirubin level and computed tomography scan findings. Acute Med Surg 2021; 8:e620. [PMID: 33815809 PMCID: PMC8013822 DOI: 10.1002/ams2.620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/29/2022] Open
Abstract
Aim Patients with gangrenous appendicitis usually require emergency surgery. Preoperative diagnosis of gangrenous appendicitis is clinically important but not always straightforward. We undertook this study to identify preoperative predictors of gangrenous appendicitis. Methods This was a single‐center case–control study. We identified 162 patients who underwent appendectomy between September 2011 and August 2014 after the diagnosis of acute appendicitis was established. We identified laboratory parameters and computed tomography (CT) scan findings predictive of histologically or surgically diagnosed gangrenous appendicitis by univariable and multivariable analyses. Results Of 146 study patients, gangrenous appendicitis was confirmed in 102. Univariable analysis showed that two laboratory factors (C‐reactive protein []and total bilirubin [T‐Bil]) and three CT scan findings were significant predictors for gangrenous appendicitis. Multivariable analysis showed that T‐Bil and two CT scan findings (appendicolith and fat stranding around the appendix) were independent predictors. The combination of “T‐Bil ≥ 1.0 mg/dL or appendicolith” was able to predict gangrenous appendicitis with a sensitivity of 90.5%, positive predictive value of 80.4%, and accuracy of 77.8%. The combination of “T‐Bil ≥ 1.0 mg/dL or fat stranding around the appendix” was able to predict gangrenous appendicitis with a sensitivity of 98.9%, positive predictive value of 76.4%, and accuracy of 71.9%. Conclusion These combinations of laboratory and CT scan findings could be valuable as predictors of gangrenous appendicitis.
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Affiliation(s)
- Itsuki Naya
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Kensuke Adachi
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan.,Department of Surgery Tokyo Metropolitan Bokutoh Hospital Bokutoh Hospital Tokyo Japan
| | - Koichi Takeuchi
- Department of Welfare and Medical Intelligence Chiba University Hospital Chiba Japan
| | - Yuno Ariyama
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Akihiro Hosaka
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Kazuhiro Imamura
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Yasuhiro Morita
- Department of Surgery Tokyo Metropolitan Tama Medical Center Tokyo Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology Jichi Medial University Tochigi Japan
| | | | - Hisanaga Horie
- Department of Surgery Jichi Medial University Tochigi Japan
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176
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Fujishiro J, Watanabe E, Hirahara N, Terui K, Tomita H, Ishimaru T, Miyata H. Laparoscopic Versus Open Appendectomy for Acute Appendicitis in Children: a Nationwide Retrospective Study on Postoperative Outcomes. J Gastrointest Surg 2021; 25:1036-44. [PMID: 32128682 DOI: 10.1007/s11605-020-04544-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Our aim was to compare postoperative outcomes of laparoscopic and open appendectomies for acute appendicitis in children under the circumstance of widespread use of laparoscopic surgery. METHOD This study included data on laparoscopic and open appendectomies in children with acute appendicitis from the National Clinical Database, which is a Japanese nationwide surgical database, in 2015. The occurrence rates of complications within 30 days after the surgery and postoperative hospital stay were compared by univariate and multivariate analyses. p < 0.05 was considered statistically significant. RESULTS This study included 4489 appendectomies, of which 3166 surgeries (70.5%) were performed laparoscopically. Appendectomy was performed for complicated and uncomplicated appendicitis in 1765 (39.3%) and 2724 cases (60.7%), respectively. Postoperative complications within 30 days were observed in 246 operations (5.5%). Organ-space surgical site infection (SSI), deep wound SSIs, and superficial wound SSIs were observed in 2.3%, 1.0%, and 2.4% of operations, respectively. On multivariate analysis, the incidence of postoperative complications (odds ratio 1.21, 95% CI 0.90-1.64, p = 0.207) and the length of hospital stay (median 4 days in both groups, p = 0.835) were not significantly different between patients who underwent laparoscopic or open appendectomy. Subgroup analysis in complicated and uncomplicated appendicitis cases also demonstrated no significant differences in the incidence of postoperative complications between those who underwent laparoscopic or open appendectomy. CONCLUSION This study suggested that the occurrence of postoperative complication and the length of hospital stay in pediatric patients who underwent laparoscopic appendectomy are similar with those in pediatric patients who underwent open appendectomy for acute appendicitis.
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177
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Cheng He R, Nobel T, Greenstein AJ. A case report of foreign body appendicitis caused by tongue piercing ingestion. Int J Surg Case Rep 2021; 81:105808. [PMID: 33887850 PMCID: PMC8050728 DOI: 10.1016/j.ijscr.2021.105808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Foreign body ingestion is a rare cause of appendicitis. Heavy, rigid, long, or sharp objects are more likely to lodge within the appendix. Laparoscopic appendectomy should be performed for foreign body appendicitis to ameliorate the risk of complications.
Introduction Foreign body ingestion is an uncommon clinical problem in healthy adults. Furthermore, it is even less common for an ingested foreign body to cause any obstructive symptoms within the gastrointestinal tract. Presentation of case Here, we describe an unusual case of acute appendicitis induced by a tongue piercing that was ingested by a 32-year-old woman with a recent history of endotracheal intubation. Abdominal X-ray revealed metallic foreign bodies in the right lower quadrant. The foreign bodies remained in place on serial X-rays despite bowel preparation and they were not visualized on colonoscopy. Computed tomography (CT) of the abdomen and pelvis confirms the location of the foreign body within the appendix. Laparoscopic appendectomy was performed without complications and the tongue piercing was recovered within the lumen of the resected appendix. Discussion Foreign body ingestion is a rare cause of appendicitis. Most ingested foreign bodies spontaneously pass through the gastrointestinal tract within a week. However, in rare instances, the foreign body becomes lodged in the appendix, often resulting in appendicitis. Conclusion In patients with appendicitis secondary to foreign body ingestion, we suggest surgical management to reduce the risk of peritonitis, perforation, and abscess formation.
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Affiliation(s)
- Rossana Cheng He
- Department of Surgery, Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA.
| | - Tamar Nobel
- Department of Surgery, Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA.
| | - Alexander J Greenstein
- Departments of Surgery and Health Policy, Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA.
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178
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Lorio E, Ballard DH, Guarisco E, Hughes J, Griffen FD, Samra NS. Appendectomy Hospital Stay: No Difference in Obese Adult or Pediatric Patient Length of Stay Compared to Nonobese Patients. Ochsner J 2021; 21:14-8. [PMID: 33828421 DOI: 10.31486/toj.19.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Studies of adult and pediatric patients undergoing appendectomy have reported variable outcomes and operative metrics related to the effect of obesity. The purpose of this study was to investigate the effect of obesity in adult and pediatric patients undergoing appendectomy at our institution. Methods: This single-center retrospective study evaluated the relationship between length of hospital stay for appendectomy and body mass index (BMI). Data obtained from the electronic medical record included age, sex, weight, height, BMI, the number of hours the patient experienced symptoms prior to presentation to the emergency room, the number of hours the patient was admitted prior to surgery, the number of hours of hospital admission after surgery, perforated appendix, preoperative comorbidities, and evidence of preoperative sepsis. Results: During the 3-year study period, 118 adults and 38 children who underwent appendectomy composed the study groups. Patients were stratified by obese and nonobese, with obesity defined as BMI ≥30.0 kg/m2. In adults, we found no significant difference between length of stay in obese (n=45) and nonobese (n=73) patients (79.6 ± 65.5 hours vs 101.6 ± 123.0 hours; P=0.21). In children, we found no significant difference between length of stay in obese (n=9) and nonobese (n=29) patients (92.9 ± 64.6 hours vs 109.0 ± 93.5 hours; P=0.54). Conclusion: Obesity did not affect length of stay in adults and children who underwent appendectomy in the present series.
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179
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Presl J, Varga M, Mittermair C, Mitterwallner S, Weitzendorfer M, Gabersek A, Borhanian K, Heuberger A, Weiss H, Emmanuel K, von Rahden B, Koch OO. Impact of the COVID-19 pandemic lockdown on the utilization of acute surgical care in the State of Salzburg, Austria: retrospective, multicenter analysis. Eur Surg 2021; 53:48-54. [PMID: 33686347 PMCID: PMC7930888 DOI: 10.1007/s10353-021-00692-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 12/24/2022]
Abstract
Background Some medical disciplines have reported a strong decrease of emergencies during the coronavirus disease 2019 (COVID-19) pandemic; however, the effect of the lockdown on general surgery emergencies remains unclear. Methods This study is a retrospective, multicenter analysis of general surgery emergency operations performed during the period from 1 March to 15th 2020 lockdown and in the same time period of 2019 in three medical centers providing emergency surgical care to the area Salzburg-North, Austria. Results In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 lockdown (p = 0.005). The length of hospital stay was reduced to 3 days in 2020 compared to 4 in 2019. Appendectomy remained the most performed emergency surgery for both periods; however the number of surgeries was reduced to less than a half, with 72 cases in 2019 and 33 cases in 2020 (p = 0.118). Emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. The strongest reduction in frequencies of emergency surgeries was reported from the designated COVID center in the examined region. Conclusions Emergency general surgery is an essential service that continues to run under all circumstances. Our data show that COVID-19-related restrictions have resulted in a significant decrease in the utilization of acute surgical care.
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Affiliation(s)
- Jaroslav Presl
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Martin Varga
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Christof Mittermair
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University (PMU) Salzburg, Kajetanerpl. 1, 5010 Salzburg, Austria
| | - Stefan Mitterwallner
- Department of Surgery, Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University (PMU) Salzburg, Paracelsusstrasse 37, 5110 Oberndorf, Austria
| | - Michael Weitzendorfer
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Ana Gabersek
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Kurosch Borhanian
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Andreas Heuberger
- Department of Surgery, Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University (PMU) Salzburg, Paracelsusstrasse 37, 5110 Oberndorf, Austria
| | - Helmut Weiss
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University (PMU) Salzburg, Kajetanerpl. 1, 5010 Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Burkhard von Rahden
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Oliver Owen Koch
- Department of Surgery, Paracelsus Medical Private University (PMU) Salzburg, University Hospital Salzburg (SALK), Müllner Hauptstr. 48, 5020 Salzburg, Austria
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180
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Rai R, Landsberg A, Nguyen A, Wiseman SM. Online educational materials for appendectomy patients have good quality but poor readability. Am J Surg 2021; 221:1203-1210. [PMID: 33712262 DOI: 10.1016/j.amjsurg.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Guidelines recommend patient health-related information be written at or below the sixth-grade level. This study evaluates the readability level and quality of online appendectomy patient education materials. METHODS Webpages were evaluated using seven readability formulae: Flesh-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed quality using the Brief DISCERN tool. RESULTS Thirty seven webpages were analyzed. The mean readability scores were: FKGL = 9.11, GFI = 11.82, CLI = 10.84, ARI = 7.99, SMOG = 11.88, FRE = 51.17, and NDC = 5.48. 6 of the 7 readability formulae indicate that the materials were written at too high a level. The average Brief DISCERN score was 17.81, indicating good quality. CONCLUSIONS Readability levels for online appendectomy patient education materials are higher than recommended but are of good quality. Authors of such materials should not only provide good quality information but also ensure readability.
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Affiliation(s)
- Roopal Rai
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Adina Landsberg
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Anne Nguyen
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Sam M Wiseman
- Department of Surgery, University of British Columbia & Paul's Hospital, C303 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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181
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De Boer C, Ghomrawi H, Many B, Bouchard ME, Linton S, Figueroa A, Kwon S, Abdullah F. Utility of Wearable Sensors to Assess Postoperative Recovery in Pediatric Patients After Appendectomy. J Surg Res 2021; 263:160-166. [PMID: 33667871 DOI: 10.1016/j.jss.2021.01.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite more than two million pediatric operations performed in the United States annually, normal postoperative recovery remains difficult to define. Wearable sensors that assess physical activity and vital signs in real time represent a tool to assess postoperative recovery. This study examined the use of a wearable, the FitBit Inspire HR, to describe recovery in children after appendectomy and to determine the sensitivity of wearable data to distinguish disease severity. MATERIALS AND METHODS Children 3-18 y old undergoing appendectomy in a tertiary children's hospital were invited to participate. Participants wore the FitBit Inpire HR after surgery for 21 d. t-tests compared daily step counts, and piecewise linear regression models were fit to examine recovery trajectories for patients with simple and complicated appendicitis. RESULTS Thirty-two patients were enrolled, and 26 met eligibility criteria. Nine (35%) children had complicated appendicitis, and 14 (54%) were female; the mean age was 9.1 y (standard deviation: 2.9). Four hundred nineteen postoperative days were captured (range: 8-22 d; median: 16 d). Step counts increased after surgery; however, piecewise models showed that patients with simple appendicitis had a more rapid increase (P < 0.01) and reached a plateau (approximately 8000 steps/d) on postoperative day 9, whereas patients with complicated appendicitis did not reach a plateau and had lower step counts during the entire 21-postoperative day period (P < 0.01). CONCLUSIONS Recovery in children after surgery can be characterized using wearables, which can also distinguish recovery trajectories based on disease severity. Establishing such "normative" recovery patterns may lead to earlier detection of complications.
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Affiliation(s)
- Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Hassan Ghomrawi
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Benjamin Many
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Megan E Bouchard
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Angie Figueroa
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Soyang Kwon
- The Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago Illinois
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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182
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Williams BM, Purcell LN, Varela C, Gallaher J, Charles A. Appendicitis Mortality in a Resource-Limited Setting: Issues of Access and Failure to Rescue. J Surg Res 2021; 259:320-325. [PMID: 33129505 PMCID: PMC7897218 DOI: 10.1016/j.jss.2020.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Appendicitis is one of the most common emergency surgery conditions worldwide, and the incidence is increasing in low- and middle-income countries. Disparities in access to care can lead to disproportionate morbidity and mortality in resource-limited settings; however, outcomes following an appendectomy in low- and middle-income countries remain poorly described. Therefore, we aimed to describe the characteristics and outcomes of patients with appendicitis presenting to a tertiary care center in Malawi. METHODS We conducted a retrospective analysis of the Kamuzu Central Hospital (KCH) Acute Care Surgery database from 2013 to 2020. We included all patients ≥13 years with a postoperative diagnosis of acute appendicitis. We performed bivariate analysis by mortality, followed by a modified Poisson regression analysis to determine predictors of mortality. RESULTS We treated 214 adults at KCH for acute appendicitis. The majority experienced prehospital delays to care, presenting at least 1 week from symptom onset (n = 99, 46.3%). Twenty (9.4%) patients had appendiceal perforation. Mortality was 5.6%. The presence of a postoperative complication the only statistically significant predictor of mortality (RR 5.1 [CI 1.13-23.03], P = 0.04) when adjusting for age, shock, transferring, and time to presentation. CONCLUSIONS Delay to intervention due to inadequate access to care predisposes our population for worse postoperative outcomes. The increased risk of mortality associated with resultant surgical complications suggests that failure to rescue is a significant contributor to appendicitis-related deaths at KCH. Improvement in barriers to diagnosis and management of complications is necessary to reduce further preventable deaths from this disease.
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Affiliation(s)
- Brittney M Williams
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Laura N Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Canal C, Scherer J, Birrer DL, Vehling MJ, Turina M, Neuhaus V. Appendectomy as Teaching Operation: No Compromise in Safety-An Audit of 17,106 Patients. J Surg Educ 2021; 78:570-578. [PMID: 32855104 DOI: 10.1016/j.jsurg.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In a surgical career, teaching of surgical procedures plays a central role. In this study we want to evaluate the influence of teaching in appendectomies on the in-hospital outcome. DESIGN AND SETTING Retrospectively, 26,436 cases from the national quality measurement database (AQC) between the years 2009 and 2017 were evaluated using the diagnosis and the procedure codes. Included were all cases with appendicitis (International Classification of Diseases diagnostic codes K35-K37), surgical treatment (appendectomy), and a documented teaching status of the procedure. Variables were sought in bivariate and multivariate analyses. The occurrence of any complication was the primary outcome, whereas in-hospital mortality was the secondary outcome. PARTICIPANTS A total of 17,106 patients with a mean age of 37 ± 19 years remained for final analysis. A total of 6267 operations (37%), were conducted as teaching-operations. Seventy-four percent of all teaching procedures were performed by residents. RESULTS We found no statistical association between teaching operations and complication rates or mortality. However, the teaching group showed longer duration of surgery (+ 11%). CONCLUSIONS There was no influence of the training status of the appendectomy procedure on complication rates and in-hospital mortality. However, there was a prolonged duration of surgery. Despite these statistically significant differences, a comparable clinical outcome was observed in all patients, thus justifying the benefits of resident training.
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Affiliation(s)
- Claudio Canal
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Julian Scherer
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Dominique Lisa Birrer
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Malte Johannes Vehling
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Turina
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland.
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Podda M, Poillucci G, Pacella D, Mortola L, Canfora A, Aresu S, Pisano M, Erdas E, Pisanu A, Cillara N. Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score-matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial). Int J Colorectal Dis 2021; 36:589-598. [PMID: 33454817 DOI: 10.1007/s00384-021-03843-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this prospective multicenter study was to compare antibiotic therapy and appendectomy as treatment for patients with uncomplicated appendicitis confirmed by ultrasound and/or computed tomography. METHODS The study was conducted from January 2017 to January 2018. Data regarding all patients discharged from the participating centers with a diagnosis of uncomplicated appendicitis were collected prospectively. RESULTS Of the 318 patients enrolled in the study, 27.4% underwent antibiotic-first therapy, and 72.6% underwent appendectomy. The matched group was composed of 87 patients in both study arms. Of the 87 patients available of 1-year follow-up in the antibiotic-first group, 64 (73.6%) did not require appendectomy. The complication-free treatment success in the antibiotic-first group was 64.4%. A statistically significant higher complication-free treatment success was found in the appendectomy group: 81.8% in the pre-matching sample and 83.9% in the post-matching sample. Patients in the antibiotic-first group reported lower VAS scores compared to those treated with an appendectomy, both at discharge (2.0 ± 1.7 vs 3.6 ± 2.3) and at 30-day follow-up (0.3 ± 0.6 vs 2.1 ± 1.7). The mean of the days of absence from work was higher in the appendectomy group (β 0.63; 95% CI 0.08-1.18). CONCLUSION Although laparoscopic appendectomy remains the gold standard of treatment for uncomplicated appendicitis, conservative treatment with antibiotics is a safe option in most cases. Approximately 65% of patients treated with antibiotics are symptom-free at 1 year, without increased risk of adverse events should symptoms recur, and better outcomes in terms of less pain and shorter period of absence from work compared to patients undergoing an appendectomy. TRIAL REGISTRATION Clinicaltrials.gov identifier (NCT number): NCT03080103.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy. .,Policlinico Universitario di Monserrato "Duilio Casula", University of Cagliari, SS 554, Km 4,500, 09042, Monserrato, Italy.
| | - Gaetano Poillucci
- Department of General and Specialized Surgery "Paride Stefanini", Policlinico Universitario Umberto I, La Sapienza University, Rome, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Lorenzo Mortola
- Department of Surgery, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Alfonso Canfora
- Department of Surgery, Villa Betania Hospital, Naples, Italy
| | - Simona Aresu
- Department of Surgery, Nostra Signora della Mercede Hospital, Lanusei, Italy
| | - Marcello Pisano
- Department of Surgery, San Marcellino Hospital, ASSL Cagliari, Muravera, Italy
| | - Enrico Erdas
- Department of General and Endocrine Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Nicola Cillara
- Department of General Surgery, Santissima Trinità Hospital, ASSL Cagliari, Cagliari, Italy
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Bahmad HF, Aljamal AA, Alvarez Moreno JC, Salami A, Bao P, Alghamdi S, Poppiti RJ. Rising incidence of appendiceal neoplasms over time: Does pathological handling of appendectomy specimens play a role? Ann Diagn Pathol 2021; 52:151724. [PMID: 33667971 DOI: 10.1016/j.anndiagpath.2021.151724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendectomy is the most common emergent surgical procedure. Primary appendiceal neoplasms are rare entities that are usually detected incidentally in less than 2% of all appendectomies. The increase in the incidence rates of appendiceal neoplasms over time raises the question whether there is an actual change in the disease occurrence or is it a matter of increased recognition and reporting of what would have been previously missed and undiagnosed. OBJECTIVES In our study, we aimed to review the archived tissue specimens of patients who were diagnosed with appendiceal neoplasms during the past decade at our institution and compare our clinical experience with published data to identify possible reasons that contribute to the increase in incidence rates of such neoplasms over the past few years. METHODS Using a pathological database of surgical specimens from patients who underwent appendectomies between January 01, 2010 and September 30, 2020 at a large academic medical center, a single-center retrospective cohort analysis was performed, and medical charts of patients were reviewed. RESULTS Of the total 1568 patients included, 102 (6.5%) had appendiceal neoplasms divided between primary (79.4%) and secondary/metastatic (20.6%) neoplasms. Annual incidence of appendiceal neoplasms over the past 10 years in our institution demonstrated an increasing trend from 5.6% in 2010 to 12.7% in 2020, which we hypothesize might be attributed to submitting more representative sections of the appendix for pathological examination than we had previously. Our results also showed that 2.8% of patients initially presenting with a typical clinical picture of acute appendicitis had appendiceal neoplasms as a truly incidental finding, while 20.3% of patients who underwent elective appendectomies for a suspicious appendiceal mass were found to be neoplastic. Interestingly, among the 80 cases of epithelial neoplasms, more non-carcinoid neoplasms were detected than carcinoid tumors. CONCLUSION Based on our results and what has been published recently, we confirm an additional increase in incidental appendiceal neoplasms found in appendectomies performed for a clinical picture of acute appendicitis, which may be related to more thorough specimen assessment. Whether this is clinically impactful remains to be determined. However, these data support a modification in the way appendectomy specimens are handled in pathology labs post-operatively.
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186
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Yen YT, Loh EW, Tam KW. Effect and safety of peritoneal lavage for appendectomy: A meta-analysis. Surgeon 2021; 19:e430-e439. [PMID: 33589397 DOI: 10.1016/j.surge.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/19/2020] [Accepted: 01/03/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Whether peritoneal lavage is beneficial for the postoperative outcomes of appendectomy is debatable. This study is a meta-analysis of randomized controlled trials (RCTs) that aimed to determine whether peritoneal lavage leads to improved appendectomy outcomes. METHODS PubMed, Embase, and Cochrane Library databases were searched for articles published before September 2020. The meta-analysis calculated the pooled effect size by using a random effects model. The primary outcome was the incidence of intra-abdominal abscess. Secondary outcomes were the incidence of surgical-site infection, hospital stay duration, operation time, and readmission incidence. RESULTS Eight RCTs involving 1487 patients were reviewed. The lavage group had a nonsignificantly lower incidence of intra-abdominal abscess (risk ratio [RR]: 0.81; 95% confidence interval [CI]: 0.55-1.18) and surgical-site infection (RR: 0.73; 95% CI: 0.31-1.72) than did the nonirrigation group. Furthermore, the lavage group showed a nonsignificantly shorter hospital stay duration and lower readmission incidence than did the nonirrigation group. However, the lavage group required significantly more operation time than did the nonirrigation group (mean difference: 7.59 min; 95% CI: 4.67-10.50). CONCLUSION Our study revealed that performing peritoneal lavage has no advantage over suction or drainage only in appendectomy. Moreover, peritoneal lavage significantly increased operation time. Consequently, for improving efficiency and reducing operation time, we suggest skipping peritoneal irrigation during appendectomy. However, the available evidence is of variable quality; therefore, high-quality prospective RCTs are required in the future.
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Affiliation(s)
- Yi-Ting Yen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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187
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Kitagawa Y, Hamasaki S, Harada T, Tamura N, Katsuno A, Umetani N. Emergency laparoscopic ileocecal resection for a low-grade appendiceal mucinous neoplasm with impending rupture: A case report. Int J Surg Case Rep 2021; 80:105636. [PMID: 33609942 PMCID: PMC7900346 DOI: 10.1016/j.ijscr.2021.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
Appendiceal mucinous neoplasms account for less than 1% of all cancers. LAMNs have an aggressive biological potential. Preoperative diagnosis of appendiceal mucinous neoplasms is difficult. Here, we used emergency MRI to identify nodules in the appendix before operation.
Introduction and importance We report the case of a patient with a low-grade appendiceal mucinous neoplasm (LAMN) who underwent emergency laparoscopic ileocecal resection to avoid the metastatic spread of tumor cells due to an impending rupture. Case presentation A 55-year-old woman presented to our hospital with pain in the right lower quadrant of the abdomen. Computed tomography revealed a markedly tense appendiceal mucinous tumor with surrounding inflammation, and laboratory test results showed elevated serum C-reactive protein (7.47 mg/dL), indicating impending rupture of the appendix. Magnetic resonance imaging revealed nodules inside the appendix, suggesting the possibility of appendiceal cancer. We performed emergency laparoscopic ileocecal resection with regional lymph node dissection. The tumor was pathologically diagnosed as a LAMN without rupture. Clinical discussion LAMN is classified as a clinically malignant tumor because it can cause pseudomyxoma peritonei due to perforation or the presence of residual tissue. Although an appendectomy would be appropriate for LAMN if the tumor margin is secured, ileocecal resection with lymph node dissection is necessary when preoperative discrimination of appendiceal cancer is impossible. Conclusion Further studies of preoperative imaging for appropriate differential diagnosis were necessary.
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Affiliation(s)
- Yusuke Kitagawa
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3, Asagaya-kita, Suginami-ku, Tokyo, 166-0001, Japan.
| | - Shunsuke Hamasaki
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3, Asagaya-kita, Suginami-ku, Tokyo, 166-0001, Japan
| | - Toshiko Harada
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3, Asagaya-kita, Suginami-ku, Tokyo, 166-0001, Japan
| | - Noriyasu Tamura
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3, Asagaya-kita, Suginami-ku, Tokyo, 166-0001, Japan
| | - Akira Katsuno
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3, Asagaya-kita, Suginami-ku, Tokyo, 166-0001, Japan
| | - Naoyuki Umetani
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3, Asagaya-kita, Suginami-ku, Tokyo, 166-0001, Japan
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188
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Abounozha S, Ibrahim R, Alshehri FM, Nawara H, Alawad A. The role of postoperative antibiotics in preventing surgical site infections in uncomplicated appendicitis. Ann Med Surg (Lond) 2021; 62:203-206. [PMID: 33537130 PMCID: PMC7843357 DOI: 10.1016/j.amsu.2021.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 02/09/2023] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients who underwent appendicectomy for uncomplicated appendicitis is the use of postoperative antibiotics associated with lower rates of surgical site infections? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the efficiency of postoperative antibiotic therapy in decreasing the rate of surgical site infections in uncomplicated appendicitis. Authors recommend against the use of postoperative antibiotics based on the supported evidence. Hence, its usage was not associated with lower rates of surgical site infections. On the contrary, it might increase the cost, postoperative morbidity and length of stay.
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Affiliation(s)
- Sabry Abounozha
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | | | | | - Hossam Nawara
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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189
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Khetarpal A, Khetarpal A. Case report--mechanical bowel obstruction with appendicitis without strangulation and leukocytosis. Ann Med Surg (Lond) 2021; 63:102152. [PMID: 33643650 PMCID: PMC7895704 DOI: 10.1016/j.amsu.2021.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
Intestinal obstruction is a common surgical emergency caused by varied conditions. Acute appendicitis is considered as one of the unusual cause of intestinal obstruction especially functional and very few cases of mechanical obstruction. Here we report a Case of 62-years-old male who presented here with a clinical picture of small bowel obstruction. On laparotomy, there was a dilated gut with long appendix having inflamed tip buried into adjoining mesentery and then appendectomy was done and obstruction was relieved. Also, bowel was found to be viable hence simple appendectomy was found to be sufficient treatment. Histopathological findings was suggestive of chronic fibrosing appendicitis. Hence, in cases of bowel obstruction in an elderly patients with clinical examination which was not typical for appendicitis can be managed with laparotomy and simple appendectomy when early intervention is made to avoid the risk of ischemia and gangrenous changes in intestinal mesentery which may require resection in later stages. Acute appendicitis is considered as one of the unusual cause of intestinal obstruction especially functional and very few cases of mechanical obstruction. A case of 62-years-old male who presented here with a clinical picture of small bowel obstruction. Bowel obstruction in an elderly patients with clinical examination which was not typical for appendicitis can be managed ---with laparotomy and simple appendectomy when early intervention is made to avoid the risk of ischemia and gangrenous changes in intestinal mesentery.
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Affiliation(s)
- Anil Khetarpal
- Department- General Surgery, Institution Khetarpal Hospital, India
| | - Ayush Khetarpal
- Department- General Surgery, Institution Khetarpal Hospital, India
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190
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Troester AM, Utria AF, Goffredo P, Cho E, Zhou P, Hassan I. Pediatric Appendectomy: an Analysis of 22,334 Cases from the Pediatric National Surgical Quality Improvement Program Data. J Gastrointest Surg 2021; 25:523-525. [PMID: 32889661 DOI: 10.1007/s11605-020-04779-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/10/2020] [Indexed: 01/31/2023]
Abstract
This data is mandatory Please provide.
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Affiliation(s)
- Alexander M Troester
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Alan F Utria
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Paolo Goffredo
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA.
| | - Edward Cho
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Peige Zhou
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
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191
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Johnson BL, Barton GW, Zhu H, Barclay C, Lopez ME, Mazziotti MV. Quantifying the effect of resident education on outcomes in pediatric appendicitis. J Pediatr Surg 2021; 56:269-273. [PMID: 33010886 DOI: 10.1016/j.jpedsurg.2020.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Surgical residents are involved in the care of patients in a climate where quality of care is an important outcome measure. The purpose of this study was to evaluate the effect of resident involvement on appendectomy outcomes. METHODS We retrospectively reviewed appendectomies, ages 0-18, from January 2016 to December 2018. Operative time, operative charges, and postoperative outcomes were evaluated for cases with and without a resident. Data were analyzed using Wilcoxon rank and Fisher's exact tests. RESULTS Of 1842 appendectomies (1267 resident present and 575 no resident present), there was no difference in postoperative stay, abscess formation, readmission, or emergency room visits for simple or complex appendicitis. Operative time was significantly longer for cases of simple appendicitis by 10 min (p = <0.0001) and charges significantly higher by $600 (p = <0.0001) when a resident was involved in the case. These differences held true for complex appendicitis (time longer by 9 min, p = <0.0001 and charges higher by $500, p = 0.03). CONCLUSION Resident involvement results in an increase in operative time and charges, with no difference in length of stay or complications. These results highlight the cost of resident involvement, without an increase in complications experienced by patients. LEVEL OF EVIDENCE Level III evidence.
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Affiliation(s)
- Brittany L Johnson
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Geran W Barton
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Huirong Zhu
- Outcomes and Impact Services, Texas Children's Hospital, Houston, TX, USA
| | - Charlene Barclay
- Outcomes and Impact Services, Texas Children's Hospital, Houston, TX, USA
| | - Monica E Lopez
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Mark V Mazziotti
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA.
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Akbulut S, Demyati K, Koc C, Tuncer A, Sahin E, Ozcan M, Samdanci E. Xanthogranulomatous appendicitis: A comprehensive literature review. World J Gastrointest Surg 2021; 13:76-86. [PMID: 33552395 PMCID: PMC7830076 DOI: 10.4240/wjgs.v13.i1.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts.
AIM To review the medical literature on xanthogranulomatous appendicitis (XGA).
METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used were “appendix vermiformis,” “appendectomy,” “acute appendicitis,” and “XGA.” The search included articles published before May 2020, and the publication language was not restricted. The search included letters to the editor, case reports, review articles, original articles, and meeting presentations. Articles or abstracts containing adequate information about age, sex, clinical presentation, white blood cells, initial diagnosis, surgical approach, histopathological and immunohistochemical features of appendectomy specimens were included in the study.
RESULTS A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. Twenty (52.6%) of the 38 patients, aged 3 to 78 years (median: 34; IQR: 31) were female, and the remaining 18 (47.4%) were male. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy.
CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion. XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Khaled Demyati
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, An-Najah National University, Nablus, 44839, Palestine
| | - Cemalettin Koc
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Emrah Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Mehmet Ozcan
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Emine Samdanci
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Zhang L, Lemke M, Mir ZM, Patel SV. Delayed vs. Early Appendectomy (DELAY) trial for adult patients with acute appendicitis: Study protocol for a randomized controlled trial. Contemp Clin Trials 2021; 102:106288. [PMID: 33497834 DOI: 10.1016/j.cct.2021.106288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Early appendectomy in patients diagnosed with acute appendicitis is the current standard of treatment in North America. Timely intervention is suggested to avoid the complications associated with perforated appendicitis; however, safety of nighttime operating is a competing concern, with mixed results demonstrated thus far. OBJECTIVES This multi-center prospective randomized controlled trial aims to assess whether delaying appendectomy until the following morning versus early appendectomy overnight affects the rate of surgical complications in adult patients diagnosed with acute appendicitis in the evening hours. METHODS This is a randomized, controlled trial across two academic institutions with blinded outcome assessors. Patients presenting with imaging-confirmed appendicitis with an expected appendectomy between 8 pm and 4 am and within 6 h of decision to operate will be randomized to early appendectomy (with 6 h of randomization, control arm) or delayed to the following morning (after 6 am, intervention arm). Primary outcome will be 30 day postoperative complications, defined as a composite of: mortality, readmission to hospital, emergency department visit, percutaneous drain insertion, reoperation, prolonged hospital stay (>7 days), and postoperative complications. Secondary outcome measures are operative time, length of stay, time to emergency department visit and compliance to treatment. DISCUSSION This is a feasible and pragmatic clinical trial, intended to provide evidence for challenging decision making for the most common surgical disease worldwide. Results of this study will aid surgeons and health care administrators on how to appropriately triage appendectomies for patients with acute appendicitis who present overnight.
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Affiliation(s)
- Lisa Zhang
- Department of Surgery, Queen's University, Victory 3, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Madeline Lemke
- Department of Surgery, Western University, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
| | - Zuhaib M Mir
- Department of Surgery, Queen's University, Victory 3, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Sunil V Patel
- Department of Surgery, Queen's University, Victory 3, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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Pérez-Soto RH, Ponce de León-Ballesteros G, Álvarez-Bautista F, Trolle-Silva AM, Medina-Franco H. Thrombocytosis and Hyponatremia as Predictors of Complicated Acute Appendicitis: Predictors of Appendicitis. J Surg Res 2021; 261:369-375. [PMID: 33493889 DOI: 10.1016/j.jss.2020.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple serologic markers have been studied to predict complicated acute appendicitis (CAA) (C-reactive protein and procalcitonin); these increase health care costs and are not always available in medical centers in Mexico. There is a need for low-cost serologic markers to predict CAA and guide the preoperative management of patients. Our objective was to analyze the predictive value of hyponatremia and thrombocytosis for complicated acute appendicitis. METHODS We analyzed 274 patients with AA surgically treated and divided them into two groups: the CAA group and the uncomplicated AA group. We compared the serum values of sodium and platelet blood counts on presentation in the emergency room between the two groups and the proportion of patients with hyponatremia and/or thrombocytosis. Receiver operating characteristic analysis was performed for the two biochemical markers. Sensitivity, specificity, and positive and negative predictive values were calculated for complicated appendicitis in the presence of hyponatremia and thrombocytosis. RESULTS We found 87 patients with CAA and 187 with uncomplicated acute appendicitis. Patients with CAA presented with lower serum sodium values and higher platelet counts than uncomplicated patients. Hyponatremia was found in 54.8% of complicated patients and 29.2% in the uncomplicated group. Thrombocytosis was present in 11.6% of the complicated group and 3.2% in uncomplicated patients. We found a specificity and positive predictive value of 100% for complicated appendicitis in patients with hyponatremia and thrombocytosis. CONCLUSIONS In patients with abdominal pain and suspected acute appendicitis, the presence of hyponatremia and thrombocytosis is a strong predictive tool for the complicated disease. This is the first study to analyze the association between thrombocytosis and complicated appendicitis.
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Affiliation(s)
- Rafael H Pérez-Soto
- General Surgeon, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
| | | | - Francisco Álvarez-Bautista
- General Surgeon, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Alicia Maybí Trolle-Silva
- Department of Anatomical Pathology at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Heriberto Medina-Franco
- Oncologic Surgery, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
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195
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Luiz do Nascimento Junior P, Teixeira Brandt C, Petroianu A. Differences between inflamed and non inflamed appendices diagnosed as acute appendicitis. Ann Med Surg (Lond) 2021; 62:135-9. [PMID: 33520210 DOI: 10.1016/j.amsu.2021.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite the great advances in diagnostic methods, the incidence of the surgical removal of a morphologically normal appendix in patients with clinical and complementary signs of acute appendicitis continues to exceed 20%. This study aimed to compare the clinical, laboratory, and ultrasound findings of inflammatory and noninflammatory appendiceal disorders diagnosed as acute appendicitis. Methods The medical records of 208 patients with clinical, laboratory, and ultrasound findings indicative of acute appendicitis were studied. The patients were divided into two groups: group 1 comprising 94 patients whose appendicular histological results suggested a normal appendix and group 2 comprising 114 patients with histopathological tests confirming acute appendicitis. The variables analyzed were age at the time of surgery, sex, nausea and vomiting, inappetence, fever, pain migrating to the right iliac fossa, pain on palpation of the right iliac fossa, Blumberg's sign, blood counts, ultrasound findings, and Alvarado score. Results An inflamed appendix was associated with inappetence, pain on palpation of the right iliac fossa, appendiceal diameter >6 mm, and Alvarado score >6 (p < 0.001). In contrast, fever was more frequently found in noninflammatory appendiceal disorders (p < 0.001). Conclusion Inappetence, pain on palpation of the right iliac fossa, appendiceal diameter > 6 mm, and Alvarado score > 6 indicate an inflammatory appendiceal disease, whereas fever is more often present in noninflammatory appendiceal diseases.
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196
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Zarei F, Ahmadinejad M. Comparison of Wound Infection in Uncomplicated Acute Appendicitis by Subcuticular Suture and Interrupted Suture. Infect Disord Drug Targets 2021; 21:e270421190327. [PMID: 33459249 DOI: 10.2174/1871526521666210114160130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postoperative complications such as; wound infection and scaring are some of the major concerns regarding suturing techniques. This study is designed to evaluate post-operative outcomes of adhering subcuticular sutures in comparison to interrupted suturing method in patients who underwent appendectomy for uncomplicated acute appendicitis. METHODS 240 patients were randomly assigned into two groups; 120 with interrupted and 120 subcuticular sutures after appendectomy, at Shohada Ashayer hospital, Khorramabad, Iran. The prevalence of wound infection, three days after the surgery in the hospital and a week after discharged was determined and evaluated statistically. RESULTS No wound infection was seen within three days of hospitalization in subcuticular group whereas, 1 patient reported infection in interrupted group, however the difference was not statistically significant. A week after discharge, a patient was reported to have wound infection in subcuticular group and 2 in interrupted group. No significant difference was seen in this regard either. 55 females and 66 males received subcuticular sutures whereas, 74 males and 46 females were given interrupted sutures for wound closing. One male in interrupted and 1 male and female subcuticular group was referred for wound infection, after discharge, respecitvely. Among these groups, no significant differences were seen. In catarrhal appendicitis, infection was reported in interrupted group only which was not statistically significant. CONCLUSIONS Subcuticular sutures provide better cosmetic outcomes without any additional complications in comparison to interrupted sutures.
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Affiliation(s)
- Farshad Zarei
- Department of Surgery, School of Medicine, Lorestan University of Medical Science, Khorramabad. Iran
| | - Mojtaba Ahmadinejad
- Department of Surgery, School of Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj. Iran
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197
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Affiliation(s)
- Martin M Bertrand
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, 30000 Nîmes, France; Department of Visceral Surgery, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France.
| | - Paul Loubet
- VBMI, INSERM U1047, Université de Montpellier, 34000 Montpellier, France; Department of Infectious and Tropical Diseases, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France
| | - Philippe Cuvillon
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, 30000 Nîmes, France; Anaesthesiology Department, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France
| | - Michel Prudhomme
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, 30000 Nîmes, France; Department of Visceral Surgery, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France
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198
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Durán Muñoz-Cruzado V, Anguiano-Diaz G, Tallón Aguilar L, Tinoco González J, Sánchez Arteaga A, Aparicio Sánchez D, Pareja Ciuró F, Padillo Ruiz J. Is the use of endoloops safe and efficient for the closure of the appendicular stump in complicated and uncomplicated acute appendicitis? Langenbecks Arch Surg 2021; 406:1581-1589. [PMID: 33409584 DOI: 10.1007/s00423-020-02050-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There is still controversy regarding the ideal technique to close the appendicular stump in laparoscopic appendectomy (LA). The objective of this study was to determine the safety and efficiency of the use of an endoloop (EL) and endostapler (ES) in complicated and uncomplicated acute appendicitis. METHODS Retrospective cohort study of patients undergoing LA from February 2013 to December 2019. Acute uncomplicated and complicated appendicitis were analysed separately, establishing two groups according to the stump closure technique: EL or ES. Seven hundred-nine patients were included (535 uncomplicated and 174 complicated). In uncomplicated appendicitis, an EL was used in 447 of the patients (83.55%) and an ES was used in 88 patients (16.45%). In complicated appendicitis, an EL was used in 85 patients (48.85%) and an ES was used in 89 patients (51.15%). An analysis of effectiveness and a cost analysis of each technique were performed. RESULTS In uncomplicated appendicitis, we found no differences with respect to global complications, although there were significant differences in the total mean hospital stay (EL group 1.55 (SD 1.48) days; ES group 2.21 (SD 1.69) days; p = 0.046). This meant a savings of 514.12€ per patient using the EL p < 0.001). In complicated appendicitis, the reoperations classified as Clavien-Dindo IIIB in the EL group (6.4%) were greater than in the ES group (0%) (p = 0.012), although the rate of postoperative abscesses (p = 0.788) and the mean volume of abscesses (p = 0.891) were similar. CONCLUSION The systematic use of an EL could reduce costs in uncomplicated appendicitis, while in complicated cases, both options are valid. Prospective studies with a greater number of patients are needed to observe differences in postoperative complications.
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Affiliation(s)
| | - Gregorio Anguiano-Diaz
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Luis Tallón Aguilar
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - José Tinoco González
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Alejandro Sánchez Arteaga
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Daniel Aparicio Sánchez
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Felipe Pareja Ciuró
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain.
| | - Javier Padillo Ruiz
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
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Emile SH, Elfallal AH, Elbaz SA, Elmetwally AM. Development and validation of risk prediction score for incisional surgical site infection after appendectomy. Updates Surg 2021; 73:2189-2197. [PMID: 33394358 DOI: 10.1007/s13304-020-00944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Surgical site infection (SSI) is a challenging and resource-consuming healthcare problem. Predicting the onset of SSI beforehand can help prevent or minimize its incidence. The present study aimed to determine the independent predictors of incisional SSI after open appendectomy using a multivariate analysis and to establish a predictive risk score of SSI after appendectomy. Records of eligible patients who underwent open appendectomy were reviewed. The characteristics and treatment outcomes of patients were collected and analyzed. Significant association between different variables and SSI after appendectomy was examined by univariate analysis. Then, variables with a significant association with SSI were entered into a multivariate binary logistic regression analysis to determine the significant independent predictors of SSI. The study included 343 patients (51.3% female). Incisional SSI was recorded in 44 (12.8%) patients. Univariate analysis revealed five parameters with a significant association with SSI, including BMI > 30 kg/m2 (p < 0.0001), diabetes mellitus (DM) (p = 0.0001), total leukocyte count (p = 0.04), free intraperitoneal fluid (p < 0.0001), and perforated/gangrenous appendicitis (p < 0.0001). After identifying four significant independent predictors of incisional SSI by binary logistic regression analysis, a predictive risk score was developed. The independent predictors of SSI were DM (OR = 6.05, p = 0.005), free intraperitoneal fluid (OR = 6.94, p = 0.0001), obesity (OR = 8.94, p = 0.0001), and perforated/gangrenous appendicitis (OR = 24.64, p = 0.0001). Four independent predictors of incisional SSI after open appendectomy were found after multivariate analysis. A predictive risk score of SSI was developed and included obesity, DM, free intraperitoneal fluid, and perforated/gangrenous appendicitis as predictors of SSI.
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Affiliation(s)
- Sameh Hany Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
| | - Ahmed Hossam Elfallal
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Samy Abbas Elbaz
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Ahmed Magdy Elmetwally
- Vascular Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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200
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D'Cruz RJ, MacDonald LQ, Zisa N, Zomorrodi A, Murren-Boezem J, Atanda A, Hirschfeld F, Berman L. Institution-initiated text messaging can reduce unplanned emergency department visits after appendectomy. J Pediatr Surg 2021; 56:37-42. [PMID: 33139024 DOI: 10.1016/j.jpedsurg.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to reduce unplanned Emergency Department (ED) visits for minor complaints in children after appendectomy through proactive institution-driven communication and utilization of telehealth resources. METHODS We developed a text messaging system to initiate communication with parents of postappendectomy patients and connect them with a telehealth visit or a phone call with a surgical provider as needed. Using descriptive statistics, chi square, and statistical process control analytics, we compared rates of postoperative ED visits for the 8 months pre- and post-implementation of the messaging system and summarized the feedback we received from patients. RESULTS A total of 791 laparoscopic appendectomies were performed in two institutions (preintervention = 382, post-intervention = 409). The postoperative ED visit rate decreased from 5.8% preimplementation to 2.4% post-implementation (p = 0.02). Over one-fifth of families messaged (21.6%) had questions in the postoperative period. The majority expressed interest in a video visit (52.5%), while some preferred to speak with the surgeon's office (25%). Over 90% of respondents found the system helpful, and 4.9% opted out. CONCLUSION Implementation of a hospital-initiated text messaging system has the potential to reduce ED visits in the immediate postoperative period after appendectomy. This system can be scaled to include different surgeries across multiple disciplines. LEVEL OF EVIDENCE III. TYPE OF STUDY Clinical Retrospective Pre/Post Intervention Study.
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Affiliation(s)
- Roshan J D'Cruz
- Dept. of Pediatric General Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803.
| | - Lisa-Qiao MacDonald
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 111 S 11th St Philadelphia, PA, USA 19107
| | - Natalina Zisa
- Nemours Children's Hospital, 13535 Nemours Pkwy, Orlando, FL 32827
| | - Arezoo Zomorrodi
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803
| | | | - Alfred Atanda
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803
| | - Fiona Hirschfeld
- Nemours Center for Health Delivery Innovation, Wilmington, Delaware, USA 19803
| | - Loren Berman
- Dept. of Pediatric General Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 111 S 11th St Philadelphia, PA, USA 19107
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