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Cheng V, Ashbrook M, Youssefzadeh AC, Kohrman N, Matsuo K, Inaba K, Matsushima K. Management for Acute Uncomplicated Appendicitis During Pregnancy: National Trends and Patient Outcomes. Ann Surg 2023; 278:932-936. [PMID: 37132381 DOI: 10.1097/sla.0000000000005893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study analyzes national trends in the management of uncomplicated appendicitis during pregnancy, comparing outcomes for nonoperative management (NOM) and appendectomy. BACKGROUND In the nonpregnant population, several randomized controlled trials demonstrated noninferiority of NOM compared with appendectomy for acute uncomplicated appendicitis. However, it remains unclear whether these findings are generalizable to pregnant patients. METHODS The National Inpatient Sample was queried for pregnant women diagnosed with acute uncomplicated appendicitis from January 2003 to September 2015. Patients were categorized by treatment: NOM, laparoscopic appendectomy (LA), and open appendectomy. A quasi-experimental analysis with interrupted time series examined the relationship between the year of admission and the likelihood of receiving NOM. Multivariable logistic regression analyses were used to evaluate the association between treatment strategy and patient outcomes. RESULTS A total of 33,120 women satisfied the inclusion criteria. Respectively, 1070 (3.2%), 18,736 (56.6%), and 13,314 (40.2%) underwent NOM, LA, and open appendectomy. The NOM rate significantly increased between 2006 and 2015, with an annual increase of 13.9% (95% CI, 8.5-19.4, P <0.001). Compared with LA, NOM was significantly associated with higher rates of preterm abortion (odds ratio [OR]: 3.057, 95% CI, 2.210-4.229, P <0.001) and preterm labor/delivery (OR: 3.186, 95% CI, 2.326-4.365, P <0.001). Each day of delay to appendectomy was associated with significantly greater rates of preterm abortion (OR: 1.210, 95% CI, 1.123-1.303, P <0.001). CONCLUSIONS Although NOM has been increasing as a treatment for pregnant patients with uncomplicated appendicitis, compared with LA, it is associated with worse clinical outcomes.
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Affiliation(s)
- Vincent Cheng
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Matthew Ashbrook
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Ariane C Youssefzadeh
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Nathan Kohrman
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Koji Matsuo
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA
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Wang Z, Bao F, Liang W, Wu H, Lin Z, Xu J, Dong F. Appendicitis in pregnant women: A systematic review and meta-analysis of the diagnostic performance of ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1492-1501. [PMID: 37747110 DOI: 10.1002/jcu.23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The accuracy of ultrasound in the detection of appendicitis in pregnant women was examined in a meta-analysis. METHODS Pregnant women with suspected acute appendicitis were evaluated using ultrasound in a systematic search of PubMed, EMBASE, and Cochrane Library databases from January 1, 2011 to August 10, 2023. The sensitivity and specificity values and diagnostic odds ratios were obtained using the pooled data. RESULTS A total of 239 patients were studied in four relevant investigations. Ultrasonography has a sensitivity of 56% and a specificity of 88% for the diagnosis of acute appendicitis, with an area under the receiver operating characteristic curve of 0.66%. Ultrasonography had a positive likelihood ratio of 4.65 (95% confidence interval, 1.42-15.23) and a negative likelihood ratio of 0.50 (95% confidence interval, 0.41-0.62). There was no evidence of publication bias (p = 0.93). CONCLUSIONS Ultrasound has moderate sensitivity for identifying appendicitis in pregnant women and may be utilized as an alternative diagnostic method.
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Affiliation(s)
- Zimo Wang
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
| | - Fuxing Bao
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
| | - Weiyu Liang
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
| | - Huaiyu Wu
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
| | - Ziwei Lin
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
| | - Jinfeng Xu
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
| | - Fajin Dong
- Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen, People's Republic of China
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Silva SMDA, Silva FLD, Grimaldi MRM, Barros LM, Sá GGDM, Galindo Neto NM. Parada cardiorrespiratória obstétrica: construção e validação de instrumento para avaliar o conhecimento da enfermagem. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220024.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RESUMO Objetivo Construir e validar instrumento para avaliar o conhecimento da enfermagem sobre parada cardiorrespiratória obstétrica. Métodos Estudo metodológico composto pela construção do instrumento, validação de conteúdo por 23 especialistas e validação da consistência interna com 74 profissionais da enfermagem e 99 estudantes de enfermagem. Foram considerados válidos os itens com concordância mínima de 90%, verificada a partir do Índice de Validação de Conteúdo, Razão de Validade de Conteúdo e teste binomial. O alpha de Cronbach foi utilizado para verificar a consistência interna e o valor superior a 0,6 classificado como aceitável. Resultados O instrumento foi composto por16 questões de múltipla escolha, dos 16 itens avaliados, oito possuíram concordância de 100% e seis 95%. A menor razão de validade de conteúdo foi de 0,82 e o alpha de Cronbach foi de 0,694. Conclusões O instrumento foi construído e validado, recomendando-se sua utilização para avaliação do conhecimento em parada cardiorrespiratória obstétrica.
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Silva SMDA, Silva FLD, Grimaldi MRM, Barros LM, Sá GGDM, Galindo Neto NM. Obstetric cardiopulmonary arrest: construction and validation of an instrument to assess nursing knowledge. Rev Gaucha Enferm 2022; 43:e20220024. [DOI: 10.1590/1983-1447.2022.20220024.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT Objective To build and validate an instrument to assess nursing knowledge about obstetric cardiopulmonary arrest. Methods A methodological study consisting of the construction of the instrument, content validation by 23 experts and validation of internal consistency with 74 nursing professionals and 99 nursing students. Items with a minimum agreement of 90%, verified from the Content Validation Index, Content Validity Ratio and binomial test were considered valid. Cronbach’s alpha was used to verify internal consistencyand a value greater than 0.6 was classified as acceptable. Results The instrument consisted of 16 multiple-choice questions, from the 16 items evaluated, eight had 100% agreement by the experts and six had 95%. The lowest content validity ratio was 0.82 and Cronbach’s alpha was 0.694. Conclusions The instrument was constructed and validated, and its use is recommended to assess knowledge in obstetric cardiopulmonary arrest.
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Erdoğan P, Erdoğan A. Case controlled study on diagnostic predictive value of inflammatory markers of complete blood count in pregnant women with acute appendicitis. J OBSTET GYNAECOL 2021; 42:1004-1010. [PMID: 34907858 DOI: 10.1080/01443615.2021.1981271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study is to evaluate and compare the diagnostic ability of platelet-related parameters and white cell-based parameters in pregnant women with appendicitis. This is a retrospective case-controlled study. Women aged between 18 and 50-years-old who had undergone appendectomy between January 2010 and January 2021 were enrolled in the study. Age, pathological diagnosis and relevant laboratory parameters were recorded for each patient. Gestational characteristics were recorded for pregnant patients. There were 58 pregnant and 1171 non-pregnant women enrolled. Pregnant women with acute appendicitis were significantly younger (p < .0001, d= -0.532), had significantly lower PLT (p = .002, d= -0.428) and ALC (p = .033, d= -.304) levels but had significantly higher MPV (p = .004, d = .415) levels than non-pregnant counterparts. In pregnant women, only MPV was the independent predictor of acute appendicitis (OR: 1,952). MPV cut-off value of 9,6 fL provided 63,5% sensitivity, 67,7% specificity, 94,2% PPV and 17,3% NPV whereas 10 fL provided 55,8% sensitivity, 100% specificity, 100% PPV and 21,4% NPV for acute appendicitis in pregnant women. Therefore, MPV might be useful for diagnosing acute appendicitis in pregnant women.Impact statementWhat is already known on this subject? In pregnant women, counts and percentages of white blood cells and neutrophils are known to be independent predictors of acute appendicitis. Meanwhile, physiologic leukocytosis of gestation is a challenge for interpretation of these parameters. Platelets and related markers are, as well, predictive for inflammatory processes in the human body.What do the results of this study add? The role of platelet-related markers in the diagnosis of acute appendicitis in pregnant women has not been studied previously. The results of the present study indicate that in pregnant women, changes in mean platelet volume might be an independent predictor of acute appendicitis.What are the implications of these findings for clinical practice and/or further research? Further similar large-scale case-controlled or cohort studies are required to validate the present results. In pregnant women with abdominal pain, the use of mean platelet volume as a biomarker could reduce negative laparotomy rates. A mean platelet volume is a useful tool for diagnosing acute appendicitis in pregnant women and provides helpful guidance for clinicians dealing with these patients in the emergency room.
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Affiliation(s)
- Pınar Erdoğan
- Midwifery Department, Zübeyde Hanım School of Health, Niğde Zübeyde Hanım School of Health, Obstetrics and Gynecology, Ömer Halisdemir University, Merkez, Turkey
| | - Alirıza Erdoğan
- Medical Faculty, General Surgery Department, General Surgery, Ömer Halisdemir University, Niğde Ömer Halisdemir University Research and Training Hospital, Merkez, Turkey
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Dongarwar D, Salihu HM. Authors' Reply: Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg 2020; 45:647-648. [PMID: 33241527 DOI: 10.1007/s00268-020-05872-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX, USA.
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Jama MA, Perin G, Balasubramanian SP. Letter to the Editor: Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg 2020; 45:645-646. [PMID: 33057763 DOI: 10.1007/s00268-020-05812-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Marwa A Jama
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK.
| | - Giordano Perin
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Saba P Balasubramanian
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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