[Adverse outcomes in the surgical treatment of acute appendicitis]

[Development of a risk map in an oral and maxillofacial surgical unit]

INTRODUCTION

the main aim of this study was to develop and implement a risk map in the Oral and Maxillofacial Surgery Service of the University Hospital «Virgen de las Nieves» of Granada to minimize the incidence of adverse effects (AE).

MATERIALS AND METHODS

Longitudinal, prospective study carried out in the Oral and Maxillofacial Surgery Service of the Hospital Universitario Virgen de las Nieves of Granada, from June 2017 to May 2018, through the methodology of «Analysis and Failure Mode Effect». Management of the different AE was addressed. The following phases were considered as it follows: identification of the problem, identification of AE for within the practice of the oral and maxillofacial surgery that represents a problem in the assistive safety, creation of an interdisciplinary working group, analysis of the current situation in patient safety and risk management using 2analysis tools, SWOT and PITELO, preparation of the patient care process, development of a catalog of AE and preparation of a risk map.

RESULTS

A total of 33 AE were identified. The risk map showed a higher incidence of AE in the Surgical Area (22) compared to the areas of Outpatient Clinic and Hospital Discharge (6). A total of 10 critical AE were identified.

CONCLUSIONS

The elaboration of a risk map allowed to determine the process of the oral and maxillofacial surgical patient, and to elaborate a catalog of AE.

The association of body mass index and perforation of the appendix in Puerto Rican children

OBJECTIVE

Puerto Rico Department of Health lacks data on appendicitis since 1996. We inquired about factors influencing perforation.

METHODS

Retrospective study of risk factors among Puerto Rican children with appendicitis from 2002-2008.

RESULTS

One hundred and seventy records were reviewed. Appendiceal perforation = 38%. Median age was 10 years. Risk factors for perforation were age younger than five years, onset of symptoms more than 36 hours previously, public insurance, more than two examiners, and public hospital. Obese patients had a tendency to present with perforation (OR: 1.5 (0.6-3.5)). In the multivariate analysis, the only variables that remained significant were age younger than five years (OR: 10.2 (2.2-46.7)), and onset of symptoms more than 36 hours previously (OR: 5.9 (2.3-14.7)).

CONCLUSION

Age younger than five years and onset of symptoms more than 36 hours previously were associated with perforation of the appendix. Body mass index for age percentile greater than the 95th had a tendency to present with perforation.

Complicaciones sépticas intraabdominales tras apendicectomía laparoscópica: descripción de una posible nueva complicación específica de la apendicectomía laparoscópica

BACKGROUND

Controversies about laparoscopic appendectomy (LA) focus mainly on the high intraabdominal infection rate. In 2005, Serour et al described a distinct complication specific to LA, termed "postlaparoscopic appendectomy complication" (PLAC). This complication is an intraabdominal infection, without abscess formation, which develops after laparoscopic appendectomy for non-complicated appendicitis (simple, phlegmonous, or normal appendix) and is observed in patients discharged after an uneventful postoperative period. We reviewed our case series to establish our intraabdominal infection rate in appendectomy and to identify cases similar to this newly described complication.

MATERIAL AND METHOD

We retrospectively reviewed 651 clinical records of appendectomy performed by the laparoscopic (LA) or open approach (OA) over an 11-year period in our hospital. The criteria for a diagnosis of PLAC were as follows: a) clinical criteria: uneventful appendectomy (OA or LA), asymptomatic status on hospital discharge, and onset of right lower quadrant pain, fever, and elevated white blood cell count after discharge; b) pathologic criteria: non-complicated appendicitis (gangrenous or perforated appendicitis were excluded), and c) ultrasound scan showing characteristic features.

RESULTS

A total of 432 LA and 219 OA were reviewed. The conversion rate was 11.1%. The main complications (intention-to-treat analysis) were wound infection (6.3% in LA versus 7.8% in OA) and intraabdominal infection (4.2% in LA versus 2.3% in OA). Four out of 18 cases of intraabdominal infection after LA fulfilled PLAC criteria, representing 1% of all LA and 22% of intraabdominal infections after LA.

CONCLUSIONS

LA seems to be associated with an increased risk of intraabdominal infection. Our results suggest that a distinct form of intraabdominal infection specific to laparoscopic appendectomy may exist.