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Surgical Endoscopy Jul 2001Perforated appendicitis is associated with a significant risk of postoperative abdominal and wound infection. Only a few controversial studies evaluate the role of... (Comparative Study)
Comparative Study
BACKGROUND
Perforated appendicitis is associated with a significant risk of postoperative abdominal and wound infection. Only a few controversial studies evaluate the role of laparoscopy in perforated appendicitis. The significance of conversion from laparoscopy to open appendectomy for perforated appendicitis is not well defined. Statistical analysis was performed using Student's t-test.
METHODS
Data on 52 patients with perforated appendicitis were prospectively collected and retrospectively reviewed. Among these patients, 18 had laparoscopic appendectomies (LA); 24 had open appendectomies (OA); and 10 had converted appendectomies (CA). The indications for either method were based on the attending surgeons's philosophy. Laparoscopic appendectomy was performed using a retrograde stapler technique. Operative time, hospital stay, ability to tolerate a liquid diet, and postoperative infectious complications were documented.
RESULTS
No statistically significant difference in the operative time in minutes was found between the LA (114 +/- 29.3), CA (120.0 +/- 32.2), and OA (105.8 +/- 64.1) groups (p = NS). There was no statistically significance difference in length of stay (days) between the LA (9.2 +/- 4.1), OA (10.5 +/- 3.3), and CA (10.0 +/- 1.8) groups. The wound infection rate was less frequent in the LA group (0%) than in 0A (14%) and CA (10%) groups. The rate of intra-abdominal abscess infections (IAAs) and ileus were 22% and 28%, respectively, in LA group, 38% and 29%, respectively, in OA group, and 60% and 50%, respectively, in CA group.
CONCLUSIONS
No difference in the rate of postoperative intra-abdominal abscesses exists between laparoscopic and open appendectomy for perforated appendicitis. Wound infections and ileus complicate the postoperative course of patients after laparoscopic appendectomy less frequently than after open appendectomy. The conversion of laparoscopic to open appendectomy for perforated appendicitis is associated with increased postoperative morbidity.
Topics: Adult; Appendectomy; Appendicitis; Female; Hospitalization; Humans; Intestinal Perforation; Laparoscopy; Length of Stay; Male; Prospective Studies; Retrospective Studies; Rupture, Spontaneous; Time Factors; Treatment Outcome
PubMed: 11591963
DOI: 10.1007/s004640020072 -
Journal of Pediatric Surgery Dec 2019Health systems must identify preventable adverse outcomes to improve surgical safety. We conducted a systematic review to determine national rates of postoperative... (Comparative Study)
Comparative Study Meta-Analysis
Deriving literature-based benchmarks for pediatric appendectomy and cholecystectomy complications from national databases in high-income countries: A systematic review and meta-analysis.
BACKGROUND
Health systems must identify preventable adverse outcomes to improve surgical safety. We conducted a systematic review to determine national rates of postoperative complications associated with two common pediatric surgery operations in High-Income Countries (HICs).
METHODS
National database studies of complication rates associated with pediatric appendectomies and cholecystectomies (2000-2016) in Canada, the US, and the UK were included. Outcomes included mortality, length of hospital stay (LOS), and other surgical complications. Outcome data were extracted and comparisons made between countries and databases.
RESULTS
Thirty-three papers met inclusion criteria (1 Canadian, 1 UK, and 4 US Databases). Mean LOS was 3.00 (±1.42) days and 3.44 (±1.55) days for appendectomy and cholecystectomy, respectively. Mortality was 0.06% after appendectomy and 0.24% after cholecystectomy. Readmission and reoperation rates were 6.79% and 0.32% for appendectomy, and 1.37% and 0.71% for cholecystectomy. For appendectomies, LOS was shorter in Canadian and UK studies compared to US studies, and mortality and readmission rates were lower (OR 0.46 95%CI 0.23 to 0.93, OR 3.63 to 3.77 95%CI) in UK studies compared to US studies.
CONCLUSIONS
Outcomes after pediatric appendectomy and cholecystectomy are good but vary between HICs. Understanding national outcomes and intercountry differences is essential in developing health system approaches to pediatric surgical safety.
LEVEL OF EVIDENCE
II.
Topics: Appendectomy; Benchmarking; Canada; Cholecystectomy; Databases, Factual; Developed Countries; Humans; Length of Stay; Patient Readmission; Postoperative Complications; Reoperation; United Kingdom; United States
PubMed: 31575414
DOI: 10.1016/j.jpedsurg.2019.08.033 -
Journal of Pediatric Surgery Jan 2019Accurate data are essential for the validity of clinical registries. This study aimed to validate NSQIP-P data, assess representativeness, and evaluate risk-adjusted... (Comparative Study)
Comparative Study
INTRODUCTION
Accurate data are essential for the validity of clinical registries. This study aimed to validate NSQIP-P data, assess representativeness, and evaluate risk-adjusted predictive ability at a single institution.
METHODS
A prospective appendectomy-specific pediatric surgery research database (RD) maintained by clinical researchers was compared to the NSQIP-P data for appendectomies performed in 2016 at a tertiary children's hospital. NSQIP-P sampled data collected by trained surgical clinical reviewers (SCRs) were compared to matched RD patients. Both datasets used NSQIP-P definitions. Using χ, datasets were compared by patient demographics, disease severity (simple vs. complicated), and outcomes.
RESULTS
458 appendectomies for acute appendicitis were performed in 2016, of which 250 (55%) were abstracted by SCRs and matched to RD patients. Patient demographics were similar between datasets. Disease severity (NSQIP-P:50% complicated vs RD:31% complicated) and composite morbidity (NSQIP-P:6.0% vs RD:14.4%) were significantly different (both p < 0.01). Demographics and outcomes were similar between matched (n = 250) and unsampled patients in the RD (n = 208). NSQIP-P's risk-adjusted predicted morbidity was significantly lower than morbidity observed in all (n = 458) RD patients (NSQIP-P:9.9% vs RD:14.2%, p < 0.01).
CONCLUSIONS
Though constituting a representative sample, NSQIP-P appendectomy data were inconsistent with department data. Discrepancies appear to be the result of underreporting of outcome variables and disease misclassification.
TYPE OF STUDY
Retrospective comparative review.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Appendectomy; Child; Databases, Factual; Female; Humans; Male; Postoperative Complications; Quality Improvement; Reproducibility of Results; Retrospective Studies; Severity of Illness Index
PubMed: 30414692
DOI: 10.1016/j.jpedsurg.2018.10.017 -
American Journal of Surgery Aug 2015Reducing healthcare costs while maintaining quality of care is one of the challenges of the current healthcare system. The purpose of this study was to compare the... (Comparative Study)
Comparative Study
BACKGROUND
Reducing healthcare costs while maintaining quality of care is one of the challenges of the current healthcare system. The purpose of this study was to compare the hospital charges accrued following laparoscopic (LA) and open (OA) appendectomies in the pediatric population.
METHODS
We retrospectively reviewed all pediatric appendectomies (n = 264) performed from 2007 to 2013 at a single academic center. Subgroup analysis on charges and costs was performed on perforated and nonperforated LA and OA.
RESULTS
A total of 195 (73.9%) appendectomies were performed laparoscopically. LA in both perforated and nonperforated groups was associated with higher surgical supply, operating room, and total hospital charges compared with OA. Surgical supply costs to the facility were higher by an average of $1,000 for both nonperforated and perforated appendicitis in the LA group. Length of stay and postoperative complications were comparable within all groups.
CONCLUSIONS
In this study, LA is associated with significantly higher surgical costs and charges than OA without improvement in outcomes. Investigation into cost reduction strategies of laparoscopy should be a component of future clinical appendicitis research.
Topics: Appendectomy; Appendicitis; Child; Female; Health Care Costs; Humans; Laparoscopy; Male; Retrospective Studies
PubMed: 25863474
DOI: 10.1016/j.amjsurg.2014.09.037 -
Archives of Pediatrics & Adolescent... Jan 2004Laparoscopic procedures are performed commonly in children. In general, the cost containment of laparoscopic surgery in children has not been evaluated. (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
Laparoscopic procedures are performed commonly in children. In general, the cost containment of laparoscopic surgery in children has not been evaluated.
OBJECTIVE
To compare the costs of laparoscopic appendectomy with those of open appendectomy.
DESIGN
Prospective clinical trial between November 1, 1997, and April 30, 2000. For analysis, cost of supplies, operation room use, and recovery in the hospital and after discharge was evaluated. Costs common to both groups were not determined.
SETTING
Operations performed in a university hospital.Patients Eighty-seven children aged 4 to 15 years who underwent appendectomy for suspected appendicitis. Patients were randomized to laparoscopic or open appendectomy. Intervention Laparoscopic appendectomies performed with the same standard set of reusable equipment.
MAIN OUTCOME MEASURES
Cost surplus of the laparoscopic procedure and recovery after surgery were evaluated, to determine the costs and effects of laparoscopic appendectomy compared with those of open appendectomy in children.
RESULTS
Excess operating and complication costs per procedure were 96 euros (EUR) in laparoscopic appendectomy. The increased operative expenses were offset by a shorter hospital stay, resulting in a marginal difference of 53 EUR in itemized total costs between the 2 procedures (total cost, 1023 EUR in the laparoscopic appendectomy group and 970 EUR in the open appendectomy group). After laparoscopic appendectomy, children returned to school and sports earlier than those who had had an open appendectomy.
CONCLUSION
Laparoscopic appendectomy was marginally more expensive, but it allowed earlier return to normal daily activities than open appendectomy.
Topics: Adolescent; Appendectomy; Child; Child, Preschool; Cost-Benefit Analysis; Finland; Humans; Laparoscopes; Laparoscopy; Prospective Studies
PubMed: 14706955
DOI: 10.1001/archpedi.158.1.34 -
The British Journal of Surgery May 1997
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy
PubMed: 9171773
DOI: 10.1002/bjs.1800840539 -
The British Journal of Surgery Apr 1992
Topics: Appendectomy; Education, Medical, Continuing; Female; Humans; Laparoscopy; Postoperative Complications; Time Factors
PubMed: 1533558
DOI: 10.1002/bjs.1800790402 -
Lancet (London, England) Oct 1991
Topics: Appendectomy; Humans; Laparoscopy; Length of Stay
PubMed: 1681253
DOI: 10.1016/0140-6736(91)91556-a -
The British Journal of Surgery Sep 1992
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy
PubMed: 1294111
DOI: 10.1002/bjs.1800790940 -
Journal of Pediatric Surgery Nov 2019To investigate the impact of hospital administrative level and caseload of pediatric appendectomies on the morbidity and mortality after appendectomy in a...
PURPOSE
To investigate the impact of hospital administrative level and caseload of pediatric appendectomies on the morbidity and mortality after appendectomy in a population-based cohort of Swedish children.
METHODS
Population-based cohort study including all Swedish children less than 15 years of age that underwent appendectomy for suspected appendicitis, 1987-2009. Patient characteristics and data on postoperative morbidity and mortality were collected from the Swedish National Patient Register and the Swedish Death Register. Primary endpoints were postoperative morbidity and mortality. Two explanatory variables were investigated: hospital administrative level and hospital annual caseload of pediatric appendectomies. Data were analyzed in regression models adjusting for available confounders.
RESULTS
The cohort comprised 55,591 children. The risk for postoperative complications was reduced in specialized pediatric surgical centers and in high caseload centers, compared to other hospitals. There were only seven postoperative deaths within 90 days of appendectomy.
CONCLUSIONS
We found clinically relevant risk reductions for reoperation and for readmission after appendectomy in specialized pediatric surgical centers. Importantly, the risk for postoperative complications was also reduced with increased hospital caseload, indicating that the merit from centralizing the management of pediatric appendectomies to specialized pediatric surgical centers may also be achieved by increasing hospital caseload of pediatric appendectomies in non-pediatric surgical units.
TYPE OF STUDY
Treatment study.
LEVEL OF EVIDENCE
Level II.
Topics: Adolescent; Appendectomy; Appendicitis; Child; Cohort Studies; Humans; Postoperative Complications; Risk Factors; Sweden
PubMed: 30992147
DOI: 10.1016/j.jpedsurg.2019.03.013