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Asian Journal of Surgery Jun 2024
PubMed: 38937236
DOI: 10.1016/j.asjsur.2024.06.048 -
Journal of Clinical Medicine Jun 2024-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA)....
Observation Safely Reduces the Use of the Computerized Tomography in Medium-to-Low-Risk Patients with Suspected Acute Appendicitis: Results of a Randomized Controlled Trial.
-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). -Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8-12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. -A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). -Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases.
PubMed: 38929896
DOI: 10.3390/jcm13123363 -
Children (Basel, Switzerland) May 2024This study aims to analyze the impact of the COVID-19 pandemic on the clinical, pathological, and surgical characteristics of acute appendicitis (AA) at the University...
BACKGROUND
This study aims to analyze the impact of the COVID-19 pandemic on the clinical, pathological, and surgical characteristics of acute appendicitis (AA) at the University Hospital Centre (UHC) Zagreb.
METHODS
This retrospective study analyzed demographic, clinical, and surgical data from consecutive AA patients. Data were collected from an electronic database for two periods: 1 January to 31 December 2019 (pre-COVID-19), and 11 March 2020, to 11 March 2021 (COVID-19 pandemic).
RESULTS
During the two study periods, 855 appendectomies were performed, 427 in the pre-pandemic, and 428 during the pandemic. Demographic data were comparable between groups. There was statistically no significant difference in the type of appendectomy ( = 0.33) and the median hospital length of stay (3; (2-5) days, = 0.08). There was an increase in the conversion rate during the pandemic period (4.2% vs. 7.7%, = 0.03). The negative appendectomy rate and the incidence of perforated AA did not differ significantly ( = 0.34 for both).
CONCLUSIONS
We did not observe a significant increase in the rate of AA complications during the COVID-19 pandemic at the UHC Zagreb. This may be attributed to two factors: (1) AA was diagnosed and treated as an emergency, which remained available during the pandemic, and (2) diagnostic and therapeutic protocols remained unaltered. We recommend a laparoscopic approach even during the COVID-19 pandemic.
PubMed: 38929221
DOI: 10.3390/children11060641 -
Surgical Endoscopy Jun 2024Informed consent is essential in ensuring patients' understanding of their medical condition, treatment, and potential risks. The objective of this study was to...
INTRODUCTION
Informed consent is essential in ensuring patients' understanding of their medical condition, treatment, and potential risks. The objective of this study was to investigate the impact of utilizing a video consent compared to standard consent for patient knowledge and satisfaction in selected general surgical procedures.
METHODS AND PROCEDURES
We included 118 patients undergoing appendectomy, cholecystectomy, inguinal hernia repair, and fundoplication at two hospitals in Omaha, NE. Patients were randomized to either a standard consent or a video consent. Outcomes included a pretest and posttest objective knowledge assessment of their procedure, as well as a satisfaction survey which was completed immediately after consent and following discharge. Given the pre-post design, a linear mixed-effect model was estimated for both outcomes. A two-way interaction effect was of primary interest to assess whether pre-to-post change in the outcome differed between patients randomized to standard or video consent.
RESULTS
Baseline characteristics were mostly similar between groups except for patient sex, p = 0.041. Both groups showed a statistically significant increase in knowledge from pretest to posttest (standard group: 0.25, 95% CI 0.01 to 0.51, p = 0.048; video group: 0.68, 95% CI 0.36 to 1.00, p < 0.001), with the video group showing significantly greater change (interaction p = 0.043) indicating that incorporating a video into the consent process resulted in a better improvement in patient's knowledge of the proposed procedure. Further, both groups showed a decrease in satisfaction post-discharge, but no statistically significant difference in the magnitude of decrease between the groups (interaction p = 0.309).
CONCLUSION
Video consent lead to a significant improvement in a patient's knowledge of the proposed treatment. Although the patient satisfaction survey didn't show a significant difference, it did show a trend. We propose incorporating videos into the consent process for routine general surgical procedures.
PubMed: 38926236
DOI: 10.1007/s00464-024-10975-9 -
F1000Research 2023Acute appendicitis is the most common surgical emergency in pregnant women. There has been a wide variance in clinical practice worldwide, with some favoring an... (Meta-Analysis)
Meta-Analysis Comparative Study
Acute appendicitis is the most common surgical emergency in pregnant women. There has been a wide variance in clinical practice worldwide, with some favoring an antibiotic-only approach while others prefer surgery as the first-line management. Therefore, we designed the current analysis to synthesize the available evidence on the efficacy and safety of antibiotics versus surgery management. We searched PubMed, Scopus, EuropePMC, and Cochrane Central from March 4, 1904 until November 25, 2022, to look for studies comparing antibiotics and surgery in pregnant patients with acute appendicitis. We only included studies that provided a comparison between the two treatments. We included preterm delivery, fetal loss, maternal death, and complications as outcomes. The results were compared using an odds ratio and 95% confidence interval. We also performed a sensitivity analysis by excluding studies with a serious risk of bias. We included five non-randomized studies for the analysis. We found that patients in the antibiotic group had a lower risk of preterm labor (OR 0.63 [95% CI 0.43-0.92]; p 0.02) but a higher risk of complications (OR 1.79 [95% CI 1.19-2.69]; p 0.005). We did not find any difference in the other outcomes. The increased risk of complications should caution clinicians about using antibiotics as the first-line management. More studies are required to identify patients who would benefit the most before antibiotics could be adopted as a treatment for acute appendicitis in pregnant patients.
Topics: Humans; Appendicitis; Pregnancy; Female; Anti-Bacterial Agents; Pregnancy Complications; Appendectomy; Acute Disease
PubMed: 38919838
DOI: 10.12688/f1000research.129906.2 -
Hospital Pharmacy Aug 2024In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the (SIP) project...
In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the (SIP) project for the purposes of developing and standardizing quality improvement measures known to reduce the rates of post-operative surgical site infections (SSIs). Four years later the (SCIP), an expansion of SIP, was published in governmental provided several additional initiatives applicable to the perioperative period. Central to both projects are the assurance of the timeliness, selection, and duration of peri-operative surgical prophylactic antibiotics. In support of this objective, various medical associations, such as the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA), have developed the . To ensure compliance with quality measures, hospitals are required to report data to the , which is then reviewed by CMS for reimbursement purposes and to measure hospital performance. To maintain optimal standards of care and satisfy all core measures, it is expected that patients undergoing most categories of surgical procedures receive prophylactic antibiotics. We recognized that patients already being administered antimicrobial therapy as treatment for the condition requiring the surgery not uncommonly also were prescribed unwarranted and redundant pre-operative antibiotics. Our study was meant to quantify such antibiotic redundancy, which only risks the development of antimicrobial resistance and adverse events, to bolster our and other hospitals antimicrobial stewardship programs. A retrospective analysis of computerized hospital records over a one-month period of time (November 2022) was conducted focusing on hospital admissions that involved surgical operative procedures. Only those patients who had received a pre-operative surgical prophylactic antibiotic were included in the analysis. Of the 92 surgeries that fulfilled the inclusion criteria, 38 (41.3%) were performed on patients who were already receiving therapeutic antibiotics for more than 24 hours targeted to treat the infection for which they were undergoing surgery. These included laparoscopic cholecystectomy (24), appendectomy (12), wound debridement (12), and soft tissue incision and drainage procedures (9), comprising nearly 50% of each type of these operations performed during the study time period. These findings demonstrate a clear opportunity to strengthen both our, and presumably other, hospitals antimicrobial stewardship programs. Together with physician education, granting the pharmacy the ability to cancel unnecessary and redundant surgical prophylactic antibiotics would conceivably be of great benefit.
PubMed: 38919764
DOI: 10.1177/00185787241230079 -
Cureus May 2024Ileocolic intussusception is a consideration in young pediatric patients with acute abdominal pain. Meckel's diverticulum is the most common pathologic lead point for...
Ileocolic intussusception is a consideration in young pediatric patients with acute abdominal pain. Meckel's diverticulum is the most common pathologic lead point for intussusception in children and the appendix acting as the lead point is rare. In addition, management guidelines for recurrent ileocolic intussusception (RICI) are lacking. We present two cases of RICI in which the pathological lead point was the appendix. The first patient, a two-year-old with no medical history, had intermittent abdominal pain and non-bloody vomiting for a month. Ultrasound revealed ileocolic intussusception, successfully managed with pneumatic reduction. However, symptoms recurred and a repeat ultrasound showed partial intussusception of the appendix into the cecum. Laparoscopic reduction and appendectomy were then performed. Symptomatic intussusception recurred, and a second laparoscopic reduction with stump appendectomy resolved all symptoms. The second patient, a three-year-old with no medical history, had colicky abdominal pain for 24 hours. Ultrasound revealed ileocolic intussusception that was pneumatically reduced. As pain recurred, laparoscopic reduction and appendectomy were performed, revealing ileocolic intussusception with a dilated appendix as the pathologic lead point. Recurrent ileocolic intussusception (RICI) with the appendix as the lead point is common, but RICI with the appendix as the lead point is rare. These cases demonstrate the role of the appendix as a pathologic lead point, and a review of the literature supports the need for surgical reduction. While enema reduction is the first line for recurrent intussusception, surgical reduction is preferred when a pathological lead point is suspected.
PubMed: 38919204
DOI: 10.7759/cureus.61120 -
Annali Italiani Di Chirurgia 2024Acute appendicitis is one of the most common causes of acute abdomen in pediatric surgery. The purpose of this study was to observe the effects of integrated rapid...
AIM
Acute appendicitis is one of the most common causes of acute abdomen in pediatric surgery. The purpose of this study was to observe the effects of integrated rapid rehabilitation nursing in children with laparoscopic appendectomy (LA) during the perioperative period.
METHODS
A total of 200 children with appendicitis who underwent LA in our hospital from January 2022 to January 2023 were retrospectively selected as the study subjects. According to the nursing mode, they were divided into a control group (n = 100) and an observation group (n = 100). The control group was treated with routine nursing intervention, and the observation group was treated with an integrated rapid rehabilitation nursing intervention. Perioperative indices (operation time, first postoperative exhaust time, length of hospital stay) were recorded and compared between the two groups. The visual analog scale (VAS) was used to score the two groups at 6 h, 12 h, 24 h, and 48 h after surgery, and the pain degree of the children was quantitatively evaluated. The levels of serum stress response indices (cortisol (Cor), norepinephrine (NE), and adrenocorticotropic hormone (ACTH)) in the two groups were measured. The incidence of postoperative complications, improvement of postoperative quality of life, and nursing satisfaction were compared between the two groups.
RESULTS
The operation time, first postoperative exhaust time, and hospitalization time in the observation group were significantly shorter than those in the control group (p < 0.05), and the VAS scores of the patients in the observation group were lower than those in the control group at each time point of 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.05). One hour after surgery, the serum Cor, NE, and ACTH levels of the two groups of patients were significantly higher than those before surgery, and the levels for the observation group were significantly lower than those of the control group (p < 0.05). After treatment, the quality of life scores of patients in both groups was significantly higher than before treatment, and the quality of life scores of patients in the observation group was significantly higher than that of the control group (p < 0.05). The postoperative complication rate of the observation group was 3.00% (3/100), which was significantly lower than that of the control group (13.00% (13/100)) (χ2 = 6.793, p = 0.009). The nursing satisfaction of the observation group was 95.00% (95/100), which was significantly higher than that of the control group (79.00% (79/100)) (χ2 = 11.317, p = 0.001).
CONCLUSIONS
The integrated rapid rehabilitation nursing management mode is an intervention that can effectively alleviate the effects of LA on stress reactions and pain in children with appendicitis. It can effectively reduce the incidence of postoperative complications and improve the patient's nursing satisfaction, allowing children with appendicitis to recover as soon as possible after surgery, and can improve patients' quality of life. It helps to improve the overall clinical efficacy, and the treatment process is simple to operate, relatively safe and reliable, has high use value, and is worthy of further promotion in clinical treatment.
Topics: Humans; Appendicitis; Child; Appendectomy; Female; Laparoscopy; Male; Retrospective Studies; Postoperative Complications; Quality of Life; Length of Stay; Perioperative Period; Child, Preschool; Operative Time
PubMed: 38918972
DOI: 10.62713/aic.3137 -
Surgery Jun 2024Robot-assisted surgery has seen exponential adoption over the last decade. Although the safety and efficacy of robotic surgery in the elective setting have been...
BACKGROUND
Robot-assisted surgery has seen exponential adoption over the last decade. Although the safety and efficacy of robotic surgery in the elective setting have been demonstrated, data regarding robotic emergency general surgery remains sparse.
METHODS
All adults undergoing non-elective appendectomy, cholecystectomy, small or large bowel resection, perforated ulcer repair, or lysis of adhesions were identified in the 2008 to 2020 National Inpatient Sample. Temporal trends were analyzed using a rank-based, non-parametric test developed by Cuzick (nptrend). Using laparoscopy as a reference, multivariable regressions were used to evaluate the association between robotic techniques and in-hospital mortality, major complications, and resource use for each emergency general surgery operation.
RESULTS
Of an estimated 4,040,555 patients undergoing emergency general surgery, 65,853 (1.6%) were performed using robotic techniques. The robotic proportion of minimally invasive emergency general surgery increased significantly overall, with the largest growth seen in robot-assisted large bowel resections and perforated ulcer repairs. After adjustment for various patient and hospital-level factors, robot-assisted large bowel resection (adjusted odds ratio 0.73, 95% confidence interval 0.58-0.91) and cholecystectomy (adjusted odds ratio 0.66, 95% confidence interval 0.55-0.81) were associated with significantly reduced odds of perioperative blood transfusion compared to traditional laparoscopy. Although robotic techniques were associated with modest reductions in postoperative length of stay, costs were uniformly higher by increments of up to $4,900.
CONCLUSION
Robotic surgery appears to be a safe and effective adjunct to laparoscopy in minimally invasive emergency general surgery, although comparable cost-effectiveness has yet to be realized. Increasing use of robotic techniques in emergency general surgery may be attributable in part to reduced complications, including blood loss, in certain operative contexts.
PubMed: 38918109
DOI: 10.1016/j.surg.2024.05.002 -
Association of High BMI With Morbidity and Mortality in Common Emergency General Surgery Procedures.The Journal of Surgical Research Jun 2024Emergency general surgery (EGS) patients are at increased risk for postoperative morbidity and mortality. Obesity is a risk factor for poor outcomes in this population....
INTRODUCTION
Emergency general surgery (EGS) patients are at increased risk for postoperative morbidity and mortality. Obesity is a risk factor for poor outcomes in this population. Our study aimed to explore the association of body mass index (BMI) with postoperative outcomes in patients requiring common EGS procedures.
METHODS
A retrospective review of the 2018-2020 National Surgical Quality Improvement Program database identified patients undergoing four common EGS procedures: large bowel resection, small bowel resection, cholecystectomy, and appendectomy. Patients were classified by BMI: normal weight (18.5-24.9 kg/m), obesity classes I (30-34.9 kg/m), II (35-39.9 kg/m), III (40-49.9 kg/m), and IV (≥50 kg/m). Main outcomes of interest were major adverse event (MAE) and mortality.
RESULTS
From 2018 to 2020, a total of 82,540 patients underwent one of four common EGS procedures. On unadjusted analysis, obesity class IV had higher mortality rates compared to classes I-III (6.2% vs 3.1%, P < 0.001). Patients in obesity classes I-III had lower odds of MAE and death relative to those of normal weight. Compared to other patients with obesity, those in obesity class IV were at increased risk of MAE (odds ratio 1.27; 95% confidence interval 1.13-1.44) and death (odds ratio 1.69; 95% confidence interval 1.34-2.13).
CONCLUSIONS
Patients with varying degrees of obesity have different risk profiles following common EGS procedures. While patients in lower obesity classes had reduced odds of adverse outcomes, those with BMI ≥50 kg/m were particularly at greater risk for postoperative morbidity and mortality. This vulnerable population warrants further investigation and increased vigilance to ensure high-quality care.
PubMed: 38917577
DOI: 10.1016/j.jss.2024.05.016