-
The Medical Journal of Malaysia May 2022Acute appendicitis is one of the most common causes of intra-abdominal emergency surgery worldwide. This study was conducted to contribute to global databases by...
INTRODUCTION
Acute appendicitis is one of the most common causes of intra-abdominal emergency surgery worldwide. This study was conducted to contribute to global databases by presenting data from our institution, which consist of multi-racial population. We aimed to evaluate the presentation, diagnosis, and management of acute appendicitis and post-operative outcome in our institution and evaluate the risks factors associated with severe complications and prolonged length of stay (LOS).
MATERIALS AND METHODS
We performed a retrospective analysis using multivariate regression analysis of all patients who underwent appendectomy (2009-2014) in our institution. The primary outcomes included demographics, presentation, and perioperative management, and the secondary outcomes included risk factors associated with prolonged LOS.
RESULTS
Of the 1185 patients, the mean age was 36.4 years, and 940 (79.3%) were male. Majority (98.1%) of patients were ASA (American Society of Anaesthesiologists) 1 or 2. Most of them (83.9%) were from the four racial subgroups (Chinese, Malay, Bangladeshi, and Indian). There was no racial variation in the diagnosis and presentation of disease. The mean duration of symptoms was 1.8 days. The history was commonly a localised or migratory abdominal pain associated with anorexia, nausea, vomiting, and fever. The commonest physical findings were right-sided abdominal tenderness associated with rebound and guarding. About 42.9% of the patients underwent pre-operative CT scan to establish the diagnosis of appendicitis prior to surgery, whilst 57.1% underwent surgery on clinical diagnosis and blood investigation (NWR and CRP). An open appendectomy was performed in 13.2% of the patients. The conversion rate of laparoscopic appendectomy was 4.9% (n = 50). The mean length of hospital stay was 3.6 days. On multivariate Cox regression, patients of Burmese and Thai descent were independently associated with a prolonged LOS. The postoperative morbidity was 5.5%. The 30-day readmission rate was 2.4%. There was no mortality in our study.
DISCUSSION
Our study showed that pre-operative diagnosis of acute appendicitis can be made accurately by classical clinical presentation or by imaging. Independent risk factors associated with increased LOS included increased age, male gender, prolonged duration of symptoms pre-admission, fever, generalised tenderness, and prolonged operative time. The effect of race on LOS has been observed in the literature for other surgical procedures. The prolonged LOS found in Burmese and Thai patients contribute to the possibility of intrinsic racial differences in the post-surgery recovery. However, the numbers are small and therefore prone to type I error. Compared to the open approach, the use of laparoscopic appendectomy was associated with shorter LOS. This has similar outcomes to those reported in the literature.
CONCLUSION
The identification of risks factors could help surgical team to predict the clinical outcomes and develop risk reduction strategy in post-operative care of these patients.
Topics: Abdominal Pain; Acute Disease; Adult; Appendectomy; Appendicitis; Female; Humans; Laparoscopy; Male; Retrospective Studies
PubMed: 35638490
DOI: No ID Found -
BMC Surgery May 2019Appendicitis in elderly patients is associated with increased risk of postoperative complications. The choice between laparoscopy and open appendectomy remains... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Appendicitis in elderly patients is associated with increased risk of postoperative complications. The choice between laparoscopy and open appendectomy remains controversial in treating elderly patients with appendicitis.
METHODS
Comprehensive search of literature of MEDLINE, Embase, Cochrane Library and ClinicalTrials was done in January 2019. Studies compared laparoscopy and open appendectomy for elderly patients with appendicitis were screened and selected. Postoperative mortality, complications, wound infection, intra-abdominal abscess and operating time, length of hospital stay were extracted and analyzed. The Review Manage 5.3 was used for data analysis.
RESULTS
Twelve studies with 126,237 patients in laparoscopy group and 213,201 patients in open group. Postoperative mortality was significantly lower following laparoscopy (OR, 0.33; 95% CI, 0.28 to 0.39). Postoperative complication and wound infection were reduced following laparoscopy ((OR, 0.65 95% CI, 0.62 to 0.67; OR,0.27, 95% CI, 0.22 to 0.32). Intra-abdominal abscess was similar between LA and OA (OR,0.44;95% CI, 0.19 to 1.03). Duration of surgery was longer following laparoscopy and length of hospital stay was shorter following laparoscopy (MD, 7.25, 95% CI, 3.13 to 11.36; MD,-2.72, 95% CI,-3.31 to - 2.13).
CONCLUSIONS
Not only laparoscopy is safe and feasible, but also it is related with decreased rates of mortality, post-operative morbidity and shorter hospitalization.
Topics: Abdominal Abscess; Aged; Appendectomy; Appendicitis; Female; Hospitalization; Humans; Laparoscopy; Length of Stay; Male; Operative Time; Postoperative Complications; Treatment Outcome; Wound Infection
PubMed: 31138196
DOI: 10.1186/s12893-019-0515-7 -
BMJ Open Feb 2020Although surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.
OBJECTIVE
We estimated the incidence of SSI after appendectomy at global and regional levels.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
Appendectomy patients.
DATA SOURCES
EMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.
RESULTS
In total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0-17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).
CONCLUSION
This study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.
PROSPERO REGISTRATION NUMBER
CRD42017075257.
Topics: Africa; Appendectomy; Clinical Trials as Topic; Europe; Humans; Incidence; Observational Studies as Topic; Surgical Wound Infection
PubMed: 32075838
DOI: 10.1136/bmjopen-2019-034266 -
Appendix and Ulcerative Colitis: a Key to Explaining the Pathogenesis and Directing Novel Therapies?Inflammatory Bowel Diseases Jan 2023The vermiform appendix is generally considered a redundant organ, but recent evidence suggests that the appendix could contribute to the pathogenesis of inflammatory... (Review)
Review
The vermiform appendix is generally considered a redundant organ, but recent evidence suggests that the appendix could contribute to the pathogenesis of inflammatory bowel diseases, in particular ulcerative colitis (UC), and may even have a therapeutic role; however, mechanisms of the appendix involvement remain unclear. Here, we highlight current evidence on the link between the appendix and UC and consider plausible therapeutic implications. A literature search was conducted using PubMed and PubMed Central from inception to Nov 2021 using the terms "Appendix", "UC", "Appendix & UC," "Appendectomy", and "Peri-appendicular patch," including only articles published in English. Reference lists from the selected studies were manually searched and reviewed to gather additional related reports. Inflammation around the appendix ("peri-appendicular patch") has been frequently observed in UC patients without other cecal involvement, and this inflammation can even precede the onset of UC. Epidemiologic studies propose that appendectomy reduces the risk of developing UC or even the risk of flare after UC is diagnosed, although this remains controversial. We reviewed studies showing altered host-microbe interactions in the appendix in UC, which suggest that the appendix could act as a priming site for disease via alterations in the immune response and changes in microbiota carried distally to the colon. In summary, recent literature suggests a possible role for microbes and immune cells within the appendix; however, the role of the appendix in the pathogenesis of UC remains unclear. Further research could clarify the therapeutic potential related to this organ.
Topics: Humans; Appendix; Colitis, Ulcerative; Appendectomy; Inflammation
PubMed: 35749298
DOI: 10.1093/ibd/izac106 -
Annals of the Royal College of Surgeons... Nov 2022
Topics: Humans; Appendectomy; Appendicitis; Laparoscopy
PubMed: 35616255
DOI: 10.1308/rcsann.2021.0323 -
International Journal of Surgery... 2012Acute appendicitis is perhaps the commonest cause of acute abdomen and surgical intervention in the form of open or laparoscopic appendicectomy. Stump appendicitis is an... (Review)
Review
Acute appendicitis is perhaps the commonest cause of acute abdomen and surgical intervention in the form of open or laparoscopic appendicectomy. Stump appendicitis is an uncommon late complication of appendicectomy; where inflammation occurs in the remaining appendicular stump. Delayed diagnosis of this condition may result in serious complications. This literature review has looked into the clinical presentation, diagnosis and treatment of Stump appendicitis.
Topics: Adolescent; Adult; Aged; Appendectomy; Appendicitis; Child; Female; Humans; Male; Middle Aged; Reoperation
PubMed: 22846617
DOI: 10.1016/j.ijsu.2012.07.007 -
BMJ (Clinical Research Ed.) Sep 2002
Topics: Acute Disease; Appendectomy; Appendicitis; Female; Humans; Laparoscopy
PubMed: 12217977
DOI: 10.1136/bmj.325.7363.505 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Dec 2022Acute appendicitis is the most common abdominal surgical emergency. This new type of coronavirus, also called SARS-CoV-2, causes severe acute respiratory syndrome, and...
BACKGROUND
Acute appendicitis is the most common abdominal surgical emergency. This new type of coronavirus, also called SARS-CoV-2, causes severe acute respiratory syndrome, and this has turned into a pandemic. We aimed to determine the risk factors associated with appendectomy and complicated appendicitis during the COVID-19 pandemic period and to evaluate the effects on the surgical treatment of acute appendicitis and its outcomes. In the current comparative study, we analyzed its effects on appendectomy management and complicated appendicitis in patients with appendicitis during the COVID-19 pandemic and past year covering the same period.
METHODS
The patients in this study consisted of adult patients with acute appendicitis who applied to the Emergency Surgery Department of Kartal Dr. Lütfi Kırdar City Hospital General Surgery Clinic between March 1, and August 31, 2020 (COVID-19 pe-riod) (Group B) and the same period of 2019 (Group A). A comparative and retrospective study was planned. A total of 658 patients who presented with acute appendicitis were included in the study. Group A and Group B consist of 347 and 311 people, respectively.
RESULTS
No significant difference was found in the demographic and clinical characteristics of the study population. There was no significant difference between Group A and B in terms of the duration of the application of patient complaints, the duration of the procedure, the time the patient was admitted to the hospital, the time of the patient being taken to the surgery, the findings during the operation, and the post-operative complications. There were similar features in general appendectomy pathologies, but in our study, a significant decrease in catarrhal appendicitis was observed in Group B, namely, during the COVID-19 pandemic period (p=0.04).
CONCLUSION
During the COVID-19 pandemic, there was no significant increase in complicated appendicitis, but a significant reduction in negative appendectomies. This result shows that during the pandemic period, patients do not come to the emergency surgery unit unnecessarily and receive timely and appropriate surgical care.
Topics: Adult; Humans; COVID-19; Pandemics; SARS-CoV-2; Retrospective Studies; Appendicitis; Acute Disease; Appendectomy
PubMed: 36588509
DOI: 10.14744/tjtes.2022.74711 -
Antimicrobial Resistance and Infection... Sep 2023We aimed to evaluate the association between post-appendectomy SSI rates and the two most commonly used regimens for perioperative antimicrobial prophylaxis in Swiss...
Association between perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in paediatric uncomplicated appendectomy: a Swiss retrospective cohort study.
OBJECTIVE
We aimed to evaluate the association between post-appendectomy SSI rates and the two most commonly used regimens for perioperative antimicrobial prophylaxis in Swiss children.
METHODS
We conducted a retrospective cohort study, analysing data from the Swiss national SSI surveillance database with a study period from 2014 to 2018. All hospitals undertaking paediatric appendectomies in Switzerland participate in the surveillance. We compared the cumulative incidence and odds of post-appendectomy SSI within 30 days of surgery in children ≤ 16 years of age undergoing appendectomy for uncomplicated appendicitis and receiving perioperative antimicrobial prophylaxis with cefuroxime plus metronidazole or with amoxicillin/clavulanic acid using multivariable adjusted logistic regression and propensity-score matching.
RESULTS
A total of 6207 cases were recorded in the study time frame. Overall SSI cumulative incidence was 1.9% (n = 119). 4256 children (54.9% male, median (IQR) age 12 [10, 14] years) received either cefuroxime plus metronidazole (n = 2348, 53.8% male) or amoxicillin/clavulanic acid (n = 1491, 57.0% male). SSI cumulative incidence was 1.1% (25/2348) among children receiving cefuroxime plus metronidazole and 2.8% (42/1491, p < 0.001) when receiving amoxicillin/clavulanic acid. The administration of cefuroxime plus metronidazole was associated with statistically significantly lower SSI odds compared to amoxicillin/clavulanic acid (aOR 0.35, 95%CI [0.20, 0.61], p < 0.001), and this was confirmed upon propensity-score matching.
CONCLUSION
We found lower odds of post-appendectomy SSI in children receiving cefuroxime plus metronidazole compared to amoxicillin/clavulanic acid. Treating amoxicillin/clavulanic acid as the baseline, only 55 children need to receive cefuroxime plus metronidazole perioperative prophylaxis to avert one SSI. Existing guidelines recommending amoxicillin/clavulanic acid may need to be revised. Trial registration ISRCTN47727811, registered retrospectively.
Topics: Child; Male; Humans; Female; Surgical Wound Infection; Metronidazole; Cefuroxime; Appendectomy; Retrospective Studies; Switzerland; Amoxicillin-Potassium Clavulanate Combination
PubMed: 37749585
DOI: 10.1186/s13756-023-01312-1 -
JSLS : Journal of the Society of... 2016To compare surgical outcomes of overweight and obese patients with acute appendicitis who have undergone single-port extracorporeal laparoscopically assisted... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
To compare surgical outcomes of overweight and obese patients with acute appendicitis who have undergone single-port extracorporeal laparoscopically assisted appendectomy (SP) with those who have had conventional 3-port laparoscopic appendectomy (TP).
METHODS
This single-center retrospective chart review included patients 21 years of age and younger with a preoperative diagnosis of appendicitis who underwent laparoscopic appendectomy from January 2010 through December 2015. Cases of gangrenous and perforated appendicitis were excluded. Subgroup analyses of patients with acute appendicitis were performed. Operative time (OT), length of stay (LOS), and cost were compared between groups stratified by body mass index (BMI) and operative technique.
RESULTS
A total of 625 appendectomies were performed-457 for acute appendicitis. Sixty-eight patients were overweight. The SP technique (n = 30) had shorter OT (median minutes, 41 vs 68; P < .001), lower cost (median , $5741 vs $8530; P < .001), and shorter LOS (median hours, 16 vs 19; P = .045) than the TP technique had (n = 38). Seventy patients were obese: 19 were treated with SP and 51 with TP. LOS did not differ significantly between the SP and TP groups, but subjects treated with SP had shorter OT (median minutes, 39 vs 63; P < .001) and lower cost (median, $6401 vs $8205; P = .043).
CONCLUSIONS
The SP technique for acute appendicitis was found to have a significantly shorter OT and lower cost in all weight groups. There were minimal differences in LOS. SP should be considered in patients with acute appendicitis, regardless of their weight.
Topics: Adolescent; Appendectomy; Appendicitis; Child; Female; Humans; Laparoscopy; Male; Operative Time; Overweight; Pediatric Obesity; Retrospective Studies
PubMed: 27186069
DOI: 10.4293/JSLS.2016.00020