scholarly journals 904 Can Patients with Acute Appendicitis be Ambulated Safely?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S O'Brien ◽  
L Armstrong
Keyword(s):  
Acute Appendicitis ◽  
Significant Proportion ◽  
Initial Assessment ◽  
Efficacy And Safety ◽  
Oral Antibiotics ◽  
Surgical Service ◽  
Open Appendicectomy ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
The Uk

Abstract Introduction During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis. Method Data was collected prospectively from 30th March 2020 – 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded. Results 190 patients presented with suspected appendicitis (range 5-71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy. Conclusions Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.

scholarly journals A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

2021 ◽  
Author(s):  
Johnathon Harris ◽  
Christina A. Fleming ◽  
Paul N. Stassen ◽  
Daniel Mullen ◽  
Helen Mohan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Diagnosis ◽  
Open Appendicectomy ◽  
Normal Appendix ◽  
Macroscopic Appearance ◽  
Surgical Department ◽  
Suspected Appendicitis ◽  
Final Histological Diagnosis ◽  
Negative Appendicectomy ◽  
Operating Surgeon

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

scholarly journals P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
H Pringle ◽  
U Donigiewicz ◽  
M Bennett ◽  
G F Fowler ◽  
E Walker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Treatment Failure ◽  
Medical Records ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management ◽  
Guide Care

Abstract Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals Appendicectomy for Uncomplicated Simple Appendicitis: Is It Always Required?

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ibrahim Falih Noori Alsubsiee ◽  
Ahmed Falih Noori Alsubsiee
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Medical Treatment ◽  
Clinical Improvement ◽  
Antibiotic Treatment ◽  
Standard Treatment ◽  
Signs And Symptoms ◽  
Oral Antibiotics ◽  
Uncomplicated Appendicitis

Background. Although appendicectomy is still the classical and standard treatment for acute appendicitis, initial conservative antibiotic only treatment for simple uncomplicated cases has been proposed and tried as a feasible and effective approach. The objective of this study was to evaluate the efficacy and outcomes of antibiotics treatment for acute simple uncomplicated appendicitis. Methods. This is a prospective controlled nonrandomized study in which a total of 156 patients whose ages range from 16 to 54 years presenting with clinical diagnosis of acute uncomplicated appendicitis were assigned for conservative antibiotics treatment, which consists of ceftriaxone I gram twice daily and metronidazole infusions, 500 mg in 100 ml, 3 times daily for 48 to 72 hours to be converted on oral antibiotics after clinical improvement for 5 to 7 days. Patients who failed to initial conservative treatment and those who had recurring symptoms of appendicitis were presented for appendectomy. Results. Antibiotic treatment was successful and feasible in 138 (88.5%) patients. Progression of the signs and symptoms despite full medical treatment was observed in 11 (7%) patients during the same admission. Further 7 (4.5%) patients showed recurrence of the symptoms during follow-up period of 6–12 months after successful initial conservative treatment and also proceeded for appendicectomy. Conclusion. Nonoperative antibiotic treatment of acute simple appendicitis is safe, feasible, and effective for properly selected cases, thus avoiding unnecessary surgery with its possible complications.

scholarly journals Evaluation of conservative management in uncomplicated acute appendicitis

2021 ◽  
Author(s):  
Vignesh M. ◽  
Rajkumar Chejara ◽  
S. V Arya ◽  
Ankit Bhatia ◽  
Rohit Chaudhary ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Conservative Management ◽  
Significant Proportion ◽  
Alvarado Score ◽  
Intravenous Antibiotics ◽  
Uncomplicated Appendicitis ◽  
Uncomplicated Acute Appendicitis

Background: Appendectomy has been the treatment for acute appendicitis for years based on the understanding that acute appendicitis always leads to perforation and peritonitis. However, there is growing evidence that a significant proportion of patients can be successfully managed with conservative treatment without developing gangrene or perforation. Conservative treatment avoids discomfort, surgery-related morbidities and minimizes treatment cost.Methods: 60 patients taken up for conservative management were evaluated and followed up for 6 months. Study patients received intravenous antibiotics for 2 days. Repeated clinical and TLC monitoring were done. In patients whose clinical condition did not improve, appendectomy was performed. Follow-up at 10 days, 30 days, 3 months and 6 months were carried out to assess recurrence in conservatively managed patients.Results: In this study, the mean age was 25.65 years with a standard deviation of ±8.96 years. The incidence of uncomplicated appendicitis was 63.3% in males and 36.7% in females. Mean Alvarado score was 7.75 with a standard deviation of ±1.20. Failure of conservative management (conversion to appendectomy) was observed in 11.7% of patients and 4 patients (6.6%) had recurrence within 6 months. The overall treatment efficacy was 81.7%.Conclusions: In many cases, first attack of uncomplicated acute appendicitis can be treated successfully by conservative management. Treatment failure on primary admission as well as short-term recurrence up to six months after conservative treatment is low and acceptable. Incidence of complications like perforation and abscess formation are also statistically low.

An audit of training in laparoscopic appendicectomy in the South Thames Region

2007 ◽  
Vol 89 (3) ◽  
pp. 102-104
Author(s):  
N Kukreja ◽  
C Bhan ◽  
A Schizas
Keyword(s):  
Acute Appendicitis ◽  
Operative Treatment ◽  
Lifetime Risk ◽  
Laparoscopic Appendicectomy ◽  
Open Appendicectomy ◽  
Surgical Trainee ◽  
Open Procedure ◽  
Abdominal Operation ◽  
The Uk ◽  
Huge Variation

Appendicitis is extremely common, with a lifetime risk of 8% in the UK. McBurney performed the first appendicectomy in 1889. Operative treatment remains the mainstay of treatment for acute appendicitis: this procedure has altered little since it was developed. Open appendicectomy is often the first abdominal operation undertaken by the surgical trainee and therefore forms an important part of training for the junior surgeon. Laparoscopic appendicectomy (LA) represents the biggest change in the management of acute appendicitis since the introduction of the open procedure. An increasing number of surgeons are performing LA. In spite of this, there remains huge variation in the ability of SpRs to perform this procedure.

scholarly journals SP4.1.14 Single centre experience in managing acute appendicitis during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Valdone Kolaityte ◽  
Ishani Mukhopadhyay ◽  
Daniel Newport ◽  
Imran Aslam
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Patient Outcomes ◽  
Treatment Strategies ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Single Centre Experience ◽  
Significant Difference ◽  
Management Approaches ◽  
The Uk

Abstract Background Given the pressure of COVID pandemic, the UK Intercollegiate guidance encouraged a move towards non-operative or open appendicectomy management of acute appendicitis. The aim of the study was to assess the approaches used to manage acute appendicitis and their outcomes during pandemic peak and after it. Methods This was a single-centre retrospective study, 2-observer data collection. We collected and analysed data on acute appendicitis management approaches (surgical and non-surgical) and patient outcomes were compared during the peak of the pandemic (04-2020 to 06-2020) and post-peak (07-2020 to 09-2020) periods. Results 190 patients - (peak – 88, F:M=1.09, median age – 30.5) and post-peak 102 (F:M=1.12, median age -31)). There were no significant differences for APPY risk score, ASA grade, comorbidities between the groups. There was more diagnostic imaging performed during the peak of the pandemic (peak 71.6%, post-peak – 56.9%) (p = 0.035 X2=4.431). Comparison between managing patients during peak and post-peak showed that approaches were the following: conservative (14.8% vs 14.7%, P = 0.998), laparoscopic appendicectomy (65.3% vs 96.6% P = <0.001), open appendicectomy (34.7% vs 3.4% P = <0.001). There was no significant difference in postoperative complications (Clavien-Dindo II-IIIb), readmission to hospital, or total LoS (median=3 days) between the groups (p > 0.05). Median LoS for patients treated conservatively was 1 day. Only 1 patient developed COVID postoperatively, the mortality was 0%. Conclusions Treatment strategies adapted and modified in COVID peak were effective and safe in managing acute appendicitis. Laparoscopic surgery remained a safe practice even in the peak of COVID pandemic.

scholarly journals The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme

2013 ◽  
Vol 95 (4) ◽  
pp. 280-284 ◽  
Author(s):  
V Kong ◽  
C Aldous ◽  
J Handley ◽  
D Clarke
Keyword(s):  
Intensive Care ◽  
Acute Appendicitis ◽  
Primary Healthcare ◽  
Cost Model ◽  
Abdominal Sepsis ◽  
Surgical Service ◽  
Intensive Care Admission ◽  
Total Cost ◽  
Uncomplicated Appendicitis ◽  
The Cost

Introduction Appendicitis in the developing world is a cause of significant preventable morbidity. This prospective study from a regional hospital in South Africa constructs a robust cost model that demonstrates the cost effectiveness of an efficient curative surgical service in a primary healthcare-orientated system. Methods A prospective audit of all patients with acute appendicitis admitted to Edendale Hospital was undertaken from September 2010 to September 2011. A microcosting approach was used to construct a cost model based on the estimated cost of operative and perioperative interventions together with the associated hospital stay. For cost analysis, patients were divided into the following cohorts: uncomplicated appendicitis, complicated appendicitis with localised intra-abdominal sepsis, complicated appendicitis with generalised intra-abdominal sepsis, with and without intensive care unit admission. Results Two hundred patients were operated on for acute appendicitis. Of these, 36% (71/200) had uncomplicated appendicitis and 57% (114/200) had perforation. Pathologies other than appendicitis were present in 8% (15/200) and these patients were excluded. Of the perforated appendices, 45% (51/114) had intra-abdominal contamination that was localised while 55% (63/114) generalised sepsis. The mean cost for each patient was: 6,578 ZAR (£566) for uncomplicated appendicitis; 14,791 ZAR (£1,272) for perforation with localised intra-abdominal sepsis and 34,773 ZAR (£2,990) for perforation with generalised intra-abdominal sepsis without intensive care admission. With intensive care admission it was 77,816 ZAR (£6,692). The total cost of managing acute appendicitis was 4,272,871 ZAR (£367,467). Almost 90% of this total cost was owing to advanced disease with abdominal sepsis and therefore potentially preventable. Conclusions Early uncomplicated appendicitis treated appropriately carries little morbidity and is relatively inexpensive to treat. As the pathology progresses, the cost rises exponentially. An efficient curative surgical service must be regarded as a cost effective component of a primary healthcare orientated system.

Efficacy and safety data for the Ab interno XEN45 gel stent implant at 3 Years: A retrospective analysis

2021 ◽  
pp. 112067212110143
Author(s):  
Itay E Gabbay ◽  
Mordechai Goldberg ◽  
Felicity Allen ◽  
Zhiheng Lin ◽  
Christine Morley ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Failure Rate ◽  
Open Angle Glaucoma ◽  
Safety Data ◽  
Angle Closure ◽  
Efficacy And Safety ◽  
Antihypertensive Medications ◽  
Uk National Health Service ◽  
The Uk ◽  
Comparative Audit

Purpose: To report efficacy and safety measures of the XEN45 gel stent at 36 months in the UK National Health Service setting. Methods: Retrospective non-comparative audit of the records of patients who underwent XEN45 implantation between June 2015 and May 2017 was performed. Main outcome measures were intraocular pressure and number of antihypertensive medications used. Failure was defined as need for further surgery or stent removal. Success was defined as a 20% decrease in intraocular pressure without the need for additional glaucoma medications or a reduction in antihypertensive medications without an increase in baseline intraocular pressure. Needling rates and preoperative factors effect were assessed. Results: The cohort included 205 patients (205 eyes) with primary open angle glaucoma (84.4%), angle closure glaucoma (7.8%), or refractory glaucoma (7.8%), 62.9% had a stand-alone procedure and 37.1%, a combined phaco-XEN45 procedure. Mean intraocular pressure was 22.6 ± 7.0 mmHg at baseline compared to 14.7 ± 3.8 mmHg at 24 months and 14.0 ± 2.9 mmHg at 36 months ( p < 0.001 for both). Mean number of medications used was 2.6 ± 1.1 at baseline compared to 0.5 ± 0.9 and 0.6 ± 1.0, at 24- and 36-months, respectively ( p < 0.001 for both). The failure rate at 36 months was 25%. Needling was required in 36.6%. Evaluation of background factors yielded an increased failure rate in non-Caucasians compared to Caucasians (74% vs 21%, p < 0.001). Conclusion: XEN45 implantation is effective and safe at 36 months’ follow-up. Patients should be advised regarding the risk of failure and possible need for bleb revisions. Careful patient selection may be required.

EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Carry Zheng ◽  
Shiela Lee ◽  
Steven Brown ◽  
Venkat Kanakala
Keyword(s):  
Acute Appendicitis ◽  
Risk Group ◽  
Pathological Finding ◽  
High Risk Group ◽  
Histological Diagnosis ◽  
Suspected Appendicitis ◽  
Tertiary Centre ◽  
Negative Appendicectomy ◽  
Age Range ◽  
Suspected Acute Appendicitis

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

Where have all the appendicectomies gone?

2021 ◽  
Author(s):  
NG Mowbray ◽  
L Hurt ◽  
A Powell-Chandler ◽  
N Reeves ◽  
S Chandler ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Health Professionals ◽  
Prospective Observational Study ◽  
Management Approach ◽  
Significant Shift ◽  
The Public ◽  
Number Of Patients ◽  
Negative Appendicectomy ◽  
American Society ◽  
The Uk

Introduction The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. Methods A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. Results A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). Conclusions The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.

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