scholarly journals EP.WE.709A local experience of non-operative management for an appendicitis cohort during COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Nainika Suresh Menon ◽  
Oliver Claydon ◽  
Billy Down ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Conservative Management ◽  
Primary Outcome ◽  
Day Treatment ◽  
District General Hospital ◽  
Operative Management ◽  
Complication Rates ◽  
Local Experience ◽  
Non Operative Management ◽  
Locally Conservative

Abstract Background During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis. This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort. Methods An observational study was conducted in a district general hospital. All episodes of appendicitis were prospectively studied from 25th March 2020 until 26th May 2020 and compared with a retrospective pre-COVID cohort from 27th November 2019 until 29th January 2020. Primary outcome was 30-day treatment failure of simple appendicitis for conservatively managed cases during COVID-19 compared to surgically managed cases pre-pandemic. Treatment failure was defined as any unplanned radiological or surgical intervention. Results Over nine weeks, there were 39 cases of appendicitis during COVID-19 and 50 cases pre-COVID-19. Twenty-six and 50 cases underwent appendicectomy during and pre-COVID-19 respectively. There was no difference in 30-day postoperative complication rates and nor were there any peri-operative COVID-19 infections. Twelve cases of simple appendicitis underwent conservative management during COVID-19 and were compared with 23 operatively managed simple cases pre-pandemic. There was a higher failure rate in the conservative versus operative group (33.3 vs 0% OR = 24.88, 95% CI 1.21 to 512.9, p = 0.0095). Length of stay was similar (1.5 vs 2.0 p = 0.576). Discussion Locally, conservative management was more likely to fail than initial appendicectomy. We suggest that surgery should remain first line for appendicitis, with conservative management reserved for those with suspected or proven COVID-19 infection.

scholarly journals Appendectomy During the COVID-19 Pandemic in Italy. A Multicenter Ambispective Cohort Study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study).

2021 ◽  
Author(s):  
Alberto Sartori ◽  
Mauro Podda ◽  
Emanuele Botteri ◽  
Roberto Passera ◽  
Alberto Arezzo ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Open Surgery ◽  
Primary Outcome ◽  
New Technologies ◽  
Operative Management ◽  
Complication Rates ◽  
Multicenter Observational Study ◽  
Non Operative Management ◽  
Pandemic Wave ◽  
Study Inclusion

Abstract Background To determine on a national basis the surgical activity regarding appendectomies during the first Italian wave of the COVID-19 pandemic. Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. Methods Multicenter, observational study investigating the outcomes of patients undergoing appendectomy in the two months of March-April 2019 vs. March-April 2020. The primary outcome was the number of appendectomies performed during each of the two months, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs. open), and the complication rates. Results 1541 patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the study inclusion criteria. 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.8%) in 2019. Patients with complicated appendicitis operated in 2019 were 76 (9.6%) vs. 87 (15.9%) in 2020 (p = 0.001). An increase in the number of post-operative complications was found in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), having a unit AAST (+ 26%) increase, having waited for surgery > 24 h (+ 58%), being the surgeon aged > 40 years (+ 47%), undergoing open surgery (+ 112%) and being converted to open surgery (+ 166%). Conclusions In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. Patients undergoing surgery during the first pandemic wave were more frequently affected by more severe appendicitis than the previous year's timeframe and a higher complication rate was reported. Trial registration: ResearchRegistry ID 5789.

scholarly journals Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

2021 ◽  
Author(s):  
Alberto Sartori ◽  
Mauro Podda ◽  
Emanuele Botteri ◽  
Roberto Passera ◽  
Ferdinando Agresta ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Open Surgery ◽  
Primary Outcome ◽  
New Technologies ◽  
Operative Management ◽  
Complication Rates ◽  
Conversion To Open Surgery ◽  
Registration Number ◽  
Non Operative Management ◽  
Pandemic Wave

AbstractMajor surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020

scholarly journals Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heather C. M. Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George E. Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract Background The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. Methods This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 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 received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested 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 Appendicitis During the COVID-19 Pandemic: Lessons Learnt From a District General Hospital

2021 ◽  
Author(s):  
Heather Caroline Mitchell Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract BackgroundThe COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. MethodsThis retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. ResultsThere were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 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 received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative.ConclusionDuring 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.

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

2020 ◽  
pp. 175319342094131
Author(s):  
Brent R. DeGeorge ◽  
Holly K. Van Houten ◽  
Raphael Mwangi ◽  
Lindsey R Sangaralingham ◽  
Sanjeev Kakar
Keyword(s):  
Upper Extremity ◽  
Distal Radius ◽  
Complication Rate ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Specific Complication ◽  
Secondary Procedures ◽  
Non Operative Management

To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. Level of evidence: III

scholarly journals Omental Infarction: a Reappraisal of Conservative Management in Children

2014 ◽  
Vol 27 (4) ◽  
pp. 433 ◽  
Author(s):  
José Estevão-Costa ◽  
Ana Sofia Alvarenga ◽  
Ana Catarina Fragoso ◽  
Maria Garcia ◽  
Miguel Campos
Keyword(s):  
Conservative Management ◽  
Imaging Techniques ◽  
Operative Management ◽  
Single Institution ◽  
Laboratory Findings ◽  
Median Hospital Stay ◽  
Course Of Disease ◽  
Omental Infarction ◽  
Non Operative Management ◽  
Median Hospital

<p><strong>Introduction</strong>: Accurate recognition of omental infarction has resulted in increasing supporters of non-operative approach. In order to assess the efficacy and safety of conservative management, we surveyed the cases of omental infarction treated at a single institution.<br /><strong>Material and Methods:</strong> Primary omental infarction treated between 2004 and 2011 were reviewed. Cases recognized by imaging studies were submitted to conservative treatment that consisted of intravenous analgesics and antibiotics. Demographics, clinical presentation, laboratory findings, imaging diagnosis and outcome were analyzed.<br /><strong>Results:</strong> There were 9 cases of omental infarction. Eight patients (4 males; median age, 8.5 years) presented at initial course of disease; all had right-sided abdominal pain and a normal or lightly increased leukocyte count. Six cases, diagnosed by CT scan after US suspicion in four, were managed conservatively, recovered uneventfully, and were discharged after a median hospital stay of 3 days. Two patients were only recognized at surgery. An additional case presented with intestinal obstruction due to an internal hernia and was successfully resolved by laparoscopy.<br /><strong>Discussion:</strong> Imaging techniques were diagnostic of omental infarction in the majority of cases, enabling a conservative approach to be adopted. Non-operative management was successful with no complications in all patients presenting at the initial course of disease. One patient presented with a harmful complication that required operative treatment.<br /><strong>Conclusion:</strong> In the absence of a standard approach for omental infarction, conservative management is an effective noninvasive alternative but it claims for active surveillance.<br /><strong>Keywords:</strong> Infarction; Omentum.</p>

scholarly journals Incidence, aetiology and outcomes of major postoperative haemorrhage after pulmonary lobectomy

2019 ◽  
Author(s):  
Brooks V Udelsman ◽  
Monica Soni ◽  
Maria Lucia Madariaga ◽  
Florian J Fintelmann ◽  
Till D Best ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Postoperative Bleeding ◽  
Median Sternotomy ◽  
Length Of Hospital Stay ◽  
Operative Management ◽  
Complication Rates ◽  
Packed Red Blood Cells ◽  
Postoperative Haemorrhage ◽  
Non Operative Management

Abstract OBJECTIVES Post-lobectomy bleeding is uncommon and rarely studied. In this study, we aimed to determine the incidence of post-lobectomy haemorrhage and compare the outcomes of reoperation and non-operative management. METHODS We conducted a single-institution review of lobectomy cases from 2009 to 2018. The patients were divided into two groups based on the treatment for postoperative bleeding: reoperation or transfusion of packed red blood cells with observation. Transfusion correcting intraoperative blood loss was excluded. One or more criteria defined postoperative bleeding: (i) drop in haematocrit ≥10 or (ii) frank, sustained chest tube bleeding with or without associated hypotension. Covariates included demographics, comorbidities and operative characteristics. Outcomes were operative mortality, complications, length of hospital stay and readmission within 30 days. RESULTS Following 1960 lobectomies (92% malignant disease, 8% non-malignant), haemorrhage occurred in 42 cases (2.1%), leading to reoperation in 27 (1.4%), and non-operative management in 15 (0.8%). The median time to reoperation was 17 h. No source of bleeding was identified in 44% of re-explorations. Patients with postoperative haemorrhage were more often male (64.3% vs 41.2%; P < 0.01) and more likely to have preoperative anaemia (45.2% vs 26.5%; P = 0.01), prior median sternotomy (14.3% vs 6.0%; P = 0.04), an infectious indication (7.1% vs 1.8%; P = 0.01) and operative adhesiolysis (45.2% vs 25.8%; P = 0.01). Compared with non-operative management, reoperation was associated with fewer units of packed red blood cells transfusion (0.4 vs 1.9; P < 0.001), while complication rates were similar and 30-day mortality was absent in either group. CONCLUSIONS Haemorrhage after lobectomy is associated with multiple risk factors. Reoperation may avoid transfusion. A prospective study should optimize timing and selection of operative and non-operative management.

scholarly journals BJS.01Antibiotics as an alternative to appendicectomy in uncomplicated adult appendicitis: analysis of a prospective, multicentre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hannah Javanmard-Emamghissi ◽  
Brett Doleman ◽  
Marianne Hollyman ◽  
Jonathan Lund ◽  
Susan Moug ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Large Scale ◽  
Day Treatment ◽  
Operative Management ◽  
Co Morbidity ◽  
Multicentre Cohort Study ◽  
Non Operative Management ◽  
Multicentre Cohort

Abstract Aims Recent randomised controlled trials have shown that non-operative management of acute appendicitis with antibiotics can prevent the need for surgery in 71-84% of patients within 90-days.  Changes in the management of appendicitis, brought about by the COVID-19 pandemic, have allowed for this large-scale observational study, which aims to report the outcomes of operative and non-operative management of appendicitis, including non-operative management rates at 90-days. Methods This prospective, multicentre cohort study at 97 sites across Great Britain and Ireland included adult patients with a clinical or radiological diagnosis of appendicitis. Propensity-score matching was conducted using age, sex, BMI, frailty, co-morbidity, adult appendicitis score and CRP. Outcomes in the non-operative group were 90-day treatment failure, and in the matched groups 30-day complications and length of hospital stay (LOS). Results This analysis included 3420 patients, of whom 1402 (41%) had initial non-operative treatment and 2018 (59%) had operative management. The success rate of non-operative management was 80% (1116) at 90-days, with 18 patients (6%) that failed non-operative management having a histologically normal appendix. Following propensity score matching, 2444 patients were included in the outcomes analysis. In the propensity score matched groups, there was a reduction in complications in the non-operative management group compared to the operative group (OR 0.36; 95% CI 0.26 to 0.50) and a shorter median LOS (2.5 vs 3 days, p &lt; 0.001). Conclusions Non-operative management of appendicitis is associated with fewer complications, a shorter LOS, and avoids surgery in the majority of patients.

Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure

2020 ◽  
pp. 175857322097209
Author(s):  
Charles I Ayekoloye ◽  
Qi Yin ◽  
Amanda Wood ◽  
Simon Frostick
Keyword(s):  
Clinical Outcome ◽  
Conservative Management ◽  
Operative Management ◽  
Satisfaction Score ◽  
Dash Score ◽  
Patient Satisfaction Score ◽  
Subjective Satisfaction ◽  
Quick Dash ◽  
Non Operative Management

Introduction Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. Methods Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17–66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. Results There was no post-operative complication. Mean Quick DASH score 10.9 (range 0–29.5) at mean 35.4-month follow-up (range 29–43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. Conclusions Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.

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