scholarly journals 2102. Does Monitoring Procalcitonin Levels in Septic and Septic Shock Patients Decrease the Use of Antibiotics and Predict Length of Hospital Stay?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S710-S711
Author(s):  
Sarah E Bilbe ◽  
Ashaur Azhar ◽  
Fatima Z Brakta ◽  
Katherine N Aymond ◽  
M Jacques Nsuami ◽  
...  
Keyword(s):  
Septic Shock ◽  
Multivariate Analysis ◽  
Medical Center ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Bivariate Analysis ◽  
Acute Phase Reactants ◽  
The Mean

Abstract Background Elevated levels of procalcitonin (PCT) reflect systemic inflammation associated with bacterial infection (BI). Compared with other acute-phase reactants, PCT levels more rapidly rise with BI and decline quickly as BI improves. A PCT protocol was implemented at University Medical Center New Orleans (UMCNO) in November 2017 that guided discontinuation of antimicrobial therapy in septic and septic shock patients if clinically improving with declining levels of PCT. Methods We performed a retrospective chart review of UMCNO patients 18+ years with a diagnosis of sepsis and a PCT level between January 1st, 2018 to July 31st, 2018 compared with those with sepsis and no PCT level. ICD-9/10 codes were used for diagnoses of sepsis and septic shock. The baseline characteristics including age, gender, body mass index, race and Charlston Comorbidity Index (CCI) data were collected. The primary objective was to compare the total days of antibiotic therapy (DOT) between the two groups. Secondary outcomes were broad-spectrum antibiotic DOT, patient length of stay (LOS), and all-cause 28-day mortality. SPSS was used for data analysis. P < 0.05 indicated statistical significance. Results There were 44 patients in the PCT group (PCTg) and 35 in the non-PCT group (nPCTg). The demographics are outlined in Table. The mean DOT was 6.25 days in PCTg and 10.74 days in nPCTg (P = 0.006). LOS was 7.5 days in PCTg and 14 in nPCTg (P = 0.006). The mean CCI was 2.4 in PCTg and 4 in nPCTg (P = 0.007). The all-cause 28-day mortality was 11% in PCTg and 23% in nPCTg (OR 0.4; 95% CI 0.128–1.466). On bivariate analysis, LOS was significantly associated with CCI (P < 0.05) and total DOT (P = 0.000). On multivariate analysis, LOS was only significantly associated with age (P = 0.015) and total DOT (P = 0.000) but not CCI (P = 0.811) nor PCTg (P = 0.250). Conclusion DOT was significantly shorter in the PCTg than in nPCTg. The LOS was 50% less in PCTg than in nPCTg; however, PCT monitoring did not contribute to LOS in multivariate analysis. Although the nPCTg were sicker, CCI did not correlate with LOS either. However, age and total DOT therapy remained positive predictors of LOS. Monitoring PCT levels decreased antibiotic use in septic patients. LOS, however, was not significantly affected by PCT monitoring. Disclosures All authors: No reported disclosures.

scholarly journals Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth K. Parker ◽  
Sahrish S. Faruquie ◽  
Gail Anderson ◽  
Linette Gomes ◽  
Andrew Kennedy ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Retrospective Chart Review ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Weight Restoration ◽  
The Mean

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

Trend of Hospital Admission and Outcome Study of Patients Admitted in a Neurology Unit at a Tertiary Care Neuroscience Hospital in Bangladesh

2018 ◽  
Vol 4 (2) ◽  
pp. 69-74
Author(s):  
Md Tauhidul Islam Chowdhury ◽  
Mohammad Shah Jahirul Hoque Choudhury ◽  
KM Ahasan Ahmed ◽  
Mohammad Sadekur Rahman Sarkar ◽  
Md Abdullah Yusuf ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Total Death ◽  
Neurological Patients ◽  
Study Population ◽  
The Mean ◽  
Day By Day

Background: Neurological disorders is becoming a growing concern both for developed and developing countries. Magnitude of the problem is increasing day by day. Among all neurological disorders, stroke is the leading cause of morbidity and mortality globally.Objectives: The purpose of the study was to see the trend of admission of patients with neurological diseases and to study the outcome of patients at referral neurology hospital in Bangladesh.Methodology: This retrospective chart review was conducted in the blue unit of the Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from 1st January to 31st December 2016 for a period of one (01) year. All the admitted patients with both sexes were selected as study population. The outcome was observed among the study population.Result: A total number of 1044 patients were admitted during the study period. Majority of the patients were in the age group of the 41 to 50 years which was 417(39.9%) cases. Both male and female were in highest number in the month of May which was 63 and 48 cases respectively. The total death of the study population was 146(14.0%) cases. The mean length of hospital stay was 8.4±2.31 days.Conclusion: Middle aged male is the main bulk of the neurological patients, admitted in a referral neurology hospital in Bangladesh. Highest admission and mortality was observed in stroke patients.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 69-74

scholarly journals The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis

2015 ◽  
Vol 38 (5) ◽  
pp. E4 ◽  
Author(s):  
Shane K. F. Seal ◽  
Paul Steinbok ◽  
Douglas J. Courtemanche
Keyword(s):  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Reoperation Rate ◽  
Orbital Surgery ◽  
Double Wedge ◽  
Metopic Synostosis ◽  
Absorbable Sutures ◽  
The Mean ◽  
Greenstick Fracture

OBJECT Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices. METHODS The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures. RESULTS A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients’ mean age at surgery was 11.4 ± 10.1 months and the mean operative time was 183.4 ± 41.0 minutes. The mean length of hospital stay was 3.7 ± 1.2 days. The mean blood loss was 150.0 ± 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 ± 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23/29, 79%) or a greenstick fracture (4/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%). CONCLUSIONS The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature.

Cellulitis: Home or Inpatient Intravenous Therapy in a Veteran Population

2019 ◽  
Vol 32 (3) ◽  
pp. 127-133
Author(s):  
Rebekah A. Wahking ◽  
Bonnie Clark ◽  
Tasha Cheatham-Wilson
Keyword(s):  
Treatment Failure ◽  
Antibiotic Treatment ◽  
Inpatient Treatment ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Primary Diagnosis ◽  
Primary Objective ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Inpatient Settings ◽  
Inpatient Group

There are few studies describing outpatient parenteral antimicrobial therapy (OPAT) for cellulitis treatment. The Hospital in Home (HIH) program is a multidisciplinary team at the Cincinnati VA Medical Center (CVAMC) that provides acute care in patients’ homes similar to inpatient hospital care for a variety of indications, including cellulitis. Efficacy of OPAT for cellulitis treatment in the HIH program has not been directly compared with inpatient treatment. The primary objective of this retrospective review is to compare the rates of efficacy of intravenous (IV) antibiotics for cellulitis treatment for patients followed by HIH and inpatient settings. Treatment failure was defined as a change in IV antibiotic medications prescribed. A retrospective chart review was completed at CVAMC for patients enrolled in HIH ( n = 111) and patients who received inpatient treatment at CVAMC ( n = 111) with IV antibiotics for a primary diagnosis of cellulitis from January 1, 2014, through June 30, 2018. Six patients in the HIH group experienced IV antibiotic treatment failure compared with 11 in the inpatient group. The HIH group showed non-inferiority in rates of treatment failure compared with the inpatient group ( p = .21). OPAT with the HIH program appears to be non-inferior to inpatient IV antibiotic treatment for cellulitis infections. Tolerance issues and rates of adverse events do not appear to be worse in patients treated with OPAT in the Veteran population.

Catumaxomab with and without prednisolone in patients with malignant ascites due to epithelial cancer: Results from the phase IIIb CASIMAS study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13097-e13097 ◽  
Author(s):  
Jalid Sehouli ◽  
Pauline Wimberger ◽  
Ignace B. Vergote ◽  
Per Rosenberg ◽  
Andreas Schneeweiss ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Statistical Significance ◽  
Malignant Ascites ◽  
Primary Objective ◽  
Epithelial Cancer ◽  
Free Survival ◽  
Pivotal Study ◽  
Phase Iiib ◽  
The Mean ◽  
Potential Impact

e13097^ Background: The primary objective of this study was to compare catumaxomab with prednisolone (CP) to catumaxomab without prednisolone (C) as 3-hour intraperitoneal (i.p.) infusion by demonstrating superiority for safety and non-inferiority for efficacy of the CP arm. Methods: 219 patients were randomized to catumaxomab plus premedication of 25 mg prednisolone (111 pts) or to catumaxomab alone (108 pts). The primary endpoint was the composite safety score (CSS) summarizing the worst CTCAE grades for the main TEAEs (pyrexia, nausea, vomiting, and abdominal pain). A potential impact of prednisolone on efficacy was assessed by the co-primary endpoint puncture-free survival (PuFS). Further parameters included overall survival (OS) and time to next therapeutic puncture (TTPu). Results: The superiority of CP for safety was not proven as the mean CSS was comparable in the two groups (CP: 4.1; C: 3.8 for; p= 0.383). The median PuFS was slightly lower in CP (30 days) compared to C (37 days). However the hazard ratio (HR) for PuFS (HR: 1.130, p=0.402) as well as the 75% quartiles (CP: 155 days, C: 92 days) were in favour of CP compared to C. The median TTPu was similar in both groups (CP: 78 days; C: 102 days, p= 0.599). The majority of patients (123 pts) had no therapeutic paracentesis prior to death (CP: 54.8%; C; 61.7%, p=0.297). Median OS was longer for CP (CP: 124 days; C: 86 days, p= 0.186) without statistical significance. Conclusions: The CASIMAS results are in concordance with the data of the pivotal study and thus confirm the robustness of the treatment effect of catumaxomab in malignant ascites. The administration of 25mg prednisolone as premedication prior to catumaxomab infusion did not change the safety profile and did not negatively impact the efficacy of catumaxomab. The composite safety score after 3-hour infusion time was comparable to that seen in the pivotal study using 6 hours.

scholarly journals Evaluation of Thrombotic Risk in Thyroid Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A861-A861
Author(s):  
Chukwuka Akamnonu ◽  
David A Cohen
Keyword(s):  
Pulmonary Embolism ◽  
Thyroid Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Cancer History ◽  
Thrombotic Risk ◽  
History Of

Abstract Introduction: Current guidelines from the International Society of Thrombosis and Hemostasis recommend limited screenings for deep vein thrombosis (DVT) or pulmonary embolism (PE) with no identifiable precipitating factor (termed unprovoked). There is paucity of data with regards to thyroid cancer screening in the setting of an unprovoked VTE. Studies from Europe have shown an association between VTE and thyroid cancer; however, these studies do not account for differences in iodine availability, thus the need for studies in the United States. Understanding the risk of thyroid cancer as a provocative factor in developing a deep venous thrombosis (DVT) or pulmonary embolism (PE) may be able to facilitate case detection of disease and prevent future morbidity and mortality from thyroid cancer and/or VTE. Objectives: The primary objective of this study is to understand the risk of developing VTE in the setting of thyroid cancer. Methods: In this retrospective chart review study, we reviewed electronic medical records of patients with a history of DVT or PE between ages 18-99, presenting to all outpatient clinics at a single academic medical center in New Jersey between October 1, 2015, and Dec 31, 2018. We screened for coexistent cancer history among this group, and from this sample we further isolated cases of thyroid cancer. Results: 345 patients were found to have a history of VTE. 187 were female (54%) and 113 (29%) had a history of malignancy. The most common cancers were breast (19%), colorectal (9%), leukemia (9%), prostate (8%), and lymphoma (8%). Thyroid cancer accounted for 2% of all discovered cases. Conclusion: In this retrospective analysis, 2% of all patients with VTE and cancer carried a diagnosis of thyroid cancer. Although this suggests a relatively low risk, given the medical burden of a venous thromboembolism and the comparable proportion of thyroid cancer in all new cancer cases, thyroid cancer should be considered a provoking factor in unprovoked VTE.

scholarly journals Agreement between Impression of Stroke in the Emergency Department and Diagnosis at the Neurology Department

2019 ◽  
Vol 7 (3) ◽  
pp. 7
Author(s):  
Samad Shams-Vahdati ◽  
Alireza Ala ◽  
Eliar Sadeghi-Hokmabad ◽  
Neda Parnianfard ◽  
Maedeh Gheybi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Chi Square ◽  
Prevention Therapy ◽  
Significant Difference ◽  
Chi Square Test ◽  
Academic Teaching Hospital ◽  
The Mean

Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.

scholarly journals Impact of a Multi-disciplinary C. difficile Action Team

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S396-S397
Author(s):  
Emily Heil ◽  
Bharathi Sivasailam ◽  
SoEun Park ◽  
Jose Diaz ◽  
Erik Von Rosenvinge ◽  
...  
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Disciplinary Action ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Post Intervention ◽  
Fecal Microbiota Transplant ◽  
Action Team

Abstract Background Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essential to optimize care and increase utilization of novel treatment modalities such as fecal microbiota transplant (FMT) and minimally invasive, colon-preserving surgical management. Methods A multi-disciplinary C. difficile action team (MD-CAT) was implemented at University of Maryland Medical Center (UMMC) in March 2016 to engage appropriate specialty consultants in the care of CDI patients. The MD-CAT reviews positive C. difficile tests at UMMC and provides guidance and suggestions to the primary team including optimal antibiotic treatment (for CDI and any concomitant infection), and consultant involvement including ID, surgery, and GI, when appropriate. Using retrospective chart review, CDI patient management and outcomes were compared before and after implementation of the MD-CAT. Differences in the time to consults and frequency of interventional treatment was compared using Chi-square or Wilcoxon Rank-sum test. Results We compared 48 patients with CDI in the pre-intervention with 89 patients in the post-intervention period. Demographic and clinical characteristics of the groups were similar. MD-CAT intervention was associated with frequent (73%) modification or discontinuation of concomitant antibiotics. Median time to GI and ID consults was significantly shorter in the post group (P = 0.007 and P = 0.004, respectively). Five of 89 (5.6%) of patients received FMT or colon-preserving surgical intervention in the post-intervention group compared with no patients in the pre-intervention group. There was no difference in 30-day all-cause mortality or CDI recurrence between groups. Conclusion Early, multi-disciplinary action on patients with CDI increased the proportion of patients undergoing active specialty consultation and improved use of concomitant antibiotics. A larger sample size is needed to determine the effects of such a team on other clinical outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Multisite Study to Examine the Amount of Inpatient Physician Continuity Experienced by Hospitalized Patients

2015 ◽  
Vol 7 (4) ◽  
pp. 624-629 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Siddhartha Singh ◽  
Jeff Whittle ◽  
Vishal Ratkalkar ◽  
Alexis M. Visotcky ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
General Medicine ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Inpatient Medicine ◽  
The Mean ◽  
Handoff Of Care

ABSTRACT Background Continuity for inpatient medicine has been widely discussed, but methods for measuring it have been lacking. Objective To measure the continuity of care experienced by hospitalized patients and to identify predictors of continuity. Methods This was a multisite prospective cohort study and retrospective chart review that took place at 3 hospitals: an academic tertiary care center, a Veterans Affairs medical center, and a community teaching hospital. Subjects were general medicine patients and internal medicine residents. We measured continuity of care using 3 metrics: (1) the percentage of hospital time covered by the primary intern; (2) the amount of time between admission and the first handoff of care; and (3) admission-discharge continuity. We conducted univariate analyses to identify patient and hospital factors that may be associated with each type of continuity of care. Results Our sample included 869 patients with a mean age of 62.6 years (SD = 17.2) and 34% female patients. The mean percentage of hospital time covered by the primary intern was 39.2% (SD = 16.3%). The mean time between admission and the first handoff of care was 13.3 hours (SD = 7.1). Forty percent of patients experienced admission-discharge continuity. In univariate and multivariable modeling, the site was significantly associated with each type of continuity. Conclusions The amount of continuity varied greatly and was influenced by the site and other factors. No site maximized every aspect of continuity. Programs and institutions should decide which aspects of continuity are most important locally and design schedules accordingly.

scholarly journals Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings

2014 ◽  
Vol 96 (6) ◽  
pp. 452-457 ◽  
Author(s):  
PA Jategaonkar ◽  
SP Yadav
Keyword(s):  
Statistical Significance ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Single Site ◽  
Laparoscopic Appendicectomy ◽  
Acute Setting ◽  
Pain Scores ◽  
Cosmetic Outcomes ◽  
The Mean

Introduction Although conventional multiport laparoscopic appendicectomy (CMLA) is preferred for managing acute appendicitis, the recently developed transumbilical laparoscopic approach is rapidly gaining popularity. However, its wide dissemination seems restricted by technical/technological issues. In this regard, a newly developed method of single site multiport umbilical laparoscopic appendicectomy (SMULA) was compared prospectively with CMLA to assess the former’s efficacy and the technical advantages in acute scenarios. Methods Overall, 430 patients were studied: 212 in the SMULA group and 218 in the CMLA group. The same surgeon performed all the procedures using routine laparoscopic instruments. The SMULA technique entailed three ports inserted directly at the umbilical mound through three distinct strategically placed mini-incisions without raising the umbilical flap. The CMLA involved the traditional three-port technique. Results Both groups were comparable in terms of demographic criteria, indications for surgery, intraoperative blood loss, time to ambulation, length of hospital stay and umbilical morbidity. Although the mean operative time was marginally longer in the SMULA group (43.35 minutes, standard deviation [SD]: 21.16 minutes) than in the CMLA group (42.28 minutes, SD: 21.41 minutes), this did not reach statistical significance. Conversely, the mean pain scores on day 0 and the cosmetic outcomes differed significantly and favoured the SMULA technique. None of the patients developed port site hernias over the follow-up period (mean 2.9 years). Conclusions The favourable outcomes for the SMULA technique are likely to be due to the three small segregated incisions at one place and better trocar ergonomics. The SMULA technique is safe in an acute setting and may be considered of value among the options for transumbilical appendicectomy.

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