scholarly journals Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis

2019 ◽  
Vol 2 (1) ◽  
pp. e000003 ◽  
Author(s):  
Patrick H Y Chung ◽  
Kanglin Dai ◽  
Zhen Yang ◽  
Kenneth K Y Wong
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Disease Severity ◽  
Complicated Appendicitis ◽  
Risk Scores ◽  
Median Score ◽  
Alvarado Score ◽  
Rebound Tenderness ◽  
Medium Risk ◽  
Operative Findings

BackgroundThis study evaluates the validity of Alvarado Score in predicting disease severity and the development of postoperative complications in pediatric appendicitis.MethodsThis is a retrospective, bicentered study on pediatric patients with emergency appendicectomy performed from 2006 to 2016. The relationship of Alvarado Score (low: 1–4, medium: 5–6, high: 7–10) and operative findings/complications was analyzed.ResultsA total of 316 patients were included and the median age on admission was 10.8 years. The overall median score was 8.0. 13.3%, 20.2%, and 66.5% of patients had low, medium, and high risk scores, respectively. 36.1% of patients had complicated appendicitis and the median score was comparable with that of the uncomplicated cases (7.0 vs 7.4, p=0.21). More complicated cases were found in the medium-risk group (high vs medium vs low=29.7% vs 61.4% vs 31.0%, p=0.01). Rebound tenderness had the highest positive predictive value (65%) for complicated appendicitis. Postoperative complications were found in 16.5% of patients with a higher median score (7.87 vs 5.8, p=0.01).ConclusionAlvarado Score does not predict disease severity but postoperative complication. Patients with medium risk score should also be treated promptly for the risk of having complicated disease. Rebound tenderness may be a signal for complicated appendicitis and should be properly examined.

Appraisal of Various Predictors for Complicated Appendicitis in Adults; A Comparative Study Between Complicated and Non-Complicated Appendicitis

2021 ◽  
Author(s):  
Ayad Ahmad Mohammed
Keyword(s):  
Acute Appendicitis ◽  
Complicated Appendicitis ◽  
General Surgeon ◽  
Alvarado Score ◽  
Delay Management ◽  
Chronic Appendicitis ◽  
Rebound Tenderness ◽  
Abdominal Emergency ◽  
And Gender ◽  
Wbc Count

Abstract Background: Acute appendicitis is the most common non traumatic surgical abdominal emergency, and is the first operation done by most of the general surgeon during their training period. The most important aspect in the management of acute appendicitis, is early diagnosis and intervention to avoid the development of complications.Patients and methods: This prospective study included 184 patients diagnosed with acute appendicitis who were grouped into complicated and non- complicated appendicitis. Both groups were compared to detect predictors for complicated appendicitis to prevent delay management. Results: About 82.6% of our patients were below 30 years (mean: 23.8 years) and 59.2% were females. Histopathology confirmed acute appendicitis in 86.5 %, chronic appendicitis in 12.5%, and normal appendix in 1.1%. About 81.5% have ALVARADO score equal or greater than 7. Complicated appendicitis was diagnosed in 23.37% of patients. There was a significant correlation between complicated appendicitis and gender, rebound tenderness, elevated temperature, elevated WBC, shift to left of WBC and Modified Alvarado Scoring (P values 0.000,0.002,0.001,0.000,0.000, and 0.006), other parameters showed no significant correlations. Conclusion: The rate of complicated appendicitis should be reduced to decrease the associated morbidity, the presence of rebound tenderness, fever, high WBC count and sift to left, a score of 7 or more by modified ALVAADO score, and male sex are highly suggestive. The presence of these factors mandates early and prompt intervention.

Superior Mesenteric Venous (SMV) Thrombosis Accompanied with Appendicitis in a Patient with Primary Diagnosis of Typhoid Fever

2020 ◽  
Vol 20 ◽  
Author(s):  
Alireza Adibimehr ◽  
SeyedAhmad SeyedAlinaghi ◽  
Anahid Nourian ◽  
Zeinab Mehrabi ◽  
Rohollah Moslemi
Keyword(s):  
Typhoid Fever ◽  
Positive Culture ◽  
Primary Diagnosis ◽  
Complicated Appendicitis ◽  
Contaminated Water ◽  
Septic Thrombophlebitis ◽  
Rebound Tenderness ◽  
Perforated Appendix ◽  
History Of ◽  
Vague Abdominal Pain

: Septic thrombophlebitis of the Superior Mesenteric Venous (SMV) is rarely accompanied by appendicitis, and symptoms are atypical, so the diagnosis is commonly delayed, resulting in it is associated with high mortality. We report a case of neglected SMV septic thrombophlebitis is caused by appendicitis. The patient represented with fever, vague abdominal pain without rebound tenderness, and history of the consumption of contaminated water. Antibiotic initiated due to suspicious typhoid fever. Then typhoid fever was ruled out. Computed tomography (CT) scans revealed micro-abscess forming complicated appendicitis and the thrombus in SMV. The patient underwent a laparoscopic appendectomy, during which retrocecal gangrened perforated appendix with a 2×2 cm abscess was drained. Based on positive culture with ESBL organism meropenem was initiated. Appendectomy and treatment with broad-spectrum antibiotics and anticoagulation led to a full recovery.

scholarly journals Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis

2020 ◽  
pp. 1-7
Author(s):  
Ming Li Chia ◽  
Shaun Wen Yang Chan ◽  
Vishal G. Shelat
Keyword(s):  
Diverticular Disease ◽  
Clinical Pathology ◽  
Vermiform Appendix ◽  
Complicated Appendicitis ◽  
Perioperative Outcomes ◽  
Alvarado Score ◽  
Single Center Experience ◽  
Modified Alvarado Score ◽  
Qsofa Score ◽  
Sirs Criteria

<b><i>Introduction:</i></b> Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. <b><i>Methods:</i></b> The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (<i>n</i> = 110), DDA (<i>n</i> = 22), endometriosis of appendix (<i>n</i> = 6), and an absent appendix (<i>n</i> = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. <b><i>Results:</i></b> The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23–87), with male preponderance (<i>n</i> = 12, 54.5%). The median Modified Alvarado score was 8 (range 4–9), and the median Andersson score was 5 (range 2–8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [<i>n</i> = 2] or abscess [<i>n</i> = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. <b><i>Conclusion:</i></b> DDA is a distinct clinical pathology associated with complicated appendicitis.

1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Dhanjal ◽  
M Ghouri ◽  
S Crank
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Maxillofacial Surgery ◽  
General Anaesthetic ◽  
Facial Injury ◽  
Postoperative Complication Rate ◽  
Female Ratio ◽  
Facial Injuries

Abstract Introduction A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team. Method Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any). Results 153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting. Conclusion Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.

Postoperative Complications after Phacoemulsification and Implantation of Foldable Acrylic Intraocular Lenses in Dogs

2021 ◽  
Author(s):  
Babita Das ◽  
Apra Shahi ◽  
Vishnu Pratap Chandrapuria ◽  
Shobha Jawre ◽  
Madhu Swamy ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Cataract Surgery ◽  
Postoperative Complication ◽  
Corneal Opacity ◽  
Intraocular Lenses ◽  
Major Postoperative Complication ◽  
Ophthalmic Pathology ◽  
Cataractous Lens ◽  
Operative Complications ◽  
Post Operative Complications

Background: Despite significant advances in canine cataract surgery over the years, many post-operative complications persist and reduces the success rate of phacoemulsification procedure. The aim of current study was to evaluate post-operative complications encountered till 90 days after bimanual phacoemulsification with implantation of different acrylic Intraocular Lenses.Methods: The study was conducted on 24 canine eyes. All the clinical cases were subjected to detailed ocular, ultrasonography and neuro-ophthalmic tests for ascertaining cataract and associated neuro-ophthalmic pathology. Dogs were divided in four groups with 6 eyes in each group and subjected to phacoemulsification procedure for removal of cataractous lens and implanted with square edge or round edge hydrophilic or hydrophobicintra ocular lenses.Result: Statistically non-significant (p£0.05) variations were found for all the post- operative complications among the groups. Within the groups initially higher values were recorded and on subsequent days a declining trend of varying degrees were observed. The corneal opacity was a major postoperative complication leading to failure to achieve vision with other coinciding neuro-ophthalmic conditions.

scholarly journals Does Serum Bilirubin Add Value in the Diagnosis of Appendicitis? A Multi-Institution Analysis of 2024 Patients

2021 ◽  
Author(s):  
Andrew Phillip Maurice ◽  
Benjamin David Swinson ◽  
Eduardo Miguel Apellaniz ◽  
Sarah Emily King ◽  
Thomas Grant Mackay ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Neutrophil Count ◽  
Serum Bilirubin ◽  
White Cell Count ◽  
Delayed Diagnosis ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
Operative Findings

Abstract BACKGROUNDEven with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis.METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count.RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p<0.0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p<0.001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p<0.0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy.CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.

scholarly journals Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

scholarly journals Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Mariateresa Giglio ◽  
Giandomenico Biancofiore ◽  
Alberto Corriero ◽  
Stefano Romagnoli ◽  
Luigi Tritapepe ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Meta Analysis ◽  
Orthopedic Procedures ◽  
Neurosurgical Procedures ◽  
Goal Directed Therapy ◽  
Number Of Patients ◽  
Risk Patients

Abstract Background Goal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery. Objectives The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures. Data sources Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on. Study appraisal and synthesis methods Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs). Results In 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result. The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87, p = 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80, p = 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78, p = 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group. Conclusions and implications of key findings The present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.

scholarly journals The association between hospital ownership and postoperative complications: Does it matter who owns the hospital?

2020 ◽  
Vol 26 (3) ◽  
pp. 2193-2201
Author(s):  
Robby Atala ◽  
Philip J Kroth
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Care Delivery ◽  
Wound Dehiscence ◽  
General Information ◽  
Hospital Ownership ◽  
Ownership Type ◽  
For Profit ◽  
Complication Score ◽  
The Government

Postoperative complications place a major burden on the healthcare systems. The type of hospital’s ownership could be one factor associated with this adverse outcome. Using CMS’s publicly available “Complications and Deaths—Hospitals” and “Hospital General Information” datasets, we analyzed the association between four postoperative complications (venous thromboembolism, joint replacement complications, wound dehiscence, postoperative sepsis) and hospital ownership. These data were collected by Medicare between April 2013 and March 2016. We found a significant association ( p = 0.029) between ownership types and the postoperative complication score. A 6-percent drop in the share of not-for-profit ownership, accompanied by a 3-percent increase in each of the government and for-profit ownership, resulted in a 20-percent drop in postoperative complication scores (from 5.75 to 4.6). There is an association between hospital ownership type and postoperative complications. Creating this awareness in leadership should prompt for redesigning of hospitals’ operations and workflows to become more compatible with safe and effective care delivery.

A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery

2015 ◽  
Vol 81 (8) ◽  
pp. 755-759 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John C. Kubasiak ◽  
Imke Janssen ◽  
Jonathan A. Myers ◽  
Minh B. Luu
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Postoperative Complication ◽  
General Surgery ◽  
Meld Score ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Umbilical Hernia Repair ◽  
The Mean

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients’ increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

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