scholarly journals Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis

2021 ◽  
Vol 9 (3) ◽  
pp. 109
Author(s):  
Ryosuke Kita ◽  
Hiroki Hashida ◽  
Daisuke Yamashita ◽  
Hiromitsu Kinoshita ◽  
Masato Kondo ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Complicated Appendicitis ◽  
Interval Appendectomy

scholarly journals Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy

2020 ◽  
Vol 36 (5) ◽  
pp. 311-315
Author(s):  
Jungtak Son ◽  
Yong Jun Park ◽  
Sung Ryol Lee ◽  
Hyung Ook Kim ◽  
Kyung Uk Jung
Keyword(s):  
Incidence Rate ◽  
Treatment Options ◽  
Complicated Appendicitis ◽  
Interval Appendectomy ◽  
Tertiary Referral Center ◽  
Interval Group ◽  
Nonsurgical Management ◽  
Increased Risk ◽  
Recurrent Appendicitis ◽  
Pathologic Analysis

Purpose: The low rate of recurrent appendicitis after initial nonsurgical management of complicated appendicitis supports the recently implemented strategy of omitting routine interval appendectomy. However, several reports have suggested an increased incidence rate of neoplasms in these patients. We aimed to identify the risk of neoplasms in the population undergoing interval appendectomy.Methods: This study retrospectively analyzed consecutive cases of appendicitis that were treated surgically between January 2014 and December 2018 at a single tertiary referral center. Patients were divided into 2 groups depending on whether they underwent immediate or interval appendectomy. Demographics and perioperative clinical and pathologic parameters were analyzed.Results: All 2,013 adults included in the study underwent surgical treatment because of an initial diagnosis of acute appendicitis. Of these, 5.5% (111 of 2,013) underwent interval appendectomy. Appendiceal neoplasm was identified on pathologic analysis in 36 cases (1.8%). The incidence of neoplasm in the interval group was 12.6% (14 of 111), which was significantly higher than that of the immediate group (1.2% [22 of 1,902], P < 0.001). Conclusion: The incidence rate of neoplasms was significantly higher in patients undergoing interval appendectomy.These findings should be considered when choosing treatment options after successful nonsurgical management of complicated appendicitis.

scholarly journals Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Keiichi Suzuki ◽  
Tomoshige Umeyama ◽  
Kenshi Omagari ◽  
Takeo Hashimoto ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Laparoscopic Appendectomy ◽  
Nonoperative Management ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Operative Management ◽  
Complicated Appendicitis ◽  
Effective Strategy ◽  
Threshold Analysis

Abstract Background The evidence regarding the safety and efficacy of nonoperative management is growing. However, the best treatment strategy for acute complicated appendicitis remains controversial. We aimed to evaluate the cost-effectiveness of treatment strategies for complicated appendicitis patients. This study sought to determine the most cost-effective strategy from the health care-payer’s perspective. Methods The primary outcome was an incremental cost effectiveness ratio (ICER) using nonoperative management with or without interval laparoscopic appendectomy (ILA) as the intervention compared with operative management with emergency laparoscopic appendectomy (ELA) alone as the control. Model variables were abstracted from a literature review, and from data obtained from the hospital records of Tochigi Medical Center. Cost-effectiveness was evaluated using an ICER. We constructed a Markov model to compare treatment strategies for complicated appendicitis in otherwise-healthy adults, over a time horizon of a single year. Uncertainty surrounding model parameters was assessed via one-way- and probabilistic-sensitivity analyses. Threshold analysis was performed using the willingness-to-pay threshold set at the World Health Organization’s criterion of $107,690. Results Three meta-analysis were included in our analysis. Operative management cost $6075 per patient. Nonoperative management with interval laparoscopic appendectomy (ILA) cost $984 more than operative management and produced only 0.005 more QALYs, resulting in an ICER of $182,587. Nonoperative management without ILA cost $235 more than operative management, and also yielded only 0.005 additional QALYs resulting in an ICER of $45,123 per QALY. Probabilistic sensitivity analysis with 1000 draws resulted in average ICER of $172,992 in nonoperative management with ILA and $462,843 in Nonoperative management without ILA. The threshold analysis demonstrated that regardless of willingness-to-pay, nonoperative management without ILA would not be most cost-effective strategy. Conclusions Nonoperative management with ILA and Nonoperative management without ILA were not cost-effective strategies compared with operative management to treat complicated appendicitis. Based on our findings, operative management remains the standard of care and nonoperative management would be reconsidered as a treatment option in complicated appendicitis from economic perspective.

Increased Risk of Neoplasm in Appendicitis Treated with Interval Appendectomy: Single-Institution Experience and Literature Review

2012 ◽  
Vol 78 (3) ◽  
pp. 339-343 ◽  
Author(s):  
Susanne G. Carpenter ◽  
Alyssa B. Chapital ◽  
Marianne V. Merritt ◽  
Daniel J. Johnson
Keyword(s):  
Care Center ◽  
Relevant Literature ◽  
Tertiary Care ◽  
Colonic Neoplasms ◽  
Complicated Appendicitis ◽  
Interval Appendectomy ◽  
Interval Group ◽  
Acute Group ◽  
Increased Risk ◽  
Common Diagnosis

Appendicitis is a common diagnosis encountered by the acute care surgeon. Management of complicated appendicitis is controversial and often involves initial nonoperative therapy with interval appendectomy. This study reviews single-institutional experience with management of complicated appendicitis with interval appendectomy and addresses an unusually high occurrence of incidental appendiceal malignancies observed with a review of relevant literature. A retrospective review of all diagnoses of appendicitis was performed over 5 years at a tertiary care center. Patient demographics, time to surgery, operative technique, pathologic diagnosis, and clinical outcomes were examined. Three hundred fifteen patients were diagnosed with acute appendicitis. Of these, 24 (7.6%) were deemed complicated and did not undergo immediate appendectomy, and 18 ultimately underwent appendectomy at our institution and were included in analysis. There were no statistical demographic or symptomatic differences between the immediate and interval appendectomy patients. Ninety-nine per cent of the immediate appendectomy patients were treated laparoscopically; 78 per cent of the interval group underwent attempted laparoscopic treatment with 56 per cent completed without conversion to open ( P < 0.01). Neoplasms were discovered in 1 per cent of the acute appendectomy group and 28 per cent of the interval appendectomy group ( P < 0.0001). Two of the three neoplasms in the acute group were carcinoid, whereas three of the five neoplasms in the interval group were adenocarcinoma. Surgeons should consider appendiceal or colonic neoplasms in cases of complicated appendicitis when nonoperative management is considered. This is most important in patients older than 40 years, in those who forego interval appendectomy, or in those who could be lost to follow-up.

Extended Antibiotic Course Prior to Interval Appendectomy in Children with Complicated Appendicitis Offers No Significant Advantage

2019 ◽  
Vol 20 (3) ◽  
pp. 197-201
Author(s):  
Faidah Badru ◽  
Nicholas Piening ◽  
Jose Greenspon ◽  
Kaveer Chatoorgoon ◽  
Colleen Fitzpatrick ◽  
...  
Keyword(s):  
Complicated Appendicitis ◽  
Interval Appendectomy

scholarly journals Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis

2020 ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Keiichi Suzuki ◽  
Tomoshige Umeyama ◽  
Kenshi Omagari ◽  
Takeo Hashimoto ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Laparoscopic Appendectomy ◽  
Nonoperative Management ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Operative Management ◽  
Complicated Appendicitis ◽  
Effective Strategy ◽  
Threshold Analysis

Abstract Background The evidence regarding the safety and efficacy of nonoperative management is growing. However, the best treatment strategy for acute complicated appendicitis remains controversial. We aimed to evaluate the cost-effectiveness of treatment strategies for complicated appendicitis patients. This study sought to determine the most cost-effective strategy from the health care-payer's perspectiveMethods The primary outcome was an incremental cost effectiveness ratio (ICER) using nonoperative management with or without interval laparoscopic appendectomy (ILA) as the intervention compared with operative management with emergency laparoscopic appendectomy (ELA) alone as the control. Model variables were abstracted from a literature review, and from data obtained from the hospital records of Tochigi Medical Center. Cost-effectiveness was evaluated using an ICER. We constructed a Markov model to compare treatment strategies for complicated appendicitis in otherwise-healthy adults, over a time horizon of a single year. Uncertainty surrounding model parameters was assessed via one-way- and probabilistic-sensitivity analyses. Threshold analysis was performed using the willingness-to-pay threshold set at the World Health Organization's criterion of $107,690.Results Three meta-analysis were included in our analysis. Operative management cost $6,075 per patient. Nonoperative management with interval laparoscopic appendectomy (ILA) cost $984 more than operative management and produced only 0.005 more QALYs, resulting in an ICER of $182,587. Nonoperative management without ILA cost $235 more than operative management, and also yielded only 0.005 additional QALYs resulting in an ICER of $45,123 per QALY. Probabilistic sensitivity analysis with 1,000 draws resulted in average ICER of $172,992 in nonoperative management with ILA and $462,843 in Nonoperative management without ILA. The threshold analysis demonstrated that regardless of willingness-to-pay, nonoperative management without ILA would not be most cost-effective strategyConclusions Nonoperative management with ILA and Nonoperative management without ILA were not cost-effective strategies compared with operative management to treat complicated appendicitis. Based on our findings, operative management remains the standard of care and nonoperative management would be reconsidered as a treatment option in complicated appendicitis from economic perspective.

A Standardized Protocol for Nonoperative Management of Complicated Appendicitis in Children Reduces Resource Utilization

2020 ◽  
Author(s):  
Christopher Pennell ◽  
Teerin Meckmongkol ◽  
Rajeev Prasad ◽  
Sean Ciullo ◽  
Lindsay Grier Arthur III ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Nonoperative Management ◽  
Nonoperative Treatment ◽  
Complicated Appendicitis ◽  
Controlled Study ◽  
Interval Appendectomy ◽  
Protocol Adherence ◽  
Standardized Protocol ◽  
Intravenous Antibiotics ◽  
Tomography Scan

Abstract Introduction To standardize care and reduce resource utilization, we implemented a standardized protocol (SP) for the nonoperative treatment of complicated appendicitis. Materials and Methods We conducted a prospective, historically controlled, study of patients <21 years with complicated appendicitis managed nonoperatively using an SP from January 2017 to November 2018. The primary outcomes included length of stay (LOS), antibiotic days, peripheral inserted central catheter (PICC) utilization, discharge on intravenous antibiotics, and predischarge imaging. Secondary outcomes were protocol adherence and the rates of adverse events (AE) including return to emergency department (ED), readmission, failure of nonoperative treatment, and interval appendectomy complications. Results Protocol adherence was 67.9%. In total, 741 children were treated for appendicitis of which 58 (30 pre-SP and 28 post-SP) were treated nonoperatively for complicated appendicitis at presentation. Patients were well matched for age, admission white blood cell, sex, body mass index, race, and the proportion requiring percutaneous drainage. After implementing the SP, fewer children had PICCs (100.0 vs. 57.1%, p ≤ 0.001), fewer were discharged on intravenous antibiotics (90.0 vs. 42.9%, p < 0.001), and total antibiotic days were reduced (14.0 vs. 10.0, p = 0.006). There was no difference in LOS (5.5 vs. 6.0 days, p = 0.790) or the proportion undergoing ultrasound (36.7 vs. 39.3%, p = 0.837) or computed tomography scan (16.7 vs. 3.6%, p = 0.195) prior to discharge. There were nonsignificant trends toward reduced AEs (46.7 vs. 35.7%, p = 0.397), returns to ED (40.0 vs. 28.6%, p = 0.360), and readmissions (26.7 vs. 17.9%, p = 0.421). The proportion failing nonoperative treatment (10.0 vs. 3.6%, p = 0.612) and experiencing complications of interval appendectomy (3.3 vs. 3.6%, p = 0.918) were not significantly different. Conclusion Implementing an SP for treating complicated appendicitis nonoperatively reduced resource utilization without negatively affecting clinical outcomes.

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