Can Acute Appendicitis be Treated by Antibiotics Alone?

2007 ◽  
Vol 73 (11) ◽  
pp. 1161-1165 ◽  
Author(s):  
Katherine Liu ◽  
Sadie Ahanchi ◽  
Mark Pisaneschi ◽  
Irene Lin ◽  
Robert Walter
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Alternative Treatment ◽  
Complication Rate ◽  
Standard Of Care ◽  
Group I ◽  
Recurrent Appendicitis ◽  
Group Ii

Emergency appendectomy at presentation has been the standard of care for acute appendicitis. We examined the use of antibiotics as an alternative treatment. From September 2002 to August 2003, 170 consecutive patients diagnosed with acute appendicitis without abscess were reviewed retrospectively. Patients were divided into two groups: Group I (n = 151) underwent emergency appendectomy and Group II (n = 19) received antibiotics alone. The mode of treatment was at the attending surgeon's discretion. The overall complication rate was eight per cent for Group I and 10 per cent for Group II patients ( P = 0.22). Group II patients suffered no complications during antibiotic treatment, and any complications that did occur developed after subsequent appendectomy. One Group II patient had recurrent appendicitis (5%). The length of stay was 2.61 ± 0.21 days for Group I and 2.95 ± 0.38 days for Group II patients ( P = 0.57). Patients with acute appendicitis may be treated safely with antibiotics alone without emergency appendectomy.

scholarly journals APPENDICULAR MASS

2010 ◽  
Vol 17 (02) ◽  
pp. 180-184
Author(s):  
SARDAR ALI ◽  
HAFIZ MUHAMMED RAFIQUE
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Cost Effective ◽  
Female Ratio ◽  
Surgical Exploration ◽  
Group I ◽  
Variable Extent ◽  
Group Ii ◽  
Adhesive Intestinal Obstruction ◽  
Appendicular Mass

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 to November 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying studentChi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.

scholarly journals Antibiotics in acute appendicitis. When and how? A general review

2019 ◽  
Vol 6 (1) ◽  
pp. 30-33
Author(s):  
L. Alecu ◽  
C. Niţipir ◽  
Iulian Slavu ◽  
V. Braga ◽  
D. Mihăilă ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Complication Rate ◽  
Acquired Resistance ◽  
Perforated Appendicitis ◽  
Interval Appendectomy ◽  
Bacterial Proliferation ◽  
Long Period ◽  
Clinical Surveillance ◽  
Relapse Rates

Introduction: An increasing interest exits towards the use of antibiotics in the treatment of uncomplicated acute appendicitis.Discussion: For a long period of time, surgery was the only treatment for acute appendicitis. Due to recent research in the etiology of acute appendicitis which seems to be driven by intraluminal bacterial proliferation, new data suggests that for non-perforated appendicitis confirmed with the help of CT, antibiotics may play a central role in the treatment. As relapse rates amount in some cases to only 5% after antibiotic treament, a discussion is required regarding the risks of interval appendectomy and its use. The debate regarding the optimal antibiotic course is on-going as some surgeons advocate for amoxicillin/clavulanic while others, due to acquired resistance recommend Ertapenem.Conclusion:  Selective antibiotic treatment for selected forms of acute appendicitis, uncomplicated without perforation is safe and has a relatively low complication rate. However, certain mentions must be made:  surgery must not be delayed if failure of antibiotics exists as it can lead to higher rates of peritonitis. Close clinical surveillance is of utmost importance

Ultrasonographic Findings after Conservative Treatment of Acute Appendicitis and Open Appendicectomy

1995 ◽  
Vol 36 (2) ◽  
pp. 173-177 ◽  
Author(s):  
S. Eriksson ◽  
Å. Tisell ◽  
L. Granström
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Randomized Study ◽  
Open Appendicectomy ◽  
Recurrent Appendicitis ◽  
Us Findings

In a randomized study we investigated the effects of antibiotics as the only treatment in acute appendicitis. Forty patients were examined, 19 after antibiotic treatment (one operated due to perforation) and 21 after surgery. All patients were examined prior to randomization, after 10 days and after 30 days. Of the positive ultrasonographic (US) findings, 18 (86%) of the 21 operated patients had histologically proven acute appendicitis. At the 10th day, 9 patients had a seroma under the scar, which had disappeared a month after surgery in all patients. In the 19 patients conservatively treated with antibiotics, the appendix could be visualized in 8 symptom-free cases on the 10th day. In 5 of the 8 patients the appendix was still visualized after 1 month. Three of these 5 had recurrent appendicitis within a year. It is concluded that US can be used not only in diagnosing acute appendicitis, but also in the evaluation of treatments such as antibiotics.

scholarly journals Diagnostic performance of CT-guided percutaneous transthoracic core needle biopsy using low tube voltage (100 kVp): comparison with conventional tube voltage (120 kVp)

2017 ◽  
Vol 59 (4) ◽  
pp. 425-433 ◽  
Author(s):  
Han Na Lee ◽  
Sang Min Lee ◽  
Jooae Choe ◽  
Sang Min Lee ◽  
Eun Jin Chae ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Complication Rate ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Diagnostic Performance ◽  
Tube Voltage ◽  
Ct Guided ◽  
Core Needle ◽  
Group I ◽  
Group Ii

Background Computed tomography (CT)-guided percutaneous transthoracic core needle biopsy (PTNB) is typically performed at 120 kVp tube voltage. However, there is no study that has demonstrated diagnostic performance including ground-glass nodules and radiation dose reduction at lower tube voltage in large population. Purpose To retrospectively compare the diagnostic performance and radiation dose between 100 kVp and 120 kVp during CT-guided PTNB. Material and Methods This study included 393 PTNBs performed in 385 patients (Group I; 120 kVp) from March 2011 to September 2011 and 1368 PTNBs performed in 1318 patients (Group II; 100 kVp) from October 2011 to December 2013. The patients underwent CT-guided PTNB with the coaxial technique. Diagnostic performance, complication rate, and radiation dose were compared between two groups. Results Technical success was achieved in 391 of 393 PTNBs (99.5%) in Group I and in 1344 of 1368 PTNBs (98.2%) in Group II ( P = 0.09). The diagnostic accuracies for pulmonary lesions were not significantly different between two groups (97.1% [362/373] versus 96.2% [1202/1249], P = 0.458). Complication rate showed no significant differences between two groups in terms of pneumothorax (19.7% [77/391] versus 19.4% [261/1344], P = 0.904) and hemoptysis (2.3% [9/391] versus 3.2% [43/1344], P = 0.360). Among patients who developed pneumothorax, three patients (3.9%, 3/77) in Group I and eight patients (3.1%, 8/261) in Group II required treatment with drainage catheter. Nobody needed further treatment for hemoptysis in the two groups. The mean radiation dose was 1.5 ± 1.9 mSv in Group I and 0.7 ± 0.3 mSv in Group II ( P < 0.001). Conclusion The 100-kVp protocol for CT-guided PTNB showed significant benefit of radiation dose reduction while maintaining high diagnostic accuracy and safety.

scholarly journals Evaluation of outcome of early appendectomy in appendicular lump

2020 ◽  
Vol 8 (1) ◽  
pp. 7
Author(s):  
A. S. M. Rezbanul Haque ◽  
Bablu Kumar Saha ◽  
M. Mahfuzul Haque ◽  
M. Abdus Sattar ◽  
Upendra Nath Ray ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Recovery Period ◽  
Medical College ◽  
Group I ◽  
Perforated Appendix ◽  
Early Exploration ◽  
The Mean ◽  
Group Ii ◽  
Surgery Department ◽  
The Cost

Background: Appendicular lump is a well-known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. This study aims to evaluate the outcome of early appendectomy in an appendicular lump.Methods: A total of 210 patients were admitted in surgery and pediatric surgery department of Rangpur medical college and hospital with the diagnosis of acute appendicitis and its sequalae over two years.Results: In this study, sixty patients were included who were presented with an appendicular lump. Maximum patients (50%) were found in the age group of 21-30 years. Males (66.67%) were more affected. Eighty percent of patients were coming from below-average socio-economic conditions. In group I, early appendicectomy had done and outcomes were satisfactory and favorable. In group II, eighteen patients were operated who were admitted at 6 to 8 days after an attack of acute appendicitis, and twelve patients were continued the conservative treatment. In group II, who had done surgery, among them, fourteen patients (77.78%) were found an appendicular abscess, and four patients (22.22%) were found perforated appendix per-operatively. In group I, the mean recovery period was less and they had minimum complications. In group II, the mean recovery period was more and they had more complications.Conclusions: Based on these findings, it can be concluded that early exploration in appendicular lump patients confirm the diagnosis, cures the problem, reduces the cost of management, and shortens the convalescence period and hospital stay with reasonably satisfactory outcomes.

scholarly journals Short Course versus Standard Course Antibiotic Treatment for Neonatal Sepsis

2017 ◽  
Vol 13 (1) ◽  
pp. 124-127
Author(s):  
Tahsinul Amin ◽  
Ayesha Najma Nur
Keyword(s):  
Clinical Outcome ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Developmental Delay ◽  
Antibiotic Treatment ◽  
Neonatal Sepsis ◽  
Group I ◽  
Short Course ◽  
Significant Difference ◽  
Group Ii

Introduction: Neonatal sepsis remains an important cause of morbidity and mortality and often requires prompt empiric treatment. However, only a minority of babies who receive antibiotics for suspected sepsis have an infection. Antimicrobial exposure in infancy has important short-term and long-term consequences. There is no consensus regarding empirical antimicrobial regimens. Objective: To compare efficacy and benefits of short course (5 days) over the standard course (7 days) antibiotic treatment for neonatal sepsis. Materials and Methods: The study was a randomized controlled trial done in the neonatal ward in a tertiary level hospital comprising total 100 term neonates equally divided in to two groups by randomization where Group-I (5 days antibiotic therapy) was compared against Group-II (7 days antibiotic therapy) in clinical recovery, hospital stay, morbidity such as seizure, developmental delay etc and mortality. Results: The study results showed that both the Group-I and Group-II were comparable in baseline clinical data and predisposing factors; however, there was no significant difference between the two groups in clinical features e.g. hypotonia (24% vs 26%, p>0.05), poor primitive reflexes (46% vs 52%, p>0.05), temperature instability (34% vs 28%, p>0.05), feeding intolerance (16% vs 14%, p>0.05), apnea / respiratory distress (28% vs 34%, p>0.05) and in clinical outcome e.g. hospital stay (5.24±0.78 vs 7.86±0.42, p>0.05), recovery (86% vs 90%, p>0.05), death (14% vs 10%, p>0.05), seizure disorder (8% vs 6%, p>0.05) and developmental delay (6% vs 4%, p>0.05). Conclusion: This study showed that there was no significant difference between the study groups in clinical outcome, however, short course antibiotic (5 days) is equally effective but economically more beneficial to standard course antibiotic (7 days) therapy for neonatal sepsis. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 124-127

Do Patient Expectations of Discharge Affect Length of Stay after Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?

2021 ◽  
Author(s):  
Ravinder Bamba ◽  
Jordan E. Wiebe ◽  
Christopher A. Ingersol ◽  
Steven Dawson ◽  
Mithun Sinha ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Breast Reconstruction ◽  
Enhanced Recovery ◽  
Perforator Flap ◽  
Patient Expectations ◽  
Outcome Variable ◽  
Diep Flap ◽  
Group I ◽  
Group Ii ◽  
Eras Protocol

Abstract Introduction Deep inferior epigastric artery perforator (DIEP) flap is a common method of breast reconstruction. Enhanced recovery after surgery (ERAS) postoperative protocols have been used to optimize patient outcomes and facilitate shorter hospital stays. The effect of patient expectations on length of stay (LOS) after DIEP has not been evaluated. The purpose of this study was to investigate whether patient expectations affect LOS. Methods A retrospective chart review was performed for patients undergoing DIEP flaps for breast reconstruction from 2017 to 2020. All patients were managed with the same ERAS protocol. Patients were divided in Group I (early expectations) and Group II (standard expectations). Group I patients had expectations set for discharge postoperative day (POD) 2 for unilateral DIEP and POD 3 for bilateral DIEP. Group II patients were given expectations for POD 3 to 4 for unilateral DIEP and POD 4 to 5 for bilateral. The primary outcome variable was LOS. Results The study included 215 DIEP flaps (45 unilateral and 85 bilateral). The average age was 49.8 years old, and the average body mass index (BMI) was 31.4. Group I (early expectations) included 56 patients (24 unilateral DIEPs, 32 bilateral). Group II (standard expectations) had 74 patients (21 unilateral, 53 bilateral). LOS for unilateral DIEP was 2.9 days for Group I compared with 3.7 days for Group II (p = 0.004). Group I bilateral DIEP patients had LOS of 3.5 days compared with 3.9 days for Group II (p = 0.02). Immediate timing of DIEP (Group I 42.9 vs. Group II 52.7%) and BMI (Group I 32.1 vs. Group II 30.8) were similar (p = 0.25). Conclusion Our study found significantly shorter hospital stay after DIEP flap for patients who expected an earlier discharge date despite similar patient characteristics and uniform ERAS protocol. Patient expectations should be considered during patient counseling and as a confounding variable when analyzing ERAS protocols.

Abstract 2710: Emergency Room Utilization of Continuous Intravenous Furosemide Together With the American Heart Association Get With the Guideline Heart Failure Care (GWTG-HF) Decreases Length of Stay for Hospitalized Heart Failure Patients at St. Joseph’s Regional Medical Center (SJRMC)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert T Faillace ◽  
James Pruden ◽  
David Adinaro ◽  
Lorraine Marut ◽  
Ilene Matza ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Emergency Room ◽  
Usual Care ◽  
Standards Of Care ◽  
Team Approach ◽  
Group I ◽  
Group Ii ◽  
Multi Disciplinary Team ◽  
Order Set

The main goals of therapy for hospitalized congestive heart failure (CHF) patients are to achieve euvolemia and to administer optimal standards of care. No study to date has examined ways to implement use of continuous intravenous furosemide (IVF) in the Emergency Room (ER) and ensure that each CHF patient consistently receives optimal standards of care throughout their hospitalization. Therefore, we hypothesized that a multi-disciplinary team approach with coordination of care from ER arrival to discharge (DC) with use of the AHA GWTG-HF Program will decrease length of stay (LOS) and provide optimal care for CHF patients as compared to usual care. METHODS: GWTG-HF was operational in 2006 with a multi-disciplinary team consisting of a Physician Champion, Advanced Practice Nurses (APNs), Case Managers and RNs. In June of 2006 the IVF program was implemented in coordination with the ER, Cardiology and Medicine Departments. ER physicians were prompted by an electronic medical record provider order entry (EMR-POE) CHF order set. GWTG-HF APNs followed these patients throughout their hospitalization. We compared the average LOS of CHF patients who received usual care in 2005 (Group I) to CHF patients who received IVF and GWTG-HF care from 6/06 to 4/07 (Group II). RESULTS: CHF cases in Group I equaled 773 as compared to 212 cases in Group II. Average LOS in I was 6.7 days as compared to 5.5 days in II (p = 0.001). Overall compliance with GWTG-HF Core Measures in 2006 was 98%. CONCLUSIONS: 1. Implementation of IVF in the ER with an EMR-POE order set helps ensure utilization of IVF in the ER at time of admission for CHF patients; 2. A multi-disciplinary team approach with use of IVF along with GWTG-HF is associated with a significant decrease in the LOS as compared to usual care; 3. A multi-disciplinary team approach to care for the CHF patient is superior to usual care with regards to LOS; and 4. GWTG-HF is associated with a high compliance with standards of hospitalized CHF care.

scholarly journals Impact of Body Mass Index on In-Hospital Length of Stay after Percutaneous Coronary Interventions

2020 ◽  
Vol 13 (1) ◽  
pp. 19-26
Author(s):  
Mohammad Khalilur Rahman Siddiqui ◽  
Md Mizanur Rahman ◽  
Borhanuddin Ahmed ◽  
Abdul Latif Molla ◽  
Md Iftekhar Uddin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Percutaneous Coronary Interventions ◽  
Hospital Outcomes ◽  
Hospital Outcome ◽  
Coronary Interventions ◽  
Group I ◽  
Percutaneous Coronary ◽  
Group Ii

Background: In-hospital length of stay (LOS) is an important metric for assessing the quality of care and planning capacity within a hospital. Percutaneous Coronary Interventions (PCI) merit short LOS following an uncomplicated procedure. Various factors have been studied that may influence LOS. The relationship between BMI and LOS after PCI has not been thoroughly investigated, especially in Bangladesh. Methods: This cross-sectional observational study was conducted at National Institute of Cardiovascular Diseases, on total 100 patients who underwent PCI with two equally divided groups on the basis of BMI of Asian ethnicity: Group I (BMI < 23 kg/m2) and Group II (BMI e” 23.0 kg/m2). In-hospital outcomes and LOS were observed and recorded after PCI. Results: The mean BMI of study population was 23.9 ± 1.9 kg/m2. The sum of occurrence of adverse in-hospital outcomes was 14.0%. Complications were significantly (p < 0.01) higher in Group I than Group II. Among all adverse in-hospital outcomes, only acute left ventricular failure was found to be statistically significant between groups (p < 0.01). The difference of mean LOS after PCI was higher in Group-I which was statistically significant (p < 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in-hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with adverse in-hospital outcome after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007). Conclusion: BMI is inversely associated with adverse in-hospital outcome after PCI. The underweight people are likely to experience longer LOS following PCI. Cardiovasc. j. 2020; 13(1): 19-26

scholarly journals APPENDICULAR MASS

2010 ◽  
Vol 17 (02) ◽  
pp. 180-184
Author(s):  
SARDAR ALI ◽  
HAFIZ MUHAMMED RAFIQUE
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Cost Effective ◽  
Chi Square ◽  
Female Ratio ◽  
Surgical Exploration ◽  
Group I ◽  
Group Ii ◽  
Adhesive Intestinal Obstruction ◽  
Appendicular Mass

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 toNovember 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying student Chi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.

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