scholarly journals Cost-effectiveness of routine imaging of suspected appendicitis

2018 ◽  
Vol 100 (1) ◽  
pp. 47-51 ◽  
Author(s):  
N D’Souza ◽  
M Marsden ◽  
S Bottomley ◽  
N Nagarajah ◽  
F Scutt ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Financial Burden ◽  
Iliac Fossa ◽  
Hospital Costs ◽  
Cost Savings ◽  
Cross Sectional ◽  
Suspected Appendicitis ◽  
Negative Appendicectomy ◽  
The Uk ◽  
Routine Imaging

Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

scholarly journals Costs of postoperative morbidity following paediatric cardiac surgery: observational study

2020 ◽  
Vol 105 (11) ◽  
pp. 1068-1074 ◽  
Author(s):  
Emma Hudson ◽  
Katherine Brown ◽  
Christina Pagel ◽  
Jo Wray ◽  
David Barron ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Health Service ◽  
Financial Burden ◽  
Hospital Costs ◽  
Incidence Rates ◽  
Care Quality ◽  
Patient Costs ◽  
Paediatric Cardiac Surgery ◽  
The Uk

ObjectiveEarly mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery.DesignTwo methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively.SettingFive specialist paediatric cardiac surgery centres, accounting for half of UK patients.PatientsCohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures.MethodsRisk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service.Outcome measuresImpact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs.ResultsSeven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3–£17 289) to £66 784 (£40 609–£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year.ConclusionPostoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.

scholarly journals Diagnostic Role of Ultrasonography in Right Iliac Fossa Pathologies

2019 ◽  
Vol 7 (3) ◽  
pp. 382-386
Author(s):  
Mishal Javaid ◽  
Ayesha Tariq ◽  
Hiba Noreen Javaid
Keyword(s):  
Imaging Modality ◽  
Iliac Fossa ◽  
Sampling Technique ◽  
High Volume ◽  
Symptom Duration ◽  
Cross Sectional ◽  
Use Of Resources ◽  
Diagnostic Role ◽  
Right Iliac Fossa Pain

Ultrasound is often the imaging modality of choice in patients with acute right iliac fossa pain.  Right iliac fossa pain remains the commonest clinical dilemma encountered by general surgeons. The management of acute right iliac fossa pain is audited, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. Objective: To determine the diagnostic role of ultrasonography in Right Iliac Fossa pathologies. Methods: A cross sectional descriptive study was carried out at the Department of Radiology in Sir Ganga Ram Hospital Lahore, Pakistan. Duration of study was from March 2018 to November 2018. 85 patients with Right Iliac Fossa pain selected through convenient sampling technique. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Conclusion: The results in the study reflect findings from high volume emergency surgical departments and patients of pain in right iliac fossa demonstrating that unfocussed abdominal and pelvic ultrasounds are not an appropriate use of resources in patients with Right iliac fossa pain. Int. J. Appl. Sci. Biotechnol. Vol 7(3): 382-386  

scholarly journals Project bank accounts: the second wave of security of payment?

2017 ◽  
Vol 22 (3) ◽  
pp. 322-338 ◽  
Author(s):  
Rachel Griffiths ◽  
Wayne Lord ◽  
Jeremy Coggins
Keyword(s):  
Construction Industry ◽  
Construction Projects ◽  
Cost Savings ◽  
Full Time ◽  
Cross Sectional ◽  
Content Type ◽  
The Public ◽  
Survey Results ◽  
Bank Accounts ◽  
The Uk

Purpose The purpose of this study is to identify building contractors’ views as to the need for, impact of and barriers to the use of project bank accounts (PBAs) in the UK construction industry. Design/methodology/approach A cross-sectional research study was carried out by the use of questionnaires to collect quantitative data. The population for the research was of construction professionals working as full-time employees for either main (Tier 1) or specialist contractors (Tiers 2-4). Findings Contractors consider PBAs as an effective initiative to encourage fair payment. There is uncertainty, however, as to whether PBAs will result in project cost savings. Head contractor resistance is perceived to be the biggest barrier to the use of PBAs. Adoption of PBAs in private-sector construction projects is likely to be slow. Research limitations/implications The relative infancy of PBA usage in the construction industry means that responses are largely based on awareness as opposed to experience. Nevertheless, survey data represent a snapshot of contractors’ perceptions with respect to PBAs, which may be used as a benchmark against which to compare future studies to monitor how contractors’ views and expectations have changed with time. Originality/value The survey results will be of particular interest to those international jurisdictions who are considering, or who have already embarked on, the path of trialling and/or using PBAs in the public sector.

scholarly journals TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Chean Khun Ng ◽  
Vi June Tay ◽  
Francesca Ligori Malcolm ◽  
Zoe Chia ◽  
Ahmed M El-Sharkawy ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Discharge Rate ◽  
White Cell Count ◽  
Iliac Fossa ◽  
Significant Proportion ◽  
Initial Presentation ◽  
Surgical Team ◽  
Emergency Operations ◽  
Suspected Appendicitis ◽  
Negative Appendicectomy

Abstract Aims Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations. Methods Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019. Results A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p < 0.001) or guarding(p < 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815). Conclusion Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.

scholarly journals The Cost of Ignoring Acute Cholecystectomy

2009 ◽  
Vol 91 (1) ◽  
pp. 39-42 ◽  
Author(s):  
JP Garner ◽  
SK Sood ◽  
J Robinson ◽  
W Barber ◽  
K Ravi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Waiting Times ◽  
Hospital Costs ◽  
Cost Savings ◽  
The Uk ◽  
Elective Cholecystectomy ◽  
First Admission

INTRODUCTION Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. PATIENTS AND METHODS The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. RESULTS In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over £40,000. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. CONCLUSIONS Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

scholarly journals VALIDITY OF ALVARADO SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

1969 ◽  
Vol 5 (2) ◽  
pp. 663-666
Author(s):  
ASGHAR ALI ◽  
ABDUR RAHMAN ◽  
FAZAL RAHIM
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Iliac Fossa ◽  
Cross Sectional Study ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Female Ratio ◽  
Suspected Appendicitis ◽  
Surgical Ward ◽  
Male To Female

BACKGROUND: The first appendectomy was performed by Claudius Amyand in 1736 when he wasoperating on a boy for hernia and found appendix lying in hernial sac. Reginald Fitz introduced the wordappendicitis in 1886 and before that it was called typhlitis or perityphlitis.Frederick Treves performedthe lstappendicle surgery in England for the new disease ‘appendicitis’ in 1887.OBJECTIVE: To study the accuracy of modified Alvarado scorning system in diagnosis of acuteappendicitis.MATERIAL & METHODS: This descriptive cross sectional study was conducted at DHQ HospitalTimergara Dir lower from January 2015 to July 2015 to find out the accuracy of Alvarado Scoringsystem in the diagnoses of acute appendicitis. A total of 50 patients admitted in surgical ward from OPDand Casualty with suspected appendicitis were included in the study. Patients less than 7 years andpatients with mass right iliac fossa were excluded. Every patient was evaluated with modified Alvaradoscoring system on a standard Proforma. Patients with Alvarado score of > 6 underwent appendectomy.The removed appendices were sent for histopathology to confirm or otherwise the provisional diagnosisof acute appendicitis and hence the accuracy of Alvarado scoring system.RESULTS: Out of 50 patients, 20 were male &30 were female with a male to female ratio of 1:1.5. Themean age of the patients was 19.7 ± 9.6years. The mean Alvarado score was 7.92 ± 1.383. TheHistopathology reports of the specimens of 37 patients were confirmative of acute appendicitis whereasthe rest of the (13 patients) removed appendices were reported normal by histopathalogist. So thesensitivity is 74%.CONCLUSION: Our study shows that Alvarado scoring system is a simple and quick tool in theevaluation and management of suspected cases of acute appendicitis. Its accuracy increases if used inpatients above 14 years of age.KEYWORD: Alvarado scoring system, Appendicitis, Accuracy.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

scholarly journals Survey of young people in one region of the UK on accessing COVID-19 information (SOCIAL)

2021 ◽  
Vol 5 (1) ◽  
pp. e000942
Author(s):  
Oliver G P Lawton ◽  
Sarah A Lawton ◽  
Lisa Dikomitis ◽  
Joanne Protheroe ◽  
Joanne Smith ◽  
...  
Keyword(s):  
Social Media ◽  
Young People ◽  
Significant Role ◽  
Online Survey ◽  
Descriptive Statistics ◽  
Sources Of Information ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Education Gaps ◽  
The Uk

COVID-19 has significantly impacted young people’s lives yet little is known about the COVID-19 related sources of information they access. We performed a cross-sectional survey of pupils (11–16 years) in North Staffordshire, UK. 408 (23%) pupils responded to an online survey emailed to them by their school. Descriptive statistics were used to summarise the data. Social media, accessed by 68%, played a significant role in the provision of information, despite it not being considered trustworthy. 89% felt that COVID-19 had negatively affected their education. Gaps in the provision of information on COVID-19 have been identified.

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