scholarly journals Association of treatments for acute appendicitis with pregnancy outcomes in the United States from 2000 to 2016: Results from a multi-level analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260991
Author(s):  
Jianzhou Yang ◽  
Shi Wu Wen ◽  
Daniel Krewski ◽  
Daniel J. Corsi ◽  
Mark Walker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Pregnancy Outcomes ◽  
Preterm Labor ◽  
Open Appendectomy ◽  
The United States ◽  
Hospital Level ◽  
Multi Level ◽  
Non Surgical Treatment

Background Open appendectomy, laparoscopic appendectomy, and non-surgical treatment are three options to treat acute appendicitis during pregnancy. Previous studies on the association of different treatment methods for acute appendicitis with pregnancy outcomes have been limited by small sample sizes and residual confounding, especially with respect to hospital-level factors. This study aimed to investigate the association of treatment method for acute appendicitis with pregnancy outcomes using a multi-level analysis. Methods A retrospective cohort study was conducted based on a large electronic health records database in the United States during the period 2000 to 2016. All pregnancies diagnosed with acute appendicitis and treated in participating hospitals during the study period were included. We conducted multi-level hierarchical logistic regression to analyze both individual- and hospital-level factors for abortion, preterm labor, and cesarean section. Results A total of 10,271 acute appendicitis during pregnancy were identified during the study period. Of them, 5,872 (57.2%) were treated by laparoscopic appendectomy, 1,403 (13.7%) by open appendectomy, and 2,996 (29.2%) by non-surgical treatment. Compared with open appendectomy, both laparoscopic appendectomy (adjusted OR, 0.6, 95% CI, 0.4, 0.9) and non-surgical treatment (adjusted OR, 0.4; 95% CI, 0.3–0.7) showed a decreased risk of preterm labor. Other important individual-level determinants of adverse pregnancy outcomes included maternal age, gestational hypertension, and anemia during pregnancy, the hospital-level determinant included the number of beds. Conclusions Compared with open appendectomy, both laparoscopic appendectomy and non-surgical treatment may be associated with a lower risk of preterm labor, without increased risks of abortion and cesarean section.

scholarly journals Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

2014 ◽  
Vol 80 (10) ◽  
pp. 1074-1077 ◽  
Author(s):  
Hossein Masoomi ◽  
Ninh T. Nguyen ◽  
Matthew O. Dolich ◽  
Steven Mills ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
United States ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Conversion Rate ◽  
Nationwide Inpatient Sample ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
The United States ◽  
Hospital Charges ◽  
Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

scholarly journals Acute Appendicitis in Pregnant Women: Our Clinical Experience

2016 ◽  
Vol 39 (6) ◽  
pp. 159 ◽  
Author(s):  
Ahmet Türkan ◽  
Metin Yalaza ◽  
Mehmet Tolga Kafadar ◽  
Gürka Değirmencioğlu
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Pregnant Women ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Fetal Loss ◽  
University Research ◽  
Lower Quadrant ◽  
Right Lower Quadrant

Purpose: The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. Methods: Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. Results: Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. Conclusion: It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient.

scholarly journals Management of acute appendicitis during the COVID-19 pandemic: Views of two Brazilian surgical societies

2021 ◽  
Vol 48 ◽  
Author(s):  
JOSÉ GUSTAVO PARREIRA ◽  
LOUISIE GALANTINI LANA DE-GODOY ◽  
TERCIO DE-CAMPOS ◽  
PEDRO DE SOUZA LUCARELLI-ANTUNES ◽  
LUIZ GUSTAVO DE-OLIVEIRA-E-SILVA ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Operative Management ◽  
Chest Ct ◽  
Therapeutic Options ◽  
Non Operative Management

ABSTRACT Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.

scholarly journals CHOOSING A METHOD OF SURGICAL TREATMENT OF ACUTE APPENDICITIS IN PATIENTS WITH CONCOMITANT PULMONARY PATHOLOGY

2020 ◽  
pp. 165-168
Author(s):  
Y. Hasan ◽  
I. E. Borodayev ◽  
V. V. Kolodiy ◽  
V. N. Kachanov ◽  
V. B. Volkov
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Optimal Method ◽  
Cardiopulmonary Disease ◽  
Abdominal Organs ◽  
Group I ◽  
Pulmonary Pathology

Summary. The article analyzes the experience of using endovideosurgical method of treatment of patients with АA with pulmonary pathology, determines the indications for the use of different methods of applying pneumoperitoneum when performing laparoscopic appendectomy (LA). Material and method. The result of treatment of 46 patients with acute appendicitis (АA) and concomitant pulmonary pathology in the last 5 years is given. Group I included 14 patients diagnosed with AA with concomitant pulmonary pathology who underwent open appendectomy, and II — 32 patients with a diagnosis of AA with concomitant pulmonary pathology, who underwent laparoscopic appendectomy with the imposition of pneumoperitoneum and metaphormia. Result. The evaluation of the treatment of 32 patients (84.8 %) with concomitant pulmonary pathology performed by LA, which allowed to dramatically reduce the number of complications from the abdominal organs, as well as to reduce the frequency of decompensation of concomitant pulmonary pathologies. Conclusions. Performing a laparolifting laparoscopic appendectomy is the optimal method for patients at high risk for cardiopulmonary disease.

scholarly journals Reasons for Undesirable Pregnancy Outcomes among Women with Appendicitis: The Experience of a Tertiary Center

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Baris Mantoglu ◽  
Fatih Altintoprak ◽  
Necattin Firat ◽  
Emre Gonullu ◽  
Enis Dikicier ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Acute Appendicitis ◽  
Preterm Delivery ◽  
Laparoscopic Appendectomy ◽  
Pregnancy Outcomes ◽  
Open Appendectomy ◽  
Multiple Pregnancy ◽  
White Blood Count ◽  
Tertiary Center ◽  
Significant Difference

Background. Although laparoscopic appendectomy increases its popularity today, the answer to the question of whether to perform open or laparoscopic appendectomy during pregnancy is appropriate in many studies, and the choice of surgery depends on the surgeon. Herein, we aimed to evaluate the variables that affect undesirable pregnancy outcomes that occur as a result of appendicitis during pregnancy. Methods. Seventy-eight pregnant patients with acute appendicitis who underwent laparoscopic or open technique intervention enrolled in this retrospective study. In addition to the demographic structure of the patients, surgical technique, the number of pregnancies, multiple pregnancy status, surgical pathologies, laboratory values, radiological imaging methods, and length of hospital stay were evaluated. The severity of appendicitis was classified according to the pathology results. The patients were divided into two groups according to the outcomes of their pregnancy. Preterm delivery and abortion involved in the study as a single complication section. Results. The mean age of the pregnant patients was 28.6 ± 5. Of the 78 pregnant women with appendicitis, 47.4% had their first pregnancy, 37.2% had their second pregnancy, and 15.4% had 3 or more pregnancies. The preterm delivery and abortus were 19.5% in the open appendectomy (OA) group and 16.2% in the laparoscopic appendectomy (LA) group. No statistically significant difference was detected in this group in terms of appendicitis pathology triggering preterm delivery or abortion (p 0.075). When white blood count (WBC) and C-reactive protein (CRP) were evaluated by laboratory findings, CRP was found to be statistically significantly higher in patients with preterm birth (p 0.042). Conclusion. Consequently, acute appendicitis may cause serious intra-abdominal infection and inflammation in addition to the complexity of the diagnosis due to the nature of pregnancy, as well as undesired pregnancy outcomes with the surgical technique, or independently with other variables.

scholarly journals Laparoscopic versus open appendectomy during pregnancy

2017 ◽  
Vol 4 (8) ◽  
pp. 2387 ◽  
Author(s):  
Mohammed M. Alkatary ◽  
Nagwan A. Bahgat
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Preterm Labor ◽  
Open Appendectomy ◽  
Laparoscopic Group ◽  
Fetal Outcome ◽  
Pathological Examination ◽  
Normal Appendix ◽  
Laparoscopic Versus Open Appendectomy

Background: Various causes can be claimed for abdominal pain during pregnancy. Acute appendicitis is the most common cause of abdominal pain during pregnancy. Diagnosis of acute appendicitis during pregnancy is a quiet challenging due to anatomical and physiological changes that occur during pregnancy.Methods: On the period from January 2010 to January 2012we reviewed the number of pregnant patients presented to our facility by abdominal pain and diagnosed as acute appendicitis. Total number was 23 patients. 2 patients were excluded as their magnetic resonance imaging showed normal appendix and were discharged. 6 patients presented on the 1st trimester, 7 patients presented on the 2nd trimester and 8 patients on the 3rd trimester. Laparoscopic appendectomy performed in 9 patients while 12 patients had open appendectomy.Results: The operative time on the laparoscopic group ranged from 50-80 minutes while on the open appendectomy ranged from 40-60 minutes. The length of stay after laparoscopic procedure was 1.5-3 days in comparison to 3-5 days following open appendectomy. Postoperative wound infection detected in 2 patients after open appendectomy (16%) compared with 1 patient (11%) following laparoscopic appendectomy. The postoperative pathology was classified as normal appendix, suppurated appendix and complicated appendix. Table 2 showed the postoperative pathological examination. Preterm labor detected in one patient only had open appendectomy. Fetal outcome was evaluated by Apgar scoring together with fetal length and weight after delivery with no significant abnormality.Conclusions: Laparoscopic appendectomy is safe for both the mother and the fetus during pregnancy irrespective of gestational age, and the procedure is associated with a low risk of post-operative complications. 

scholarly journals Unligature method of laparoscopic appendectomy in children

2020 ◽  
Vol 10 (1) ◽  
pp. 53-58
Author(s):  
Vyacheslav G. Svarich ◽  
Evgeniy G. Perevozchikov ◽  
Ilya M. Kagantsov
Keyword(s):  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Operation Time ◽  
High Energy ◽  
Inflammatory Infiltration ◽  
Surgical Department ◽  
Clinical Hospital ◽  
Digital Assessment

Aim. On the basis of the accumulated clinical material to show the possibility of a ligature-free method of laparoscopic appendectomy in children. Materials and methods. From 2000 to 2019, 2044 children with acute appendicitis were treated in the surgical department of the Republican childrens clinical hospital in Syktyvkar. Of these, 651 patients had an open appendectomy with treatment of the stump of the vermiform process by the submersible method, 1363 children had a laparoscopic appendectomy with ligature treatment of the stump of the process, and 32 patients had their first non-ligature laparoscopic appendectomy with the intersection of the vermiform process with the Ligasure device. Results. On average, surgery for ligature-free laparoscopic appendectomy lasted 7 3 minutes less than for laparoscopic appendectomy using the ligature method for treating the stump of the worm-like process. Experimentally, it was found that this method of appendectomy should not be used when the thickness of the worm-like process is more than 1.5 cm, with pronounced inflammatory infiltration of the caecum dome and perforation at the base of the process. With ligature-free appendectomy, the operation time was reduced. In the period from 1 to 6 months, there were no intra-abdominal postoperative complications associated with the new method of surgery. Conclusion. Ligar-free laparoscopic appendectomy in children using modern high-energy platforms with a digital assessment of the degree of tissue coagulation readiness made it possible to avoid intraoperative and postoperative complications, simplify the technique of its implementation, and reduce the time of surgery.

scholarly journals Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors

2016 ◽  
Vol 16 (2) ◽  
pp. 12-16
Author(s):  
Elina Silina ◽  
Asnate Jurgele ◽  
Arturs Viksne ◽  
Zane Abola ◽  
Arnis Engelis ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Clinical Signs ◽  
Drug Combinations ◽  
Antimicrobial Drug ◽  
Nonsurgical Management ◽  
Unsuccessful Treatment ◽  
Significant Difference ◽  
Non Surgical Treatment

SummaryIntroduction.For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens.Aim of the Study.The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations.Material and methods.A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed.Results.Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597).The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge.Conclusions.Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.

scholarly journals The effectiveness and appropriateness of Interval Laparoscopic Appendectomy on adult appendiceal mass, a retrospective cohort

2019 ◽  
Author(s):  
Shiro Fujihata ◽  
Hidehiko Kitagami ◽  
Yosuke Kitayama ◽  
Ayumi Suzuki ◽  
Moritsugu Tanaka ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Laparoscopic Appendectomy ◽  
Perioperative Complications ◽  
Oral Intake ◽  
Operation Time ◽  
Appendiceal Mass ◽  
Uncomplicated Appendicitis ◽  
Objective Parameter ◽  
Significant Difference ◽  
Non Surgical Treatment

Abstract Background: Appendiceal mass sometimes requires extended resection and difficult to treat postoperative complications. Interval appendectomy has been performed mainly in the field of pediatric surgery to avoid them. Recently, there are a few reports on interval laparoscopic appendectomy (ILA). We examined not only the safety and effectiveness of ILA for adult appendiceal mass (AAM), but also the appropriateness of ILA for which cases should be treated non-surgically for ILA or converted to surgical treatment. Methods: Among 956 appendectomies performed between April 2012 and March 2018, there were 49 cases of AAM, of which 34 cases underwent ILA; ILA group. The safety and efficacy of ILA were examined by comparing with 477 cases of adult uncomplicated appendicitis underwent laparoscopic appendectomy (LA); LA group. The appropriateness of ILA was examined by comparing with the remaining 15 cases of AAM; non-ILA group. Results: The ILA group had a longer operation time than the LA group, but the postoperative hospital stay was shorter, and no significant difference were found in the bleeding volume, the days required for oral intake of solid food, and the perioperative complications. Examining the factors for failure of non-surgical treatment or relapse of inflammation during interval period, higher WBC day3 / day0 was found to be an independent risk factor. Conclusion: ILA against AAM was almost as safe and effective as LA for adult uncomplicated appendicitis. WBC day3 / day0 may be effective as an objective parameter for judging the termination of non-surgical treatment for ILA. This determination to convert ineffective non-surgical treatment to surgical treatment earlier may reduce the burden on the patient.

Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

2020 ◽  
Author(s):  
Grith Laerkholm Hansen ◽  
Jakob Kleif ◽  
Christian Jakobsen ◽  
Anders Paerregaard
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Pediatric Population ◽  
Open Appendectomy ◽  
Postoperative Mortality ◽  
Population Based ◽  
Postoperative Hospital Stay ◽  
Population Based Study ◽  
Registration System

Abstract Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

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