scholarly journals Non-operative treatment of acute appendicitis in selected patients

2017 ◽  
Vol 4 (10) ◽  
pp. 3190
Author(s):  
Nazim Agaoglu ◽  
Mehmet Ulusahin
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Success Rate ◽  
Operative Treatment ◽  
Operative Management ◽  
Treatment Method ◽  
Normal Activity ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Success Rates

Background: Surgical approach for acute appendicitis (AA) is a standard live saving treatment method. The purpose of this study was to assess the feasibility, initial safety and success rate of non-operative treatment of AA in selected patients.Methods: Selected AA patients were enrolled in this prospective study (non-operative treatment). This was based on IV antibiotic therapy and followed up with oral antibiotic. Patients who declined to participate or excluded were managed with appendectomy and considered as controls. The primary goal of the study was to determine the feasibility, initial safety, early and late success rates of non-operative management. Secondary outcomes include hospital length of stay and charge, days of missed works and return to normal activity at home of patients treated non-operatively in comparison to appendectomy group.Results: In non-operative group (36 patients), 7 patients failed to response and managed by appendectomy with early success rate of 80.5%. Three patients experienced recurrent attacks of AA were managed with appendectomy. Late success rate was 72.2%. In appendectomy group (53 patients) one patient with adenocarcinoma of the colon detected during surgery and in ten patients the appendix was perforated. One patient died due to generalized peritonitis. In non-operative group length of stay and hospital charge were lower but only days to resume home activities and days of missed work were shorter and statistically significant as compared to appendectomy group.Conclusions: This study confirms the feasibility, safety and optimum success rate of non-operative treatment of early AA in selected patients.

scholarly journals NON OPERATIVE MANAGEMENT OF ACUTE APPENDICITIS- A PROSPECTIVE STUDY.

2019 ◽  
pp. 1-3
Author(s):  
Rakesh Kumar Verma ◽  
Surit Majumdar
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Prospective Study ◽  
Success Rate ◽  
Operative Treatment ◽  
Operative Management ◽  
Oral Antibiotic ◽  
Lower Quadrant ◽  
Non Operative Management

BACKGROUND: Right lower quadrant abdominal pain is a common cause of Emergency department admission.Acute appendicitis is one of the commonest diagnosis in this setting.The natural history of acute appendicitis non-operatively treated with antibiotics remains unclear. In this prospective study, operative and non-operative management of acute appendicitis were evaluated regarding their safety and cost effectiveness. AIMS AND OBJECTIVE: The purpose of this study was to assess the feasibility, initial safety and efficacy, early and late success rate of non-operative treatment of confirmed acute uncomplicated appendicitis and to monitor the long-term follow-up of non-operated patients. METHODS AND MATERIALS: Selected Acute Appendicitis patients were enrolled in this prospective comparative study (Conservative or non-operative vs operative or surgical treatment).Conservative treatment was based on a brief gut rest (partial or complete) and antibiotic therapy (Initially parenteral and then followed up with oral antibiotic). 105 patients of AA were selected for study, as per inclusion criteria. They were offered the options of conservative and surgical treatment. 52 patients opted for and complied with conservative treatment; rest (53) declined and opted for surgery,so were operated (Laparoscopic/Open) and taken as controls.Enrolment in study was done from March 2015 to February 2017 and they were further followed up for a period of 2 plus years. Secondary outcomes include hospital length of stay and cost,days of missed works and return to normal activity at home;and these were compared in both the groups (conservative vs.operative). RESULT: In non-operative group (52 patients), 4 patients (7.69 %) failed to respond satisfactorily and managed by appendectomy. 2 patients (3.85 %) developed appendicular lump in the course and they were also operated with interval appendicectomy, so 6 patients were considered as early failures (11.54%) with early success rate of 88.46%. Four patients experienced recurrent attacks of acute appendicitis (AA);in them, repeat conservative approach was not tried and they were managed with appendectomy.This brought down the Late success rate to 80.76%.In appendectomy group, 2 patients complained of persistent discomfort in right lower abdomen, five patients developed wound or port site infection and one patient developed incisional hernia. In non-operative group, hospital stays were shorter with lesser hospital costs and days of missed work and also statistically significant as compared to appendectomy group. CONCLUSION:This study confirms the feasibility,safety and optimum success rate of non-operative treatment of early AA in selected patients.

scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

scholarly journals Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

2020 ◽  
Vol 86 (11) ◽  
pp. 1508-1512
Author(s):  
Mariana Kumaira Fonseca ◽  
Eduardo N. Trindade ◽  
Omero P. Costa Filho ◽  
Miguel P. Nácul ◽  
Artur P. Seabra
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Symptom Onset ◽  
Hospital Admissions ◽  
Average Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Time Interval ◽  
Emergency Presentation

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

S111 – Monitoring Frequency: A Determinant in Free Tissue Transfer

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P114-P114
Author(s):  
Joshua D Hornig
Keyword(s):  
Length Of Stay ◽  
Group Versus ◽  
Free Tissue Transfer ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Success Rates ◽  
Minimal Group ◽  
Tissue Transfer ◽  
Flap Loss ◽  
Flap Monitoring

Objectives 1) To compare the success rates of free tissue transfer (FTT) between a cohort of patients who underwent frequent scheduled checks to a cohort who received checks on an as-needed basis. 2) To compare the overall flap survival, ICU stay, in-hospital stay, complications, and cost. Methods Patients meeting the criteria for free tissue transfer were divided into 2 cohorts: minimal FTT monitoring and frequent scheduled FTT monitoring. In August 2005, frequent scheduled flap monitoring was instituted. The study was set up to identify if this method impacted overall patient outcomes. The 2 groups were compared over several dimensions: overall flap outcome, total vs. partial flap loss, length of stay in hospital, revision procedures, and complications. Results A total of 212 patients were identified. 107 of the patients were in the frequent, scheduled group and 105 were in the minimal group. The overall FTT success rates were significantly higher in the frequently scheduled group versus the minimal group (100% vs 89%). The rates of partial flap loss and total flap loss were higher in the minimal group (11% vs 4%). The overall length of stay in the hospital, length of stay in the ICU, and complication rates were nonsignificant between the 2 groups. However, the number of revision procedures were significantly lower in the frequently scheduled FTT group. Conclusions The implementation of frequent scheduled flap monitoring significantly improves free tissue transfer survival in head and neck patients and decreases the number of revision procedures that need to be performed.

scholarly journals Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks

2018 ◽  
Vol 79 (05) ◽  
pp. 451-457 ◽  
Author(s):  
Enrique Perez ◽  
Daniel Carlton ◽  
Matthew Alfarano ◽  
Eric Smouha
Keyword(s):  
Cerebrospinal Fluid ◽  
Length Of Stay ◽  
Skull Base ◽  
Success Rate ◽  
Average Length ◽  
Tertiary Care ◽  
Success Rates ◽  
Base Thickness ◽  
Transmastoid Approach ◽  
Csf Leaks

Objective Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population. Method We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case. Results We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (R 2 = 0.00011). Conclusion The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.

Cost minimization analysis of outpatient parenteral/oral antibiotic therapy at a trauma hospital: Public health system

2021 ◽  
pp. 1-6
Author(s):  
Gustavo Henrique Loesch ◽  
June Alisson Westarb Cruz ◽  
Juliano Gasparetto ◽  
Dayana dos Santos Oliveira ◽  
Joao Paulo Telles ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Cost Minimization ◽  
Cumulative Risk ◽  
Hospital Environment ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Medication Costs ◽  
The Impact

Abstract Objective: To evaluate the impact of outpatient parenteral antimicrobial therapy (OPAT) on a public hospital in a middle-income country. Design: A retrospective, observational study analyzing the economic data retrieved on the dehospitalization of patients on antibiotic therapy. Setting: Public university trauma hospital. Patients: Data were collected from June 2017 to May 2020. Antibiotic cost, hospital length of stay, and risk of multidrug-resistant (MDR) infection or colonization were reviewed, along with the break-even point at which a balance occurs between OPAT antimicrobial costs and all in-hospital costs. A cumulative risk curve was constructed showing the incidence of MDR during the review period. Results: In total, 225 patients were studied. The implementation of OPAT resulted in a reduction of $156,681 (49.6%), which is equivalent to an average of $696 per patient, as well as a shortened length of stay, from 33.5 to 15.7 days. OPAT reduces the risk of acquiring infection by MDR bacteria by having the final treatments administered outside of the hospital environment. The breakeven curves, comparing the duration of the OPAT to daily medication costs, allowed for the prediction of the time and dollar costs of antibiotic therapy. Conclusions: OPAT presented a significant cost savings, shortened length of stay, and reduced risk of contamination of patients by MDR.

scholarly journals Management of pediatric blunt abdominal trauma: تدبير رضوح البطن الكليلة عند الأطفال

2021 ◽  
Vol 5 (4) ◽  
pp. 27-20
Author(s):  
Wassem Ameer Shater, Mohammad Ali Nasser, Ali Mohammad Allou Wassem Ameer Shater, Mohammad Ali Nasser, Ali Mohammad Allou
Keyword(s):  
Operative Treatment ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Surgical Intervention ◽  
Operative Management ◽  
Pancreatic Injury ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Abdominal Injuries ◽  
Non Operative Management

Aim of study: Evaluating a non- operative treatment of pediatric blunt abdominal trauma and avoiding unnecessary surgical intervention in Tishreen University Hospital. Methods: During years (2016- 2020) a retroprospective study was conducted on 62 children who had isolated blunt abdominal trauma or associated with other injuries, most of them were managed by non- operative treatment but some required surgical management. Results: Non- operative management of pediatric blunt abdominal injuries was applied for 59 patients, three patients required a surgical procedure, the spleen was the most organ exposed to injury (40) child, followed by liver (26) child, kidney (4) and (1) pancreatic injury. Non- operative management was successful in most solid organs injuries with grades 1, 2 and 3, but it failed in 5 grade splenic injury. one out of two hollow viscus injuries required surgical intervention. There were no statistical differences between the study groups in age, gender and injury mechanism. Hospital length of stay was significantly longer in patients who underwent a laparotomy (6) days compared to other non- operative patients (3) days, one complication occurred during non- operative management as pseudocyst after pancreatic injury, (4) patient died in the non- operative group due to hemodynamic instability and associated severe cerebral injuries. Conclusion: It is safe to treat most children with blunt abdominal injuries non- operatively if monitoring is adequate with hemodynamic stability.

scholarly journals Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

2020 ◽  
Vol 4 (1) ◽  
pp. e000831
Author(s):  
George S Bethell ◽  
Clare M Rees ◽  
Jonathan R Sutcliffe ◽  
Nigel J Hall
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Imaging ◽  
Hospital Admission ◽  
Patient Outcomes ◽  
Operative Treatment ◽  
Treatment Strategy ◽  
Hospital Readmissions ◽  
Operative Management ◽  
Study Cohort ◽  
The Uk

ObjectivesAcute appendicitis is the most common surgical condition in children. In the UK, appendicectomy is the most common treatment with non-operative management unusual. Due to concerns about the risk of SARS-CoV-2 transmission during surgical procedures, surgeons were advised to consider non-operative treatment and avoid laparoscopy where possible. This study aims to report management and outcomes, to date, of children with appendicitis in the UK and Ireland during the COVID-19 pandemic.DesignSurvey of consultant surgeons who treat children with appendicitis that informed a prospective multicentre observational cohort study.SettingData were collected from centres in the UK and Ireland for cases admitted between 1 April and 31 May 2020 (first 2 months of the COVID-19 pandemic) at both general surgical and specialist paediatric surgical centres.ParticipantsThe study cohort includes 838 children with a clinical and/or radiological diagnosis of acute appendicitis of which 527 (63%) were male.Main outcomes measuredPrimary outcome was treatment strategy used for acute appendicitis. Other outcomes reported include change in treatment strategy over time, use of diagnostic imaging and important patient outcomes to 30 days following hospital admission.ResultsFrom very early in the pandemic surgeons experienced a change in their management of children with appendicitis and almost all surgeons who responded to the survey anticipated further changes during the pandemic. Overall, 326/838 (39%) were initially treated non-operatively of whom 81/326 (25%) proceeded to appendicectomy within the initial hospital admission. Of cases treated initially surgically 243/512 (48%) were performed laparoscopically. Diagnostic imaging was used in 445/838 (53%) children. Cases treated non-operatively had a shorter hospital stay than those treated surgically but hospital readmissions within 30 days were similar between groups. In cases treated surgically the negative appendicectomy rate was 4.5%. There was a trend towards increased use of surgical treatment and from open to laparoscopic appendicectomy as the pandemic progressed.ConclusionNon-operative treatment of appendicitis has been widely used for the first time in children in the UK and Ireland and is safe and effective in selected patients. Overall patient outcomes do not appear to have been adversely impacted by change in management during the pandemic thus far.

scholarly journals 191. Oral Antibiotic Step-Down Therapy for Non-Staphylococcal Gram-Positive Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S203-S203
Author(s):  
Kelvin Gandhi ◽  
Magdalena Wrzesinski ◽  
Kristen Bunnell ◽  
Ashley Long ◽  
Vanessa Hutzley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Bloodstream Infections ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bivariate Analysis ◽  
Oral Antibiotic ◽  
Clinical Failure ◽  
Oral Group ◽  
Step Down ◽  
Primary Composite Outcome

Abstract Background Bloodstream infections are traditionally treated with intravenous (IV) antimicrobial therapy, which may increase length of stay and healthcare costs. The purpose of this study is to evaluate if oral antibiotic step-down therapy for non-staphylococcal gram-positive bloodstream infections (GP-BSIs) is non-inferior to IV antibiotics. Methods This single-center, retrospective cohort study included patients with a non-Staphylococcus aureus, non-Staphylococcus lugdunensis GP-BSI from January 2017 to December 2019. Patients were excluded if they fit any of the following criteria: organism identified as contaminant, polymicrobial BSI, recurrent BSI within the past 90 days, or receipt of an effective antibiotic for a duration longer than what is indicated for BSI treatment. Patients were categorized into those who received an IV antibiotic for the total duration of therapy and those who received an oral step-down antibiotic for at least one-third of the treatment course. The primary composite outcome was the incidence of 90-day clinical failure consisting of 90-day all-cause mortality, change in therapy due to inadequate clinical response, and 90-day BSI recurrence. The secondary outcomes included the individual components of the primary composite outcome, line-related complications, and hospital length of stay. Bivariate analysis was conducted to assess for predictors of 90-day clinical failure. Results A total of 308 patients were included (oral group, n=94; IV group, n=214). Pitt Bacteremia Scores were low overall, but higher in the IV group (0 vs 1, p=0.045). The oral group had a higher proportion of GP-BSI caused by streptococcal species (76% vs 61%, p< 0.001). The oral group had a lower incidence of 90-day clinical failure and was found to be noninferior to the IV group (9% vs 14%; mean difference -5%, 90% CI -12.7 to 2.6). The IV group had a longer hospital length of stay (4 vs 6 days, p< 0.001), however there were no other significant differences in secondary outcomes. Bivariate analysis found no significant predictors of 90-day clinical failure. Conclusion Oral antibiotic step-down therapy was found to be non-inferior to IV antibiotic therapy, and thus may be an alternative option for the treatment of non-staphylococcal GP-BSIs. Disclosures All Authors: No reported disclosures

CROSS SECTIONAL STUDY OF SUCCESS RATE OF EXTERNAL DACRYOCYSTORHINOSTOMY SURGERY WITH AND WITHOUT INTUBATION STENT USAGE IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 11-12
Author(s):  
Kokila G. Kamath ◽  
Vishal S Jadhav
Keyword(s):  
Success Rate ◽  
Tertiary Care ◽  
Operative Management ◽  
Care Hospital ◽  
Success Rates ◽  
Silicone Tube ◽  
Cross Sectional ◽  
Silicone Tube Intubation ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Dacryocystorhinostomy is widely considered as the standard treatment due to chronic nasolacrimal duct obstruction (NLDO). These procedures include standard external Dacryocystorhinostomy (DCR), non-laser endonasal endoscopic DCR (EN-DCR), and endonasal endoscopic laser DCR (LA-DCR)1. However external DCR is considered as the gold standard surgical method in the treatment of NLDO. Our study describes a comparative study of success rates of external DCR surgery, wherein 30 patients each were included for with and without silicone tube intubation usage respectively. The results showed a higher success rate (90%) in outcome of external DCR surgery using silicone tube intubation as compared to that without its usage (80%). Therefore, this study was aimed to shed further light on EXDCR surgery using intubation stents. The study also helps in shedding light on better post-operative management and obtaining higher success rates in case of EX-DCR surgery.

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