scholarly journals Appendicitis During the COVID-19 Pandemic: Lessons Learnt From a District General Hospital

2021 ◽  
Author(s):  
Heather Caroline Mitchell Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract BackgroundThe COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. MethodsThis retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. ResultsThere were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p=0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative.ConclusionDuring the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heather C. M. Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George E. Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract Background The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. Methods This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
H Pringle ◽  
U Donigiewicz ◽  
M Bennett ◽  
G F Fowler ◽  
E Walker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Treatment Failure ◽  
Medical Records ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management ◽  
Guide Care

Abstract Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals EP.WE.709A local experience of non-operative management for an appendicitis cohort during COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Nainika Suresh Menon ◽  
Oliver Claydon ◽  
Billy Down ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Conservative Management ◽  
Primary Outcome ◽  
Day Treatment ◽  
District General Hospital ◽  
Operative Management ◽  
Complication Rates ◽  
Local Experience ◽  
Non Operative Management ◽  
Locally Conservative

Abstract Background During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis. This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort. Methods An observational study was conducted in a district general hospital. All episodes of appendicitis were prospectively studied from 25th March 2020 until 26th May 2020 and compared with a retrospective pre-COVID cohort from 27th November 2019 until 29th January 2020. Primary outcome was 30-day treatment failure of simple appendicitis for conservatively managed cases during COVID-19 compared to surgically managed cases pre-pandemic. Treatment failure was defined as any unplanned radiological or surgical intervention. Results Over nine weeks, there were 39 cases of appendicitis during COVID-19 and 50 cases pre-COVID-19. Twenty-six and 50 cases underwent appendicectomy during and pre-COVID-19 respectively. There was no difference in 30-day postoperative complication rates and nor were there any peri-operative COVID-19 infections. Twelve cases of simple appendicitis underwent conservative management during COVID-19 and were compared with 23 operatively managed simple cases pre-pandemic. There was a higher failure rate in the conservative versus operative group (33.3 vs 0% OR = 24.88, 95% CI 1.21 to 512.9, p = 0.0095). Length of stay was similar (1.5 vs 2.0 p = 0.576). Discussion Locally, conservative management was more likely to fail than initial appendicectomy. We suggest that surgery should remain first line for appendicitis, with conservative management reserved for those with suspected or proven COVID-19 infection.

scholarly journals A Retrospective Cohort and Systematic Review of Non-Operative Management of Exposed Calvaria Post-Radiotherapy

Cureus ◽  
2020 ◽  
Author(s):  
Pinkal Patel ◽  
James Edward Massey Young ◽  
Mark McRae ◽  
Jenny Santos ◽  
Carolyn Levis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Retrospective Cohort ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital?

2009 ◽  
Vol 17 (1) ◽  
pp. 22 ◽  
Author(s):  
George A Giannopoulos ◽  
Iraklis E Katsoulis ◽  
Nikolaos E Tzanakis ◽  
Panayotis A Patsaouras ◽  
Michalis K Digalakis
Keyword(s):  
General Hospital ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
District General Hospital ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Renal Shell injuries with Retaining renal shell fragments due to improvised explosive devices. Acute conservative approach and long term follow-up

2021 ◽  
Author(s):  
Murat Zor ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Sercan Yilmaz ◽  
Sinan Akay ◽  
...  
Keyword(s):  
Renal Injury ◽  
Medical Records ◽  
Operative Management ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Grade 3 ◽  
One Year ◽  
Non Operative Management ◽  
Shell Fragments

Abstract Introduction: Among penetrating injuries, renal shrapnel injuries consist of a rarity of renal gunshot injuries. Due to the paucity of cases reported in the literature, there is no consensus regarding the management of renal shrapnel injuries and retaining renal shell fragments. In this study we aimed to report our non-operative management experience of renal shrapnel injuries who had also retaining renal shell fragments.Material and Methods: We retrospectively evaluated the medical records of renal shrapnel injuries that had also retaining renal shell fragments. All hemodynamically stable patients managed non-operatively and included to the study. The medical records of age, renal injury grade according to AAST, presenting pulse, systolic blood pressure, transfusion requirement, complications and need for adjuvant procedures, non-operative management success and mortality was reviewed. Complication rates due to retaining renal shell fragments were assessed by interviewing via telephone at the end of the first year of injury. The patients asked for plumbism symptoms and any surgical intervention for these foreign bodies.Results: A total of 8 patients with retaining renal shell fragments due to renal shrapnel injuries were included to the study. Mean patient age was 27,8 years. Mean follow-up period was 38.7±15.1 months. All patients were male. AAST renal injury scores were grade 1 one, grade 2 two, grade 3 four, grade 4 one patient. All patients were successfully managed non-operatively and discharged on the 7th day without any complication. No symptoms of plumbism and surgery necessity secondary to retaining renal shell fragments were seen in at least one year follow-up.Conclusion: Our study demonstrates that non-operative management of renal shrapnel injuries with retaining renal shell fragments lead low complication rates and high chance of renal preservation. However, we must keep in mind that this kind of management is safe in experienced trauma centers that have experienced staff.

scholarly journals Study of conservative treatment in uncomplicated acute appendicitis

2017 ◽  
Vol 4 (4) ◽  
pp. 1409 ◽  
Author(s):  
B. S. Gedam ◽  
Ajit Gujela ◽  
Prasad Y. Bansod ◽  
Murtaza Akhtar
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Treatment Failure ◽  
Tertiary Care ◽  
Operative Management ◽  
Care Hospital ◽  
Alvarado Score ◽  
Modified Alvarado Score ◽  
Uncomplicated Acute Appendicitis ◽  
Non Operative Management

Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.

scholarly journals Testicular appendage torsion managed non-operatively

2017 ◽  
Vol 4 (4) ◽  
pp. 1201
Author(s):  
Masimba Nyandowe ◽  
Alfred Egedovo
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Operative Management ◽  
Inclusion Criteria ◽  
Viable Option ◽  
Testicular Pain ◽  
Non Operative Management

Background: Acute testicular pain is one of the commonest reasons of testicular exploration. Testicular appendage torsion is one of conditions presenting with testicular pain. If the diagnosis is certain this can be managed conservatively. Operative management is reserved for those patients in whom non-operative management fails. The objective of this study was to ascertain the success of conservative management.Methods: The medical records of thirty-four consecutive patients who were diagnosed with testicular appendage torsion, were managed non-operatively and satisfied the inclusion criteria were retrospectively analysed.  Results: The average age of patients was 16.3 years. 94% of the patients were successfully managed non-operatively. Pain not controlled by analgesia was the main reason for representing to the emergency department. All patients were discharged from any further follow up by day 9.Conclusions: Where the diagnosis of testicular appendage torsion is confidently made, non-operative management is a viable option. Larger studies are required to confirm these findings.

scholarly journals Splenic trauma, the way forward in reducing splenectomy: our 15-year experience

2020 ◽  
Vol 102 (4) ◽  
pp. 263-270
Author(s):  
H Jesani ◽  
L Jesani ◽  
A Rangaraj ◽  
A Rasheed
Keyword(s):  
Computed Tomography ◽  
Splenic Injury ◽  
District General Hospital ◽  
Operative Management ◽  
Therapeutic Modality ◽  
Splenic Trauma ◽  
Female Ratio ◽  
Non Operative Management ◽  
Male To Female ◽  
Retrospective Database

Introduction The aim of this study was to study radiological assessment, management and outcome of traumatic splenic injury over 15 years in a UK district general hospital. Method A retrospective database was established including all splenic injury cases from June 2002 to June 2017 by searching the clinical electronic database. We searched the radiological database for computed tomography reported phrases ‘spleen injury’, ‘laceration’, ‘haematoma’, ‘trauma’. We interrogated theatre records for operations coded as splenectomy and cross-referenced this with pathology. Records were reviewed for demographics, vital observations, documentation of American Association for the Surgery of Trauma (AAST) grading of splenic injury, subsequent management and outcomes. Results There were 126 patients identified with traumatic splenic injury, with male to female ratio three to one. Operative management was undertaken in 54/126 (43%) patients and selective non-operative management in the remaining. Splenic artery embolisation was undertaken in 5/126 (4%) and 2/126 underwent splenorrhaphy. Computed tomography was undertaken in 109/126 (87%) patients and AAST grading was reported in 18 (17%) patients. AAST grade reporting did not improve significantly when comparing the first 7.5 years with the latter (2/30, 7%; 16/79, 20%), respectively; p = 0.09). Selective non-operative management increased significantly over the studied period (14/34, 42%; 58/93, 62%; p = 0.04). The overall hospital mortality was 10.3%. Discussion and conclusion AAST grade reporting of splenic injury has remained sub-optimal over 15 years. Despite progression towards selective non-operative management, operative intervention remained unacceptably high, with splenectomy being the main therapeutic modality. Standardisation through an integrated multidisciplinary diagnostic and management pathway offers the optimal strategy to reduce trauma-induced splenectomy.

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