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1.
Isr Med Assoc J ; 26(6): 355-360, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38884308

RESUMO

BACKGROUND: Pseudomonas aeruginosa (PSA) is an infectious pathogen associated with acute appendicitis; however, it is not consistently addressed by empirical antibiotic therapy, despite potential complications. OBJECTIVES: To investigate the incidence, predictors, and outcomes of PSA-associated acute appendicitis in children. METHODS: We conducted a retrospective analysis involving pediatric patients who underwent acute appendicitis surgery and had positive peritoneal cultures. Clinical, microbiological, and intraoperative data were extracted from medical records. RESULTS: Among 2523 children with acute appendicitis, 798 (31.6%) underwent peritoneal cultures, revealing 338 positive cases (42.3%), with PSA detected in 77 cases (22.8%). Children with PSA were three times more likely to exhibit high intraoperative grading ≥ 3 (93.4% vs. 76.8%, 95% confidence interval [95%CI] 1.2-8.3, P = 0.023) and nearly four times more likely to have polymicrobial cultures (88.3% vs. 62.1%, 95%CI 1.8-8.0, P < 0.001) than those without PSA in peritoneal cultures. Duration of symptoms did not predict PSA isolation (P = 0.827). Patients with PSA had longer median hospital stays (8 days, interquartile range [IQR] 7-10) than those with other pathogens (7 days, IQR 5-9) (P = 0.004). Antibiotic treatment duration, intensive care unit admission rates, readmission, and mortality were similar between the two groups (P = 0.893, 0.197, 0.760, and 0.761, respectively). CONCLUSIONS: PSA is a common pathogen in children diagnosed with acute appendicitis and positive peritoneal cultures. The likelihood of isolating PSA increases with high-grade intraoperative assessment and in the presence of multiple pathogens in peritoneal cultures, suggests antipseudomonal treatment.


Assuntos
Antibacterianos , Apendicite , Infecções por Pseudomonas , Pseudomonas aeruginosa , Humanos , Apendicite/microbiologia , Apendicite/cirurgia , Apendicite/epidemiologia , Feminino , Pseudomonas aeruginosa/isolamento & purificação , Criança , Estudos Retrospectivos , Masculino , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/diagnóstico , Incidência , Antibacterianos/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Apendicectomia/métodos , Doença Aguda , Israel/epidemiologia , Adolescente , Pré-Escolar
2.
BMC Surg ; 24(1): 166, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38807152

RESUMO

BACKGROUND: The emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR testing mandates for medical treatment seekers were introduced to mitigate virus transmission. AIMS: This study examines the impact of these changes on the management of patients with appendicitis. METHODS: We conducted a retrospective analysis of medical records for 748 patients diagnosed with appendicitis who underwent surgery at a tertiary care hospital during two distinct periods, the pre-pandemic year 2019 and the post-pandemic year 2021. Patient demographics, clinical characteristics, laboratory data, surgical outcomes, and hospital stay duration were assessed. RESULTS: While no significant differences were observed in the general characteristics of patients between the two groups, the time from hospital visit to operation increased significantly during the pandemic. Unexpectedly, delayed surgical intervention was associated with shorter hospital stays but did not directly impact complication rates. There was no discernible variation in the type of surgery or surgical timing based on symptom onset. The pandemic also prompted an increase in appendicitis cases, potentially related to coronavirus protein expression within the appendix. CONCLUSIONS: The COVID-19 pandemic has reshaped the landscape of appendicitis management. This study underscores the complex interplay of factors, including changes in hospital protocols, patient concerns, and surgical timing. Further research is needed to explore the potential link between COVID-19 and appendicitis. These insights are valuable for informing healthcare practices during and beyond the pandemic.


Assuntos
Apendicectomia , Apendicite , COVID-19 , Tempo de Internação , Humanos , Apendicite/cirurgia , Apendicite/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Retrospectivos , Masculino , Feminino , China/epidemiologia , Adulto , Apendicectomia/métodos , Pessoa de Meia-Idade , Tempo de Internação/estatística & dados numéricos , Tempo para o Tratamento , Pandemias , SARS-CoV-2 , Adulto Jovem , Idoso
3.
J Surg Res ; 298: 307-315, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38640616

RESUMO

INTRODUCTION: Nonoperative management (NOM) of uncomplicated appendicitis (UA) has been increasingly utilized in recent years. The aim of this study was to describe nationwide trends of sociodemographic characteristics, outcomes, and costs of patients undergoing medical versus surgical management for UA. METHODS: The 2018-2019 National (Nationwide) Inpatient Sample was queried for adults (age ≥18 y) with UA; diagnosis, as well as laparoscopic and open appendectomy, were defined by the International Classification of Diseases, 10th Revision, Clinical Modification codes. We examined several characteristics, including cost of care and length of hospital stay. RESULTS: Among the 167,125 patients with UA, 137,644 (82.4%) underwent operative management and 29,481 (17.6%) underwent NOM. In bivariate analysis, we found that patients who had NOM were older (53 versus 43 y, P < 0.001) and more likely to have Medicare (33.6% versus 16.1%, P < 0.001), with higher prevalence of comorbidities such as diabetes (7.8% versus 5.5%, P < 0.001). The majority of NOM patients were treated at urban teaching hospitals (74.5% versus 66.3%, P < 0.001). They had longer LOS's (5.4 versus 2.3 d, P < 0.001) with higher inpatient costs ($15,584 versus $11,559, P < 0.001) than those who had an appendectomy. Through logistic regression we found that older patients had up to 4.03-times greater odds of undergoing NOM (95% CI: 3.22-5.05, P < 0.001). CONCLUSIONS: NOM of UA is more commonly utilized in patients with comorbidities, older age, and those treated in teaching hospitals. This may, however, come at the price of longer length of stay and higher costs. Further guidelines need to be developed to clearly delineate which patients could benefit from NOM.


Assuntos
Apendicectomia , Apendicite , Tempo de Internação , Humanos , Apendicite/cirurgia , Apendicite/economia , Apendicite/terapia , Apendicite/epidemiologia , Adulto , Masculino , Feminino , Pessoa de Meia-Idade , Apendicectomia/economia , Apendicectomia/estatística & dados numéricos , Estados Unidos/epidemiologia , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/economia , Idoso , Adulto Jovem , Adolescente , Laparoscopia/economia , Laparoscopia/estatística & dados numéricos , Estudos Retrospectivos , Tratamento Conservador/economia , Tratamento Conservador/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos
4.
J Pediatr Surg ; 59(8): 1477-1485, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38565474

RESUMO

OBJECTIVE: Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach. METHODS: A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769). RESULTS: Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35-2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)). CONCLUSION: Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing. LEVEL OF EVIDENCE: Level II.


Assuntos
Apendicectomia , Apendicite , Obstrução Intestinal , Complicações Pós-Operatórias , Humanos , Apendicite/cirurgia , Apendicite/complicações , Apendicite/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/cirurgia , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Criança , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Aderências Teciduais/complicações , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Incidência , Fatores de Risco
5.
Int J Colorectal Dis ; 39(1): 50, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38598172

RESUMO

PURPOSE: Appendicitis, characterized by inflammation of the vermiform appendix, is a common abdominal emergency necessitating appendectomy. Recent evidence suggests a potential link between appendicitis and subsequent diverticular disease, yet population-based studies investigating this association are limited. METHODS: Utilizing the Disease Analyzer database encompassing data from over 1000 primary care practices in Germany, we conducted a retrospective cohort study. We included 25,379 adults diagnosed with appendicitis and an equal number of matched controls without appendicitis. The incidence of diverticular disease over a 10-year follow-up period was compared between the two cohorts. Cox regression analysis was performed to assess the association between appendicitis and diverticular disease, adjusting for potential confounders. RESULTS: Our findings revealed a significant association between appendicitis and subsequent diverticular disease (HR: 1.76; 95% CI: 1.57-1.97), with an increased risk observed across all age groups. Notably, this association was stronger in men (HR: 2.00; 95% CI: 1.68-2.37) than in women (HR: 1.58; 95% CI: 1.36-1.84). The cumulative 10-year incidence of diverticular disease was higher in patients with appendicitis (6.5%) compared to those without (3.6%). Additionally, we observed a clear age-dependent increase in the incidence of diverticular disease. CONCLUSION: This large-scale population-based study provides valuable insights into the interaction between appendicitis and diverticular disease. The study underscores the need for further research elucidating the underlying mechanisms linking appendicitis to diverticular disease. Probiotics emerge as a potential therapeutic avenue warranting exploration in the management of both conditions. These findings have important implications for clinical practice, highlighting the importance of considering appendicitis as a potential risk factor for diverticular disease, particularly in men. Further investigation is warranted to validate these findings and explore potential therapeutic interventions targeting the shared pathophysiological pathways underlying both conditions.


Assuntos
Apendicite , Doenças Diverticulares , Adulto , Masculino , Humanos , Feminino , Apendicite/complicações , Apendicite/epidemiologia , Estudos de Coortes , Estudos Retrospectivos , Inflamação , Doenças Diverticulares/complicações , Doenças Diverticulares/epidemiologia
6.
BMC Surg ; 24(1): 121, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38658891

RESUMO

BACKGROUND: Nonoperative management of uncomplicated appendicitis is currently being promoted as treatment option, albeit 0.7-2.5% of appendectomies performed due to suspected acute appendicitis show histologically malignant findings. The purpose of this study was to investigate the incidence of neoplasm and malignancy of the appendix in patients presenting with suspected acute appendicitis in real world setting. METHODS: This is a retrospective single-centre investigation of 457 patients undergoing appendectomy between the years 2017-2020. The patients' demographics, symptoms and diagnosis, intraoperative findings, and histopathological results were analysed. RESULTS: In 3.7% (n = 17) histological analysis revealed neoplasms or malignancies. Median age was 48 years (20-90 years), without sex predominance. Leukocytes (11.3 ± 3.7 G/l) and C-reactive protein (54.2 ± 69.0 mg/l) were elevated. Histological analysis revealed low-grade mucinous appendiceal neoplasia (n = 3), sessile serrated adenoma of the appendix (n = 3), neuroendocrine tumours (n = 7), appendiceal adenocarcinoma of intestinal type (n = 3), and goblet cell carcinoma (n = 1). Additional treatment varied between no treatment or follow-up due to early tumour stage (n = 4), follow-up care (n = 3), additional surgical treatment (n = 8), or best supportive care (n = 2). CONCLUSIONS: Preoperative diagnosis of appendiceal tumours is difficult. Nonoperative management of patients with acute, uncomplicated appendicitis potentially prevents the correct diagnosis of malignant appendiceal pathologies. Therefore, close follow-up or surgical removal of the appendix is mandatory.


Assuntos
Apendicectomia , Neoplasias do Apêndice , Apendicite , Humanos , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/terapia , Neoplasias do Apêndice/cirurgia , Apendicite/epidemiologia , Apendicite/cirurgia , Apendicite/diagnóstico , Apendicite/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Masculino , Feminino , Adulto , Idoso , Apendicectomia/estatística & dados numéricos , Incidência , Idoso de 80 Anos ou mais , Adulto Jovem , Doença Aguda
9.
Langenbecks Arch Surg ; 409(1): 87, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38441707

RESUMO

INTRODUCTION: Appendiceal neoplasms (ANs) are rare, with an estimated incidence of around 1%: neuroendocrine tumours (NETs) and low-grade appendiceal mucinous neoplasms (LAMNs) comprise most cases. Most tumours are cured by appendectomy alone, although some require right hemicolectomy and intra-operative chemotherapy. The aim of the present study is to evaluate our institution's experience in terms of the prevalence of AN, their histological types, treatment and outcomes in adult patients undergoing emergency appendectomy. MATERIAL AND METHODS: Single-centre retrospective cohort analysis of patients treated for acute appendicitis at a large academic medical centre. Patients with a diagnosis of acute appendicitis (AA) where further compared with patients with acute appendicitis and a histologically confirmed diagnosis of appendiceal neoplasm (AN). RESULTS: A diagnosis of acute appendicitis was made in 1200 patients. Of these, 989 patients underwent emergency appendectomy. The overall incidence of appendiceal neoplasm was 9.3% (92 patients). AN rate increased with increasing age. Patients under the age of 30 had a 3.8% (14/367 patients) rate of occult neoplasm, whereas patients between 40 and 89 years and older had a 13.0% rate of neoplasm. No difference was found in clinical presentations and type of approach while we found a lower complicated appendicitis rate in the AN group. CONCLUSION: ANs are less rare with respect to the literature; however, clinically, there are no specific signs of suspicious and simple appendicectomy appears to be curative in most cases. However, age plays an important role; older patients are at higher risk for AN. ANs still challenge the non-operative management concept introduced into the surgical literature.


Assuntos
Neoplasias do Apêndice , Apendicite , Adulto , Humanos , Apendicite/epidemiologia , Apendicite/cirurgia , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/cirurgia , Apendicectomia , Estudos Retrospectivos , Doença Aguda
10.
Arch Dis Child ; 109(4): 339-346, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38325911

RESUMO

OBJECTIVE: To describe the COVID-19 pandemic's impact on acute appendicitis management on children and young people (CYP). DESIGN: Retrospective cohort study. SETTING: All English National Health Service hospitals. PATIENTS: Acute appendicitis admissions (all, simple, complex) by CYP (under-5s, 5-9s, 10-24s). EXPOSURE: Study pandemic period: February 2020-March 2021. Comparator pre-pandemic period: February 2015-January 2020. MAIN OUTCOME MEASURES: Monthly appendicectomy and laparoscopic appendicectomy rate trends and absolute differences between pandemic month and the pre-pandemic average. Proportions of appendicitis admissions comprising complex appendicitis by hospital with or without specialist paediatric centres were compared. RESULTS: 101 462 acute appendicitis admissions were analysed. Appendicectomy rates fell most in April 2020 for the 5-9s (-18.4% (95% CI -26.8% to -10.0%)) and 10-24s (-28.4% (-38.9% to -18.0%)), driven by reductions in appendicectomies for simple appendicitis. This was equivalent to -54 procedures (-68.4 to -39.6) and -512 (-555.9 to -467.3) for the 5-9s and 10-24s, respectively. Laparoscopic appendicectomies fell in April 2020 for the 5-9s (-15.5% (-23.2% to -7.8%)) and 10-24s (-44.8% (-57.9% to -31.6%) across all types, which was equivalent to -43 (-56.1 to 30.3) and -643 (-692.5 to -593.1) procedures for the 5-9s and 10-24s, respectively. A larger proportion of complex appendicitis admissions were treated within trusts with specialist paediatric centres during the pandemic. CONCLUSIONS: For CYP across English hospitals, a sharp recovery followed a steep reduction in appendicectomy rates in April 2020, due to concerns with COVID-19 transmission. This builds on smaller-sized studies reporting the immediate short-term impacts.


Assuntos
Apendicite , COVID-19 , Humanos , Criança , Adolescente , COVID-19/epidemiologia , Estudos Retrospectivos , Pandemias , Apendicite/epidemiologia , Apendicite/cirurgia , Medicina Estatal , Doença Aguda
11.
JAMA Netw Open ; 7(1): e2353667, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38270955

RESUMO

This cohort study compares rates of delayed diagnosis and complications of appendicitis by race and ethnicity and Child Opportunity Index among children in 8 states.


Assuntos
Apendicite , Humanos , Criança , Apendicite/diagnóstico , Apendicite/epidemiologia
12.
BMC Surg ; 24(1): 18, 2024 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-38191368

RESUMO

INTRODUCTION: With it becoming a global pandemic, the coronavirus disease of 2019 (COVID-19) imposed public health restraints that hampered patient's presentation to hospitals. In Lebanon, little is known about the presentation patterns of acute appendicitis (AA) patients among different population groups during the COVID-19. Therefore, this study aims to assess the effects of the COVID-19 pandemic on the rates of cases seen during the pandemic period, the adopted management strategies, and evaluate the patient outcomes compared to presentations from previous years. METHODS: This is a retrospective, observational cohort study with no interventional procedures. All patients presented to our tertiary health care center were diagnosed with AA between February 2019 and February 2021 comprised the study analysis. We divided our patients into the pre-pandemic period cohort March 1st, 2019, till February 29th, 2020, and the pandemic period cohort March 1st 2020 till March 1st 2021. RESULTS: We collected data retrospectively from 342 patients: 201 patients presented in the pre-pandemic period and 141 during the pandemic period. Male predominance was seen in both cohorts (51.7% and 58.9% respectively). A decrease in the number of AA cases was seen during the pandemic, however, the duration of symptoms before presentation was similar in both cohorts (p = 0.382) Additionally, the number of complicated appendicitis cases was not different between cohorts. The main imaging modality was CT in both groups with no statistically significant difference in the type of imaging between them (p = 0.398). Further, the predominant treatment modality remained surgery during the pandemic, with no difference between both periods (p = 0.200), and no statistically significant difference in the type of surgery performed as laparoscopic surgery remained the most common surgery type in the pandemic period (p = 0.43). Finally, no extra surgical and post-surgical complications were identified. CONCLUSION: In conclusion, our study is an example of how the COVID-19 pandemic did not significantly affect patients presenting for AA. Despite the COVID-19-related restrictions, Lebanese patients with worrying symptoms were presenting to the emergency department and the American University of Beirut Medical Center was providing them with the standards of care. Our study mirrors the Lebanese experience and gives an example of a population that focused more on their current symptoms than the fear of acquiring the COVID-19 virus. Further research is needed to assess whether this was the correct approach during these times.


Assuntos
Apendicite , COVID-19 , Humanos , Masculino , Feminino , Centros de Atenção Terciária , COVID-19/epidemiologia , Apendicite/epidemiologia , Apendicite/cirurgia , Líbano/epidemiologia , Pandemias , Estudos de Coortes , Estudos Retrospectivos , Doença Aguda
13.
Am Surg ; 90(4): 780-787, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37915247

RESUMO

BACKGROUND: Appendectomy is the gold standard for simple appendicitis. During the coronavirus-19 pandemic, it was estimated that appendectomies in the United States decreased by 24%. We aimed to describe trends in acute appendicitis management at a center located in one of the largest epicenters of the pandemic. METHODS: This is a retrospective cohort study in a single institution located in Queens, New York, of patients who presented with acute appendicitis. A pre-COVID time period, March-June 2019, was compared to peak-COVID, March-June 2020, and late-COVID, March-June 2021. RESULTS: Of the 382 patients admitted with appendicitis during the time periods, 164 were admitted pre-COVID. Appendicitis presentations decreased by 44% during peak-COVID and 23% in late-COVID. Patients were younger during peak-COVID compared to pre-COVID (39 vs 34 years old, P = .036). Incidence of complicated appendicitis in pre-, peak-, and late-COVID was equivalent (41% vs 46% vs 45%) and operative management was similar (85% vs 76% vs 79%). Non-operative patients had shorter lengths of stay (pre- vs peak-COVID: 4.6 vs 2.9 days, P = .006). Readmission rates were similar between the cohorts across time periods. CONCLUSIONS: During peak-COVID, there was a significant decrease in presentation of acute appendicitis but clinical presentation and outcomes remained similar between the cohorts. Patients who were managed non-operatively may be discharged earlier without increased rates of readmissions.


Assuntos
Apendicite , COVID-19 , Humanos , Adulto , COVID-19/epidemiologia , Cidade de Nova Iorque/epidemiologia , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Pandemias , Estudos Retrospectivos , Doença Aguda
15.
ANZ J Surg ; 94(1-2): 204-207, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38082452

RESUMO

INTRODUCTION: Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors. METHODS: A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected. RESULTS: Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre-operative imaging (from 40% to nearly 100%). CONCLUSION: Low NAR under 2% is an achievable benchmark in the era of accessible pre-operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near-zero rates of NAR.


Assuntos
Apendicite , Apêndice , Criança , Humanos , Apendicectomia , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Estudos Retrospectivos , Apêndice/cirurgia , Apêndice/patologia , Tomografia Computadorizada por Raios X , Doença Aguda
16.
Dtsch Arztebl Int ; 121(2): 39-44, 2024 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-37967286

RESUMO

BACKGROUND: Appendectomy in children is performed either lapa - roscopically (LA) or by open surgery (OA). We studied whether, and how, the outcome is affected by the technique used and by the intraoperative conversion of LA to OA. METHODS: We analyzed routine data from children and adolescents in three age groups (1-5 years, 6-12 years, and 13-17 years) who were insured by the AOK statutory health insurance carrier in Germany and who underwent appendectomy in the period 2017-2019. General surgical complications and reoperations within 90 days were assessed with relevant indicators. Associations between the surgical technique and these indicators were studied with logistic regression. RESULTS: Of the 21 541 patients included in the study, general surgical complications were observed in 2.1% and reoperations in 1.8% overall. Broken down by age group, the corresponding figures were 5.4% and 4.4% (age 1 to 5), 2.5% and 1.8% (age 6 to 12), and 1.5% and 1.6% (age 13 to 17). The main risk factors for complications and reoperations were acute complicated appendicitis and conversion from LA to OA. Regression analysis revealed similar outcomes with OA compared to LA in the 1-to-5 age group, (odds ratios and 95% confidence intervals: 1.1 [0.6; 2.1] for general surgical complications and 1.5 [0.8; 2.7] for reoperations), but worse outcomes with OA in the other two age groups (age 6 to 12: 1.9 [1.2; 2.9] and 2.1 [1.5; 2.9]; age 13 to 17: 1.7 [1.0; 2.9] and 2.2 [1.4; 3.6]). When conversions were assigned to the LA group, the odds ratio (OA compared to LA) for reoperation across all age groups was 3.5 [2.8; 4.4] in patients with acute uncomplicated appendicitis and 4.2 [3.4; 5.3] in patients with complicated appendicitis. Complicated appendicitis also increased the rate of general surgical complications and the length of stay in hospital. CONCLUSION: Among children in the two older age groups, LA was followed by fewer general surgical complications and reoperations than OA. These differences were less pronounced when conversions were counted as belonging to the LA group. Children aged 1-5 appear to benefit the least from the lapa - roscopic technique.


Assuntos
Apendicite , Laparoscopia , Adolescente , Criança , Humanos , Idoso , Lactente , Pré-Escolar , Apendicectomia/efeitos adversos , Apendicite/epidemiologia , Apendicite/cirurgia , Reoperação , Alemanha/epidemiologia
17.
J Surg Res ; 294: 16-25, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37857139

RESUMO

INTRODUCTION: An ultrasound (US)-first approach for evaluating appendicitis is recommended by the American College of Radiology. We sought to assess the access to and utilization of an US-first approach for children with acute appendicitis in United States Emergency Departments. METHODS: Utilizing the 2019 Nationwide Emergency Department Sample, we performed a retrospective cohort study of patients <18 y with a primary diagnosis of acute appendicitis based on International Classification of Disease 10th Edition Diagnosis codes. Our primary outcome was the presentation to a hospital that does not perform US for children with acute appendicitis. Our secondary outcome was the receipt of a US at US-capable hospital. We developed generalized linear models with inverse-probability weighting to determine the association between patient characteristics and outcomes. RESULTS: Of 49,703 total children, 24,102 (48%) received a US evaluation. The odds of presenting at a hospital with no US use were significantly higher for patients aged 11-17 compared to patients <6 y (adjusted odds ratio [aOR] [95% confidence interval (CI)]: 1.59, [1.19- 2.13], P = 0.002); lowest median household income quartile compared to highest (aOR [95% CI]: 2.50, [1.52-4.10], P < 0.001); rural locations compared to metropolitan (aOR [95% CI]: 8.36 [5.54-12.6], P < 0.001), and Hispanic compared to non-Hispanic White (aOR [95% CI]: 0.63 [0.45-0.90], P = 0.01). The odds of receiving a US at US-capable hospitals were significantly lower for patients >6 y, lowest median household income quartiles, and rural locations (P < 0.05). CONCLUSIONS: Rural, older, and poorer children are more likely to present to hospitals that do not utilize US in the diagnosis of acute appendicitis and are less likely to undergo US at US-capable hospitals.


Assuntos
Apendicite , Serviço Hospitalar de Emergência , Disparidades em Assistência à Saúde , Ultrassonografia , Criança , Humanos , Apendicite/diagnóstico por imagem , Apendicite/epidemiologia , Apendicite/etnologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ultrassonografia/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Brancos/estatística & dados numéricos , Fatores Etários , População Rural
18.
Khirurgiia (Mosk) ; (10): 47-52, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37916557

RESUMO

OBJECTIVE: To determine the factors associated with prolonged hospital-stay after appendectomy in SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective observational cohort study included 420 patients after surgery for acute appendicitis between March 2019 and March 2020, April 2020 and April 2021. There were 336 patients before the SARS-COV-2 pandemic, and 84 ones underwent surgery during the pandemic. RESULTS: Incidence of prolonged hospital stay was 15% and 26%, respectively (RR 1.76). RR is more than 1 and assumes SARS-CoV-2 infection as a risk factor. CONCLUSION: There is an association between SARS-CoV-2 infection and prolonged hospital-stay after surgery for acute appendicitis (RR 1.76).


Assuntos
Apendicite , COVID-19 , Humanos , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/complicações , Estudos Retrospectivos , Apendicectomia/efeitos adversos , Tempo de Internação , Pandemias , Apendicite/epidemiologia , Apendicite/cirurgia , Apendicite/complicações , Complicações Pós-Operatórias/epidemiologia , Doença Aguda , Hospitais
19.
Langenbecks Arch Surg ; 408(1): 432, 2023 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-37940770

RESUMO

INTRODUCTION: Studies evaluating the rate and histology of appendiceal neoplasms between complicated and uncomplicated appendicitis include a small number of patients. Therefore, we sought a meta-analysis and systematic review comparing the rates and types of appendiceal neoplasm between complicated and uncomplicated appendicitis. METHODS: We included articles published from the time of inception of the datasets to September 30, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. RESULTS: A total of 4962 patients with appendicitis enrolled in 4 comparative studies were included. The mean age was 43.55 years (16- 94), and half were male (51%). Based on intra-operative findings, 1394 (38%) had complicated appendicitis, and 3558 (62%) had uncomplicated appendicitis. The overall incidence rate of neoplasm was 1.98%. No significant difference was found in the incidence rate of appendiceal neoplasm between complicated (3.29%) and uncomplicated (1.49%) appendicitis (OR 0.44, 95% CI 0.16- 1.23; p < 0.087; I2 = 54.9%). The most common appendiceal neoplasms were Neuroendocrine Tumors (NET) (49.21%), Nonmucinous Adenocarcinoma (24.24%), Mixed Adeno-Neuroendocrine Tumor (MANEC) (11.40%), Mucinous Adenocarcinoma (4.44%). There was a significant difference between complicated and uncomplicated appendicitis in rates of adenocarcinoma (50% vs. 13%), NET (31% vs. 74%), MANEC (19% vs. 13%) (P < 0.001). CONCLUSION: While there was no significant difference in the overall neoplasm rate between complicated and uncomplicated appendicitis, the NET rate was significantly higher in uncomplicated appendicitis. In comparison, the Adenocarcinoma rate was considerably higher in Complicated appendicitis. These findings emphasize the importance of evaluating risk factors for neoplasm when considering appendectomy in patients with appendicitis.


Assuntos
Adenocarcinoma , Neoplasias do Apêndice , Apendicite , Tumores Neuroendócrinos , Humanos , Masculino , Adulto , Feminino , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Apendicite/epidemiologia , Apendicite/cirurgia , Incidência , Fatores de Risco , Apendicectomia/efeitos adversos , Estudos Retrospectivos
20.
Pediatrics ; 152(6)2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38018230

RESUMO

OBJECTIVE: To investigate the potential association between preterm birth and infantile appendicitis. METHODS: We conducted a retrospective, multicenter, matched case-control study. This study included consecutive patients <1 year of age with surgery- or autopsy-confirmed appendicitis, admitted between December 2007 and May 2023. For each case, 10 healthy infants were randomly selected and matched by age. Infants were categorized as neonates (0 to 28 days) or older infants (>28 days and <1 year). RESULTS: The study included 106 infants diagnosed with appendicitis (median age 2.4 months) and 1060 age-matched healthy controls. In the univariate analysis, preterm birth was significantly associated with the development of appendicitis within the first year of life (odds ratio [OR], 4.23; 95% confidence interval [CI], 2.67-6.70). Other factors associated with a higher risk of infantile appendicitis included being male (OR, 1.91; 95%CI, 1.25-2.94), weight-for-age z-score (OR, 0.72; 95%CI, 0.64-0.81), and exclusively fed on formula (OR, 2.95; 95%CI, 1.77-4.91). In multivariable analyses, preterm remained significantly associated with appendicitis (adjusted OR, 3.32; 95%CI, 1.76-6.24). Subgroup analysis revealed that a preterm birth history increased the risk of appendicitis in both neonates (adjusted OR, 4.56; 95%CI, 2.14-9.71) and older infants (adjusted OR, 3.63; 95%CI, 1.72-7.65). However, preterm did not significantly influence the incidence of appendiceal perforation. CONCLUSIONS: Preterm infants have an increased risk of appendicitis during the first year of life. A preterm birth history may help improve the timely diagnosis of infantile appendicitis.


Assuntos
Apendicite , Nascimento Prematuro , Lactente , Feminino , Recém-Nascido , Humanos , Masculino , Recém-Nascido Prematuro , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Estudos de Casos e Controles
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