RESUMO
INTRODUCTION: The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis. MATERIALS AND METHODS: In this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed. RESULTS: The two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4-21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2-29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4-20.0), p = 0.016) were identified as independent risk factors for wound infections. CONCLUSION: The duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred.
Assuntos
Abscesso Abdominal , Antibacterianos , Apendicectomia , Apendicite , Infecção da Ferida Cirúrgica , Humanos , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Masculino , Feminino , Estudos Retrospectivos , Abscesso Abdominal/prevenção & controle , Abscesso Abdominal/etiologia , Antibacterianos/uso terapêutico , Adulto , Infecção da Ferida Cirúrgica/prevenção & controle , Pessoa de Meia-Idade , Incidência , Fatores de Risco , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologiaRESUMO
BACKGROUND: Perforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis. METHODS: This is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage. RESULTS: A total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table 1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835). CONCLUSIONS: Following laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay.
Assuntos
Apendicectomia , Apendicite , Drenagem , Laparoscopia , Complicações Pós-Operatórias , Humanos , Apendicectomia/métodos , Apendicectomia/efeitos adversos , Feminino , Masculino , Apendicite/cirurgia , Estudos Retrospectivos , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Drenagem/métodos , Adulto , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Adolescente , Tempo de Internação/estatística & dados numéricos , Abscesso Abdominal/prevenção & controle , Abscesso Abdominal/etiologia , Abscesso Abdominal/epidemiologia , Criança , Adulto JovemRESUMO
BACKGROUND: Laparoscopic appendectomy followed by postoperative intravenous (IV) antibiotics is the standard of care for acute appendicitis and postoperative prevention of intra-abdominal abscesses. The aim of or study was to determine if intraperitoneal irrigation with antibiotics could help prevent intra-abdominal abscess formation after laparoscopic appendectomy for complicated appendicitis in pediatric patients. METHODS: A retrospective study was conducted on consecutive pediatric patients with acute appendicitis who had appendectomy in our Pediatric Surgery Department between August 2020 and February 2022. We compared two groups with similar age and symptoms. The first group (A) was treated with the normal standard of care, i.e., laparoscopic appendectomy and postoperative IV antibiotic therapy. For the second group (B) intraperitoneal cefazoline irrigation was added at the end of the laparoscopic procedure. Postoperative intra-abdominal abscess was diagnosed with ultrasound examination, performed after clinical suspicion/abnormal blood test results. RESULTS: One hundred sixty patients (males:females 109:51; median age 10.5 years [range 3-17 years]) who had laparosopic appendectomy for complicated appendicitis were included, 82 in group A and 78 in group B. In the first 7 days after surgery, 18 patients in group and 5 in group B developed an intra-abdominal abscess (p < 0.005). Drains were positioned in 38 patients in group A vs. 9 in group B. One patient in group A had a different complication which was infection of the surgical incision. CONCLUSIONS: Intraperitoneal cefazoline irrigation at the end of the laparoscopic appendectomy in pediatric patients significantly reduces the formation of intra-abdominal abscesses.
Assuntos
Abscesso Abdominal , Antibacterianos , Apendicectomia , Apendicite , Laparoscopia , Complicações Pós-Operatórias , Humanos , Apendicectomia/efeitos adversos , Criança , Estudos Retrospectivos , Abscesso Abdominal/prevenção & controle , Abscesso Abdominal/etiologia , Masculino , Feminino , Pré-Escolar , Adolescente , Apendicite/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefazolina/administração & dosagem , Cefazolina/uso terapêutico , Lavagem Peritoneal/métodosRESUMO
There is much controversy about the application of abdominal irrigation in the prevention of wound infection (WI) and intra-abdominal abscess (IAA) in the postoperative period. Therefore, we performed a meta-analysis of the effect of suctioning and lavage on appendectomy to assess the efficacy of either suctioning or lavage. Data were collected and estimated with RevMan 5.3 software. Based on our research, we found 563 publications in our database, and we eventually chose seven of them to analyse. The main results were IAA after the operation and WI. Inclusion criteria were clinical trials of an appendectomy with suctioning or lavage. In the end, seven trials were chosen to meet the eligibility criteria, and the majority were retrospective. The results of seven studies showed that there was no statistically significant difference between abdominal lavage and suctioning treatment for post-operative WI (OR, 1.82; 95% CI, 0.40, 2.61; p = 0.96); There was no statistically significant difference between the two groups in the risk of postoperative abdominal abscess after operation (OR, 1.16; 95% CI, 0.71, 1.89; p = 0.56). No evidence has been found that the use of abdominal lavage in the treatment of postoperative infectious complications after appendectomy is superior to aspiration.
Assuntos
Abscesso Abdominal , Apendicite , Laparoscopia , Humanos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Sucção/efeitos adversos , Sucção/métodos , Irrigação Terapêutica , Apendicite/cirurgia , Estudos Retrospectivos , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Abscesso Abdominal/cirurgia , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Complicações Pós-Operatórias/etiologia , Laparoscopia/métodosRESUMO
Children undergoing appendicectomy for complicated appendicitis are at an increased risk of post-operative morbidity. Placement of an intra-peritoneal drain to prevent post-operative complications is controversial. We aimed to assess the efficacy of prophylactic drain placement to prevent complications in children with complicated appendicitis. A systematic review was performed in accordance with PRISMA guidelines. Cochrane, MEDLINE and Web of Science databases were searched from inception to November 2022 for studies directly comparing drain placement to no drain placement in children ≤ 18 years of age undergoing operative treatment of complicated appendicitis. A total of 5108 children with complicated appendicitis were included from 16 studies; 2231 (44%) received a drain. Placement of a drain associated with a significantly increased risk of intra-peritoneal abscess formation (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.16-2.24, p = 0.004) but there was no significant difference in wound infection rate (OR 1.46, 95% CI 0.74-2.88, p = 0.28). Length of stay was significantly longer in the drain group (mean difference 2.02 days, 95% CI 1.14-2.90, p < 0.001). Although the quality and certainty of the available evidence is low, prophylactic drain placement does not prevent intra-peritoneal abscess following appendicectomy in children with complicated appendicitis.
Assuntos
Abscesso Abdominal , Apendicite , Laparoscopia , Peritonite , Humanos , Criança , Abscesso/cirurgia , Apendicite/complicações , Apendicite/cirurgia , Tempo de Internação , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Abscesso Abdominal/cirurgia , Drenagem/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Peritonite/cirurgia , Apendicectomia/efeitos adversos , Laparoscopia/efeitos adversosRESUMO
BACKGROUND: Previous studies have reported contrasting results regarding the advantages of spleen preservation during laparoscopic distal pancreatectomy (LDP) for preventing infectious complications. METHODS: A total of 3787 patients who underwent LDP for benign or low-grade malignant pancreatic disease in 92 centers across Korea and Japan were included in this retrospective study. Postoperative infectious complications and other complications were compared between LDP with splenectomy (LDPS) and LDP with spleen preservation (LSPDP) by propensity score matching (PSM) analysis. RESULTS: After PSM, the LSPDP group had a lower rate of overall infectious complications (P = .079) and a significantly lower rate of intra-abdominal abscess (P = .014) compared with the LDPS group. Within the LSPDP group, the vessel preservation subgroup had a significantly higher rate of infectious complications (P = .002) compared with the vessel resection subgroup. Low-volume centers had a higher rate of intra-abdominal abscess than high-volume centers in the LSPDP group (P = .001) and the splenic vessel preservation subgroup (P = .003). CONCLUSIONS: Spleen preservation in LDP for benign or borderline malignant pancreatic diseases was advantageous in lowering the risk of infectious complications, specifically intra-abdominal abscess. However, the risk of intra-abdominal abscess may differ according to the level of surgeon's experience.
Assuntos
Abscesso Abdominal , Laparoscopia , Pancreatopatias , Neoplasias Pancreáticas , Humanos , Baço/cirurgia , Esplenectomia/efeitos adversos , Esplenectomia/métodos , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Estudos Retrospectivos , Pontuação de Propensão , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/complicações , Pancreatopatias/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Abscesso Abdominal/prevenção & controle , Abscesso Abdominal/complicações , Resultado do TratamentoRESUMO
AIM OF THE STUDY: Perforated appendicitis is common in children, often associated with long hospital stays and high risk of complications. There has been much discussion regarding whether antibiotics prescribed after discharge might reduce the risk of intra-abdominal abscess. This study aims to evaluate whether giving post-discharge antibiotics after appendectomy for perforated appendicitis reduces the risk of abscess. METHOD: After obtaining IRB approval, we reviewed the records of 363 patients who underwent appendectomy for perforated appendicitis at our tertiary pediatric institution from July 2015 to December 2021. Based on surgeon's preference, patients comprised two groups: those discharged with antibiotics (n = 86) or without antibiotics (n = 277). We compared post-discharge ED visits, 30-day readmissions, and SSI, analyzed with population proportion Z-tests with significance levels of 0.05. RESULTS: Post-discharge organ-space infections occurred in 4/86 (4.7%) of those with antibiotics and 9/277 (3.2%) of those without (P = 0.54). Post-discharge ED visits occurred in 10/86 (11.6%) for those with antibiotics and 23/277 (8.3%) for those without (P = 0.35). Thirty-day readmissions occurred in 6/86 (7.0%) for those with antibiotics and 10/277 (3.6%) for those without (P = 0.18). Superficial and deep SSI occurred in 0/86 (0%) for those with antibiotics and 5/277 (1.8%) for those without (P = 0.21). CONCLUSION: In children who underwent appendectomy for perforated appendicitis, antibiotics prescribed after discharge did not reduce the incidence of intra-abdominal abscess, ED visits, or SSI. Given appropriate clinical judgment, it is safe to discharge patients with perforated appendicitis home without antibiotics. LEVEL OF EVIDENCE: Level III treatment study: retrospective comparative study.
Assuntos
Abscesso Abdominal , Apendicite , Criança , Humanos , Antibacterianos/uso terapêutico , Alta do Paciente , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Apendicite/complicações , Estudos Retrospectivos , Assistência ao Convalescente , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologiaRESUMO
Background: We sought to assess the efficacy of prophylactic abdominal drainage to prevent complications after appendectomy for perforated appendicitis. Methods: In this post hoc analysis of a prospective multi-center study of appendicitis in adults (≥ 18 years), we included patients with perforated appendicitis diagnosed intra-operatively. The 634 subjects were divided into groups on the basis of receipt of prophylactic drains. The demographics and outcomes analyzed were surgical site infection (SSI), intra-abdominal abscess (IAA), Clavien-Dindo complications, secondary interventions, and hospital length of stay (LOS). Multivariable logistic regression for the cumulative 30-day incidence of IAA was performed controlling for age, Charlson Comorbidity Index (CCI), antibiotic duration, presence of drains, and Operative American Association for the Surgery of Trauma (AAST) Grade. Results: In comparing the Drain (n = 159) versus No-Drain (n = 475) groups, there was no difference in the frequency of male gender (61% versus 55%; p = 0.168), weight (87.9 ± 27.9 versus 83.8 ± 23.4 kg; p = 0.071), Alvarado score (7 [6-8] versus 7 [6-8]; p = 0.591), white blood cell (WBC) count (14.8 ± 4.8 versus 14.9 ± 4.5; p = 0.867), or CCI (1 [0-3] versus 1 [0-2]; p = 0.113). The Drain group was significantly older (51 ± 16 versus 48 ± 17 years; p = 0.017). Drain use increased as AAST EGS Appendicitis Operative Severity Grade increased: Grade 3 (62/311; 20%), Grade 4 (46/168; 27%), and Grade 5 (51/155; 33%); p = 0.007. For index hospitalization, the Drain group had a higher complication rate (43% versus 28%; p = 0.001) and longer LOS (4 [3-7] versus 3 [1-5] days; p < 0.001). We could not detect a difference between the groups in the incidence of SSI, IAA, or secondary interventions. There was no difference in 30-day emergency department visits, re-admissions, or secondary interventions. Multi-variable logistic regression showed that only AAST Grade (odds ratio 2.7; 95% confidence interval7 1.5-4.7; p = 0.001) was predictive of the cumulative 30-day incidence of IAA. Conclusions: Prophylactic drainage after appendectomy for perforated appendicitis in adults is not associated with fewer intra-abdominal abscesses but is associated with longer hospital LOS. Increasing AAST EGS Appendicitis Operative Grade is a strong predictor of intra-abdominal abscess.
Assuntos
Abscesso Abdominal , Apendicite , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/prevenção & controle , Adulto , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Drenagem , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: Postoperative oral antibiotic management at discharge for perforated appendicitis varies by institution. A prior study at our institution led to a decrease in antibiotic therapy in patients without leukocytosis. A subsequent protocol change eliminated the white blood cell count check and oral antibiotics if discharge criteria were met by postoperative day seven. We hypothesized this change could be made without an increase in abscess or readmission rates. METHODS: We conducted a retrospective review of patients with perforated appendicitis over two 1-year periods after institutional review board approval (262061). In the pre-protocol group, a white blood cell count was checked at discharge and patients with leukocytosis were prescribed oral antibiotics to complete a total of 7 d. In the post-protocol group, no white blood cell count was checked and patients were discharged home without antibiotics. RESULTS: There were a total of 174 patients with complicated appendicitis in the two 1-year periods with 129 (74%) patients with perforated appendicitis discharged before postoperative day seven. The pre-protocol group included 71 children, and post-protocol included 58 children. There were no differences between mean postoperative days to discharge (2.57 versus 3, P = 0.0896), postoperative abscess rate (12.7% versus 12.1%, P = 1.0000), or readmission rate (12.7% versus 17.2%, P = 0.6184). None of the patients in the post-protocol group were discharged home with oral antibiotics compared with 22.5% in the pre-protocol group (P < 0.001). CONCLUSIONS: For pediatric patients with perforated appendicitis discharged before postoperative day seven, stopping antibiotics at the time of discharge significantly decreased our home antibiotic use without an increase in postoperative morbidity.
Assuntos
Abscesso Abdominal/epidemiologia , Antibioticoprofilaxia/normas , Apendicite/cirurgia , Perfuração Intestinal/cirurgia , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Administração Oral , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/estatística & dados numéricos , Apendicectomia/efeitos adversos , Apendicite/complicações , Criança , Humanos , Perfuração Intestinal/etiologia , Masculino , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Autoadministração/normas , Autoadministração/estatística & dados numéricosRESUMO
OBJECTIVE: The aim of the study was to investigate the effect of abdominal drainage at appendectomy for complicated appendicitis in children. SUMMARY OF BACKGROUND DATA: Although an abdominal drain placement at appendectomy is an option for reducing or preventing postoperative infectious complication, there is controversy regarding its effect for complicated appendicitis. METHOD: The study used the data on appendectomies for complicated appendicitis in children (≤15 years old) that were operated in 2015 and registered in the National Clinical Database, a nationwide surgical database in Japan. One-to-two propensity score matching was performed to compare postoperative outcomes between patients with and without drainage at appendectomy. RESULT: The study included 1762 pediatric appendectomies for complicated appendicitis, 458 of which underwent abdominal drainage at appendectomy. In the propensity-matched analysis, the drainage group showed a significant increase in wound dehiscence [drain (-) vs drain (+); 0.3% vs 2.4%, P = 0.001], and postoperative hospital stay (median: 7 days vs 9 days, P < 0.001). There were no significant differences in the incidence of any complications, organ space surgical site infection, re-admission, and reoperation.Subgroup analyses in perforated appendicitis and perforated appendicitis with abscess, and open and laparoscopic appendectomy all demonstrated that drain placement was not associated with a reduction in any complication or organ space surgical site infection. However, it was significantly associated with longer hospital stays. CONCLUSION: This study suggested that an abdominal drain placement at appendectomy for complicated appendicitis among children has no advantage and can be harmful for preventing postoperative complications.
Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia , Apendicite/complicações , Apendicite/cirurgia , Drenagem , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Apendicectomia/efeitos adversos , Criança , Pré-Escolar , Drenagem/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pontuação de Propensão , Deiscência da Ferida Operatória/etiologiaRESUMO
BACKGROUND/PURPOSE: Prophylactic, intraabdominal drains have been used to prevent intraabdominal abscess (IAA) after perforated appendicitis. We hypothesized that routine drain placement would reduce the IAA rate in pediatric perforated appendicitis. METHODS: A 27-month quality improvement (QI) initiative was conducted: closed-suction, intraabdominal drains were placed intraoperatively in pediatric (ageâ¯<â¯18) perforated appendicitis patients. QI patients were compared to controls admitted during the preceding 8â¯months and following 4â¯months. The primary outcome was 30-day IAA rate. Univariate and multivariate analyses were performed. RESULTS: Two hundred seventy QI patients were compared to 109 controls. There was 100% compliance during 21 of 27â¯months of the QI initiative; only 7 QI patients did not receive drains. IAA occurred in 20.0% of QI patients and 22.9% of control (pâ¯=â¯0.52). After adjustment, the QI initiative was not associated with reduced odds of IAA (OR 0.83, 95% CI 0.48-1.44). Median length of stay was longer in QI patients during the index admission (pâ¯=â¯0.03) and over 30 postoperative days (pâ¯=â¯0.03), but these relationships did not persist after adjustment. CONCLUSIONS: A QI initiative investigating prophylactic, intraabdominal drain placement in perforated appendicitis did not reduce the IAA rate. We recommend against routine drain placement in pediatric perforated appendicitis. LEVEL OF EVIDENCE: Level III.
Assuntos
Abscesso Abdominal , Apendicite , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Apendicectomia , Apendicite/cirurgia , Criança , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Estudos RetrospectivosRESUMO
BACKGROUND & AIMS: Sarcopenia is considered a risk factor of postoperative complications among patients undergoing abdominal surgery. However, few studies have demonstrated an effective strategy for reducing complications in sarcopenic patients. This study aimed to examine retrospectively the effect of preoperative immunonutrition on postoperative complications, especially infectious complications, in low skeletal muscle mass patients undergoing pancreaticoduodenectomy (PD). METHODS: This was a retrospective, consecutive cohort study conducted in our institution. Skeletal muscle mass was assessed using preoperative computed tomography images in 298 consecutive patients who underwent PD between May 2009 and May 2016. Cross-sectional areas at the third lumbar vertebrae normalized for stature (cm2/m2) were defined as the skeletal muscle mass index (SMI). Low SMI was defined as the lowest sex-specific quartile of SMI. Risk factors for postoperative infectious complications and the effect of preoperative immunonutrition on low SMI patients who underwent PD were evaluated. RESULTS: Results of multivariate analysis showed that the presence of low SMI and absence of preoperative immunonutrition were independent risk factors for postoperative infectious complications after PD (odds ratio [OR], 3.17 and 3.10, respectively; P < 0.001). In high SMI patients, the rate of postoperative infectious complications was significantly lower in those who received immunonutrition than in those who did not receive immunonutrition (31.9 vs. 46.1%, respectively; OR, 1.82; P = 0.045). Further, similar findings were exhibited in low SMI patients (26.3 vs. 83.6%, respectively; OR, 14.31; P < 0.001), even though OR was markedly higher in low vs. high SMI patients. CONCLUSION: There is a stronger association with reduced infectious complications in patients who have low SMI and receive immunonutrition (UMIN-CTR Identifier: UMIN000035775.).
Assuntos
Terapia Nutricional/métodos , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Sarcopenia/terapia , Abscesso Abdominal/microbiologia , Abscesso Abdominal/prevenção & controle , Idoso , Suplementos Nutricionais , Enterite/microbiologia , Enterite/prevenção & controle , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Músculo Esquelético/patologia , Razão de Chances , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Background: Acute appendicitis is one of the most frequent surgical emergencies and is a common cause of non-traumatic acute abdominal emergencies that require surgical intervention. Most complicated appendicitis started de novo as simple appendicitis raising the notion that it is a disease in evolution that has become of clinical importance due to delayed or missed diagnosis. Complicated appendicitis has been associated with a significant risk of postoperative septic complications, including wound infections and intra-abdominal abscess formation. This study aimed to evaluate the types of complicated appendicitis and their relationship to patient's demographic data, postoperative course and the length of hospital stay in Al-Basra Teaching Hospital. Methods: This was a prospective clinical study involving patients with acute appendicitis admitted to Al-Basra Teaching Hospital from January 2017 to October 2019. The demographic data, types of complicated appendicitis, hospitalization duration, and postoperative complications were evaluated. The patients were divided into six groups according to age. All data were recorded and analyzed. Results: A total of 1210 patients, age from 6 to 69 years, mean age of patients was 23.45, males out-numbered females. Perforated appendicitis represents the main type of complicated appendicitis, and it was reported mostly among elderly patients. Patients with complicated appendicitis had a longer hospitalization and more postoperative complications than patients with non-complicated appendicitis. Conclusion: we concluded that nearly one third of the patients with acute appendicitis had complicated appendicitis, so they need a special pre and postoperative care and old age had non classical clinical picture with poor outcome.
Assuntos
Humanos , Apendicite/complicações , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Geral , Infecção dos Ferimentos/prevenção & controle , Estudos Prospectivos , Abscesso Abdominal/prevenção & controle , Diagnóstico Tardio , Tempo de InternaçãoRESUMO
BACKGROUND: There is little consensus regarding the use of postoperative antibiotics in the management of perforated appendicitis in children. Patients are commonly discharged with oral antibiotics after a course of intravenous antibiotics; however, recent literature suggests that patients can be safely discharged without any oral antibiotics. To further evaluate this protocol, we conducted a multicenter retrospective preimplementation/postimplementation study comparing rates of abscess formation and rehospitalization between patients discharged with and without oral antibiotics. MATERIALS AND METHODS: We reviewed the records of all pediatric patients who underwent appendectomies for perforated appendicitis at NYU Tisch Hospital, Bellevue Hospital, and Hackensack University Medical Center from January 2014 to June 2019. Data pertaining to patient demographics, hospital course, intraoperative appearance of the appendix, antibiotic treatment, abscess formation, and rehospitalization were collected. RESULTS: A total of 253 patients were included: 162 received oral antibiotics and 91 did not. The median length of antibiotic treatment (oral and intravenous) was 11 (10-14) d for patients on oral antibiotics and 5 (3-6) d for patients without oral antibiotics (P < 0.01). The median leukocyte count at discharge was 9.5 (7.4-10.9) and 8.1 (6.8-10.4) for these groups, respectively (P = 0.02). Postoperative abscesses occurred in 22% of patients receiving oral antibiotics and 15% of patients on no antibiotics (P = 0.25). Rates of rehospitalization for these groups were 10% and 11%, respectively (P = 0.99). CONCLUSIONS: Children who have undergone appendectomy for perforated appendicitis can be safely discharged without oral antibiotics on meeting clinical discharge criteria and white blood cell count normalization.
Assuntos
Abscesso Abdominal/epidemiologia , Antibacterianos/administração & dosagem , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/epidemiologia , Abscesso Abdominal/sangue , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Administração Intravenosa , Administração Oral , Adolescente , Apendicite/sangue , Apendicite/complicações , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Humanos , Contagem de Leucócitos , Masculino , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Approximately 30% of appendectomies are for complicated acute appendicitis (CAA). With laparoscopy, the main post-operative complication is deep abscesses (12% of cases of CAA, versus 4% for open surgery). A recent cohort study compared short and long courses of postoperative antibiotic therapy in patients with CAA. There was no significant intergroup difference in the post-operative complication rate (12% of organ/space surgical site infection (SSI)). Moreover, antibiotic therapy is increasingly less indicated for other situations (non-complicated appendicitis, post-operative course of cholecystitis, perianal abscess), calling into question whether post-operative antibiotic therapy is required after laparoscopic appendectomy for CAA. METHODS/DESIGN: This study is a prospective, multicenter, parallel-group, randomized (1:1), double-blinded, placebo-controlled, phase III non-inferiority study with blind evaluation of the primary efficacy criterion. The primary objective is to evaluate the impact of the absence of post-operative antibiotic therapy on the organ/space surgical site infection (SSI) rate in patients presenting with CAA (other than in cases of generalized peritonitis). Patients in the experimental group will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, a placebo for ceftriaxone (2 g/24 h in one intravenous injection) and a placebo for metronidazole (1500 mg/24 h in three intravenous injections, for 3 days). In the control group, patients will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, antibiotic therapy (ceftriaxone 2 g/24 h and metronidazole 1500 mg/24 h for 3 days). In the event of allergy to ceftriaxone, it will be replaced by levofloxacin (500 mg/24 h in one intravenous injection, for 3 days). The expected organ space SSI rate is 12% in the population of patients with CAA operated on by laparoscopy. With a non-inferiority margin of 5%, a two-sided alpha risk of 5%, a beta risk of 20%, and a loss-to-follow-up rate of 10%, the calculated sample size is 1476 included patients, i.e., 738 per group. Due to three interim analyses at 10%, 25%, and 50% of the planned sample size, the total sample size increases to 1494 patients (747 per arm). TRIAL REGISTRATION: Ethical authorization by the Comité de Protection des Personnes and the Agence Nationale de Sécurité du Médicament: ID-RCB 2017-00334-59. Registered on ClinicalTrials.gov (NCT03688295) on 28 September 2018.
Assuntos
Abscesso Abdominal/prevenção & controle , Antibacterianos/administração & dosagem , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Abscesso Abdominal/epidemiologia , Administração Intravenosa , Antibacterianos/efeitos adversos , Ensaios Clínicos Fase III como Assunto , Método Duplo-Cego , Esquema de Medicação , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Time to treatment initiation is a key element to be considered in infectious pathologies such as acute appendicitis (AA). There are few articles in the literature analyzing the relationship between early pre-surgical antibiotic treatment initiation and complication occurrence in AA. Our objective is to analyze such influence and the effects of late treatment initiation. MATERIALS AND METHODS: A retrospective, observational study was carried out in children undergoing surgery for AA between 2017 and 2018. Demographic variables, time to antibiotic treatment initiation, time to surgery, and postoperative complications were analyzed. RESULTS: 592 patients with a median 12-month follow-up were included in the study. Antibiotic treatment initiation in the first 8 hours following diagnosis prevents complications [OR 0.24 (95% CI: 0.07-0.80)] and dramatically reduces the occurrence of intra-abdominal abscess from 25.0% to 5.5% (p=0.03). Antibiotic treatment initiation in the first 4 hours following diagnosis significantly reduced wound infection rate in non-overweight patients [2.9% vs. 13.6%; OR 0.19 (95% CI: 0.045-0.793); p=0.042]. Surgery within the first 24 hours following diagnosis reduced the proportion of advanced AA (gangrenous appendicitis and peritonitis) from 100% to 38.6% (p=0.023). CONCLUSIONS: Antibiotic treatment initiation in the first 4 hours following AA prevented the occurrence of post-surgical complications, especially in non-overweight patients. An adequate clinical approach and an early assessment by the pediatric surgeon are key to reduce the morbidity associated with AA.
OBJETIVO: El tiempo hasta el inicio del tratamiento es un elemento fundamental a considerar en patologías infecciosas como la apendicitis aguda (AA). Existen escasos artículos en la literatura que analicen la relación entre el inicio precoz de la antibioterapia prequirúrgica y el desarrollo de complicaciones en la AA. Nuestro objetivo es analizar dicha influencia y el efecto de su retraso. MATERIAL Y METODOS: Se realizó un estudio observacional retrospectivo en niños intervenidos de AA entre 2017-2018. Se analizaron variables demográficas, tiempo transcurrido hasta el inicio de la antibioterapia, tiempo hasta la cirugía y complicaciones postoperatorias. RESULTADOS: Se incluyeron 592 pacientes con mediana de seguimiento de 12 meses. El inicio de la antibioterapia en las primeras 8 horas tras el diagnóstico previene la aparición de complicaciones [OR 0,24 (IC95% 0,07-0,80)], disminuyendo significativamente el porcentaje de aparición de abscesos intraabdominales del 25,0 al 5,5% (p= 0,03). El inicio de la antibioterapia en las primeras 4 horas tras el diagnóstico disminuyó significativamente la tasa de infección de herida en pacientes sin sobrepeso [2,9 vs. 13,6%; OR 0,19 (IC95% 0,045-0,793); p= 0,042]. La intervención quirúrgica en las primeras 24 horas tras el diagnóstico disminuyó la proporción de AA evolucionada (gangrenada y peritonitis) del 100 al 38,6% (p= 0,023). CONCLUSIONES: El inicio de la antibioterapia en las primeras 4 horas tras el diagnóstico de AA previno el desarrollo de complicaciones postquirúrgicas, sobre todo en pacientes sin sobrepeso. Una orientación clínica adecuada y valoración precoz por el cirujano pediátrico son un elemento clave para disminuir la morbilidad asociada a la AA.
Assuntos
Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Tempo para o Tratamento , Abscesso Abdominal/prevenção & controle , Doença Aguda , Adolescente , Índice de Massa Corporal , Criança , Esquema de Medicação , Feminino , Gangrena/prevenção & controle , Humanos , Masculino , Peritonite/prevenção & controle , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do TratamentoRESUMO
BACKGROUND: The need for extended postoperative antibiotics (Abx) for complicated (gangrenous or perforated) appendicitis (CA) remains unclear. We hypothesize that giving ≤24 h of Abx for CA is not inferior to a longer duration in preventing infectious complications after appendectomy. METHODS: In this post hoc analysis of a prospective multicenter study, only patients with intraoperative diagnosis of CA were included. ANOVA and Chi-squared tests were used to compare length of stay, 30-day readmission rates, surgical site infection (SSI), and intra-abdominal abscess (IAA) between patients receiving ≥96 h and ≤24 h of Abx. RESULTS: Of 751 patients with CA, 704 met inclusion criteria. Mean age was 48 (±17) y; 391 (56%) were male. A total of 185 (26%) received Abx for ≤24 h and 100 (14% of overall) received no Abx. 85 (12%) patients were lost to follow-up at 30 d postop. Twenty-seven (4%) patients developed an SSI (≤24 h = 5 (3%), ≥96 h = 22 (5%), P = 0.502) and 82 (13%) developed IAA (≤24 h = 11 (7%), ≥96 h = 71 (15%), P = 0.008) within 30d postop. Sixty-six (11%) patients underwent a secondary intervention for infection within 30 d postop. 41% of SSIs (11/27) and 60% (49/82) of IAA occurred during the index hospitalization. On the multivariate analysis, there was not any evidence of an association between the duration of Abx and an increased rate of SSI (P = 0.539), IAA (P = 0.274), emergency department visits (P = 0.509), readmission (P = 0.911), or secondary interventions (P = 0.523). CONCLUSIONS: No evidence of an association between the duration of Abx (≤24 h versus ≥ 96 h) for complicated appendicitis and an increased rate of SSI was observed and ≤24 h duration was associated with shorter length of stay. Because of possible selection bias, adequately powered randomized trials are required to definitely prove noninferiority of shorter course Abx duration.
Assuntos
Abscesso Abdominal/epidemiologia , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Apendicectomia/efeitos adversos , Apendicite/terapia , Infecção da Ferida Cirúrgica/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Apendicite/complicações , Esquema de Medicação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
The optimal method for preventing abscesses in perforated appendicitis is unclear. We compared the efficacy of lavage versus aspiration for periappendicular collections/abscesses in perforated appendicitis. Our study included 286 patients. After the removal of the appendectomy material, those who underwent aspiration without prior lavage were assigned to Group I, whereas those who underwent aspiration after lavage with 500 mL physiological saline were assigned to Group II. The primary outcome measure was postoperative complications. Secondary outcome measures were intraoperative complications, morbidity, and mortality. Group I comprised 174 patients (60 female and 114 male; mean age 34.47±17.40 y), whereas Group II comprised 112 patients (39 female and 73 male; mean age 36.22±18.60 y). The 2 groups were not significantly different in age, hospitalization duration, sex, abscess formation, morbidity, or mortality. Our results demonstrate that aspiration of the surgery area without prior lavage is sufficient and can be safely applied in perforated appendicitis.
Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Paracentese/métodos , Lavagem Peritoneal/métodos , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: This study aims to establish compliance levels to prescription guidelines among Australian surgeons in the use of antibiotics in the surgical management of appendicitis. The secondary outcomes are predictors of post-operative infective complications; surgical site infection (SSI) and intra-abdominal abscess (IAA) at 30 days. METHODS: A multi-centre, prospective, observational study was conducted over a period of 2 months with a 30-day follow-up. Patients were eligible for recruitment if they underwent appendicectomy for suspected appendicitis. Antibiotics prescription practices were recorded and compared to national guidelines. RESULTS: A total of 1189 patients were recruited across 27 centres; 1081 (92.1%) patients were given prophylactic antibiotics at the time of appendicectomy. Patients with gangrenous appendicitis were more likely to receive prophylactic antibiotics (98.9%); lower rates of use were seen in the non-appendicitis group (85.7%). A total of 619 (53.3%) patients received antibiotics in the post-operative period. Despite recommendations, 300 (44.3%) patients with simple appendicitis received post-operative antibiotics. Only six (2.9%) patients with complicated appendicitis did not receive antibiotics. Overall, SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islanders (P = 0.02) and patients with converted operations (P = 0.001) were more likely to have a SSI. Patients with complicated appendicitis and those operated on by a consultant were more likely to increase the odds of IAA (odds ratio 3.8 and 5.1, respectively). CONCLUSION: This broad-based study shows mixed compliance with antibiotic guidelines in the surgical management of appendicitis in Australia. The use of post-operative antibiotics in patients with simple appendicitis should be a target for antimicrobial stewardship programmes to prevent antibiotic over-utilization.
Assuntos
Abscesso Abdominal/prevenção & controle , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Prescrições de Medicamentos/normas , Tratamento de Emergência , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Abscesso Abdominal/epidemiologia , Adolescente , Adulto , Idoso , Austrália , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto JovemRESUMO
Postoperative antibiotics are recommended after appendectomy for complex appendicitis to reduce infectious complications. The duration of this treatment varies considerably between and even within institutions. The aim of this review was to critically appraise studies on duration of antibiotic treatment following appendectomy for complex appendicitis. A systematic literature search according to the PRISMA guidelines was performed. Comparative studies evaluating different durations of postoperative antibiotic therapy. Primary endpoint was intra-abdominal abscess (IAA) after appendectomy. Secondary endpoints were surgical site infection, readmission and length of hospital stay. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Pooled event rates were calculated using a random-effects model. Nine studies reporting 2006 patients with complex appendicitis were included. The methodological quality of the included articles was poor. IAA was seen in 138 patients (8,6%). Meta-analysis revealed a statistically significant difference in IAA incidence between antibiotic treatment of ≤5 vs. >5 days (risk ratio (OR) 0.36 [95% CI 0.23-0.57] (p < 0.0001)) but not between ≤3 vs. >3 days (OR 0.81 [95% CI 0.38-1.74] (p = 0.59)). Descriptive statistics were used for secondary endpoints. The duration of postoperative antibiotic treatment is not associated with IAA following appendectomy for complex appendicitis.