In-hospital delay increases the risk of perforation in adults with appendicitis.

BACKGROUND: The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial. METHODS: A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (≤12 vs. >12 h). RESULTS: Delay>12 h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P=0.010) whereas a delay of 6 or 9 h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (≤65 years vs. >65 years, odds ratio (OR) 4.5, P<0.001); co-morbidity (Charlson index>0 vs. Charlson index=0, OR 2.3, P<0.001); time of admission (after hours vs. regular hours, OR 0.8, P=0.040), in-hospital delay (>12 vs. ≤12 h, OR 1.5, P=0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P<0.001) and longer length of hospital stay (9.5 vs. 4.4 days; P<0.001). CONCLUSIONS: In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12 h, age over 65 years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay.

Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome.

OBJECTIVES: The influence of surgical treatment of bladder outlet obstruction on sexual function is uncertain and available evidence is conflicting. Transurethral resection of the prostate (TURP) causes retrograde ejaculation, but its effect on erectile function is controversial. We have prospectively investigated the influence of TURP on erectile and ejaculatory function. METHODS: Between January 2000 and January 2005, 11 hospitals in Switzerland informed the Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss health care system, about patients scheduled for TURP. VO obtained the Danish Prostate Symptom Score (DAN-PSS) including the sexual function domain (DAN-PSSsex) before and 4 mo after surgery and compared the respective scores. RESULTS: Data from 1014 patients were evaluated. Mean patient age was 69 yr. DAN-PSSsex questionnaires were returned by 988 patients before and 642 patients after TURP; 722 (73.1%) and 474 (73.8%) of the patients, respectively, stated that they were still sexually active. The mean erectile function score improved insignificantly from 1.66 to 1.47 (p=0.11), the mean ejaculatory function score worsened from 1.27 to 2.34 (p<0.00) and the mean discomfort on ejaculation score improved from 0.37 to 0.29 (p=0.10) before and after TURP, respectively. CONCLUSION: The results confirm that TURP has no negative influence on the quality of erections measured by self-assessment questionnaires. The loss of ejaculatory function is significant and is associated with considerable bother. However, three of four patients undergoing TURP are still sexually active and the surgery has no influence on this ratio.

Peri-operative morbidity and changes in symptom scores after transurethral prostatectomy in Switzerland: results of an independent assessment of outcome.

OBJECTIVES: To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS: Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS: The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.