Recent Trend of Using Computed Tomography to Diagnose Pediatric Appendicitis at the First Hospital Visit: A Descriptive Study Using a Medical Claims Database.

OBJECTIVE: We recognize that computed tomography (CT) should not be used to diagnosis pediatric appendicitis due to radiation exposure. However, few studies have recently shown a trend in its use. This study aimed to investigate the annual use of CT for the diagnosis of pediatric appendicitis at the first hospital visit. METHODS: This was a descriptive study using nationwide claims data. We extracted the data of children younger than 15 years who underwent imaging tests to diagnose acute and suspected appendicitis at the first visit between January 2008 and September 2018. We summarized the patient characteristics and the percentage of CT, ultrasonography (US), or CT/US utilization by year, age, and department. RESULTS: We identified 6658 children who underwent CT (2349 [35.8%]), US (53,57 [54.5%]), and CT/US (634 [9.7%]). The annual CT use dropped from 43.1% in 2012 to 29.4% in 2018. According to age group, the highest percentage of CT use in 2018 was 84.6% in preschool children, followed by adolescents (40.3%), upper-grade (26.0%), and lower-grade (15.0%) children. Data of annual CT use by department revealed that CT usage was much higher in internal and emergency medicine than in pediatrics. Furthermore, adolescents accounted for approximately 50% of CT use in internal medicine. CONCLUSIONS: The percentage of CT use for pediatric appendicitis at the first visit declined annually. However, CT use still tended to be higher in preschool- and adolescent-aged children, or in departments other than pediatrics. Further studies are required to clarify the clinical benefits of CT use to diagnose pediatric appendicitis.

Comparison of laparoscopic and open inguinal hernia repair in adults: A retrospective cohort study using a medical claims database.

INTRODUCTION: This study aimed to investigate and compare the surgical complications following laparoscopic inguinal hernia repair (LIHR) with those following open inguinal hernia repair (OIHR). METHODS: This was a retrospective cohort study based on nationwide claims data. We extracted the data of patients aged ≥20 years who underwent inguinal hernia repair (IHR) between 2009 and 2020. The primary outcome was postoperative complications of IHR, and the secondary outcomes were recurrence of hernia and length of hospital stay. Patient characteristics were adjusted with propensity score (PS) matching, the annual proportions of LIHR versus OIHR were summarized, and the surgical outcomes of each IHR were analyzed. RESULTS: Of the 15 728 eligible patients, 6512 underwent LIHR. The proportion of LIHR increased from 14.7% to 52.8% annually during the study period. From the analysis of 6060 pairs created by PS matching, the risk of surgical site infection (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56-0.86; P = .0007), and acute postoperative pain (OR 0.69; 95% CI 0.60-0.79; P < .0001), and chronic postoperative pain (OR 0.83; 95% CI 0.70-0.98; P = .0291) were significantly lower with LIHR than with OIHR. The recurrent rate was not significantly different between the LIHR and OIHR groups (OR, 0.68; 95% CI 0.45-1.01; P = .0558). Furthermore, no significant difference was found in the length of hospital stay between the LIHR and OIHR groups (2.91 ± 1.94 days vs 2.97 ± 2.61 days, difference ± SE: 0.06 ± 0.04, P = .1307). CONCLUSION: LIHR might be superior to OIHR in terms of fewer surgical complications and might be preferred over OIHR in the future.

Coefficient factor for graft weight estimation from preoperative computed tomography volumetry in living donor liver transplantation.

In the clinical setting of living donor liver transplantation (LDLT), it is common to find a discrepancy between the graft volume estimated by preoperative computed tomography volumetry and the actual graft weight (AGW) measured on the back-table. In this study, we attempt to find the coefficient factor that correlates the estimated graft volume to the AGW. Whole livers explanted in 25 LDLT recipients (17 cirrhotic and 8 morphologically normal with familial amyloid polyneuropathy) were evaluated to compare cirrhotic livers and noncirrhotic normal livers. In addition, right lobe grafts (n = 39) and left lobe grafts (n = 35) used in LDLTs were also evaluated to further determine the correlation between estimated graft volume and AGW. The correlation coefficient between estimated liver volume and actual liver weight was 1.01 in whole cirrhotic livers, whereas it was 0.85 in whole livers with familial amyloid polyneuropathy. In the partial liver grafts, it was 0.84 in right lobe grafts and 0.85 in left lobe grafts. In conclusion, we suggest that a correlation coefficient of 0.85 should be applied for the accurate calculation of the graft weight from the volume estimated by preoperative computed tomography in LDLT.