Appendicitis in a deployed military setting: diagnosis, management and impact on the fighting force

Howes, Rob; Webster, Claire; Garner, Jeff

doi:10.1136/jramc-2015-000614

Cited by 3 publications

(10 citation statements)

References 23 publications

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“…The 133 included studies collectively reported on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and more than 11.4 million participants (median per study, 989 [IQR, 257-6857]) from 63 LMICs . Of all 133 LMICs, we found studies from 15 of all 29 low-income countries (51.7%), 25 of all 50 lower-middle–income countries (50.0%), and 23 of all 55 upper-middle–income countries (41.8%) . Fourteen studies (10.5%) were multinational …”

Section: Resultsmentioning

confidence: 99%

“…Most studies (115 [86.5%]) were published in 2010 or after, with a marked increase in the number of included studies per year. Most articles were written in English (126 [94.7%]) . Health care settings were hospital based or secondary care in 93 studies (69.9%) …”

Section: Resultsmentioning

confidence: 99%

“…Most articles were written in English (126 [94.7%]) . Health care settings were hospital based or secondary care in 93 studies (69.9%) . Of the 133 included studies, 107 (80.5%) were observational…”

Section: Resultsmentioning

confidence: 99%

“…Health care settings were hospital based or secondary care in 93 studies (69.9%) . Of the 133 included studies, 107 (80.5%) were observational and 17 (12.8%) were qualitative . Most of the included studies (115 [86.5%]) had a gynecology and obstetrics focus…”

Section: Resultsmentioning

confidence: 99%

“…9, 17, 38, 40-45, 49-51, 55, 58, 61, 62, 64, 65, 67-70, 73-77, 79, 81, 82, 84, 86, 90, 92-95, 98-111, 113-116, 118-120, 122-132, 134-136, 138, 139, 141-143, 147-153, 155, 156, 158-164 Of the 133 included studies, 107 (80.5%) were observational 9, 11, 38-45, 47-51, 53-64, 66, 67, 69-76, 79-90, 92-98, 100-102, 104-106, 108-114, 117-126, 128-131, 133-139, 141-144, 147, 148, 151-159, 162, 164 and 17 (12.8%) were qualitative. 46,62,70,77,78,87,90,99,100,116,124,127,143,149,150,156,160 Most of the included studies (115 [86.5%]) had a gynecology and obstetrics focus 9,11,16,17,20,38,39…”

Section: Jama Network Open | Global Healthmentioning

confidence: 99%

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Low-Value Surgical Procedures in Low- and Middle-Income Countries

Albarqouni,

Abukmail,

MohammedAli

et al. 2023

JAMA Netw Open

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ImportanceOveruse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures.ObjectivesTo assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs.Evidence ReviewWe searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions.FindingsOf 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle–income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders.Conclusions and RelevanceThis systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Jama Network Open | Global Healthmentioning

confidence: 99%

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Low-Value Surgical Procedures in Low- and Middle-Income Countries

Albarqouni,

Abukmail,

MohammedAli

et al. 2023

JAMA Netw Open

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The medical and operational impact of the deployment of a scanner within Role 2 in Mali for the French army

Choufani

Caubère

Reslinger

et al. 2020

Injury

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Outcome of Laparoscopic Versus Open Appendectomy for Acute Appendicitis—Results of a Propensity Score Matching Analysis of 542 Patients and Consequences for the Military Surgeon

Beltzer,

Haas,

Jahn

et al. 2023

Military Medicine

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Introduction Appendectomy is the treatment of choice for acute appendicitis. The procedure can be performed open or laparoscopically. However, laparoscopy is not available on military missions abroad. It is unclear whether treatment outcomes differ between the two surgical approaches. Materials and Methods Treatment data of all patients undergoing open and laparoscopic appendectomies in the German Armed Forces Hospital of Ulm from 2013 to 2017 were collected retrospectively. A propensity score matching analysis was performed to minimize the influence of potential confounders and to assess the influence of surgical approach on outcome (reoperations, superficial and deep surgical infections, length of postoperative ileus, need for intravenous analgesics, and operative time). Results A total of 542 patients with complete datasets were included in the propensity score matching analysis, among these 64 with open and 478 laparoscopic procedures. There were no statistically significant differences between open and laparoscopic surgeries with respect to all outcome variables, with the exception of a 25-minute prolonged operative time for the open approach. Conclusions Open appendectomy can be considered equivalent in outcome to the laparoscopic procedure and thus can be performed on military missions abroad without compromising outcome. Military surgeons must continue to be trained and confident in open appendectomy.

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Appendicitis in a deployed military setting: diagnosis, management and impact on the fighting force

Cited by 3 publications

References 23 publications

Low-Value Surgical Procedures in Low- and Middle-Income Countries

Low-Value Surgical Procedures in Low- and Middle-Income Countries

The medical and operational impact of the deployment of a scanner within Role 2 in Mali for the French army

Outcome of Laparoscopic Versus Open Appendectomy for Acute Appendicitis—Results of a Propensity Score Matching Analysis of 542 Patients and Consequences for the Military Surgeon

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