Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial

Haijanen, Jussi; Sippola, Suvi; Tuominen, Risto; Grönroos, Juha; Paajanen, Hannu; Rautio, Tero; Nordström, Pia; Aarnio, Markku; Rantanen, Tuomo; Hurme, Saija; Salminen, Paulina

doi:10.1371/journal.pone.0220202

Cited by 35 publications

(41 citation statements)

References 33 publications

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“…According to the APPAC conservative therapy with antibiotics was noninferior to surgery (17). At 5 years, the majority (61%) of antibiotic group patients did not undergo appendicectomy and the overall costs of the surgical arm were 1.4 times higher (18,19). No information was provided concerning the time from surgery to discharge (17).…”

Section: Discussionmentioning

confidence: 99%

Immediate Effects of Urgent Reorganisation of Emergency Department-Based Treatment Pathway in Nonperforated Appendicitis: A Retrospective Study

Ojakäär

Purdy

Kechagias

et al. 2020

Preprint

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Background Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. According to it, postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess whether this reorganisation affected the length of in-hospital stay (LOS) and the 30-day complication rate.Methods This is a retrospective pre- and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-hour observation unit of the ED instead of surgical ward. Patients operated during the first three months after the reorganisation were compared to those operated during the three months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age <18 years and perforated disease. Results During the study period, appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7 hours for all patients after the reorganisation compared to 24.4 hours before the reorganisation (standard error 6.2 hours, 95% confidence interval 2.3–15.2 hours, p < 0.01). There were no more complications in the group treated postoperatively in the ED. Conclusions Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the ED – instead of the surgical ward – occurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.

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Section: Discussionmentioning

confidence: 99%

Immediate Effects of Urgent Reorganisation of Emergency Department-Based Treatment Pathway in Nonperforated Appendicitis: A Retrospective Study

Ojakäär

Purdy

Kechagias

et al. 2020

Preprint

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“…Most patients treated with antibiotics respond clinically with a general symptom reduction [5] and avoidance of peritonitis [6]. Nonoperative management of acute appendicitis also has the additional benefits of decreased morbidity, quicker return to work, the requirement of fewer doses of narcotics, and is also cost-effective [7,8].…”

Section: Discussionmentioning

confidence: 99%

Appendicitis: In the Times of COVID-19

Haider¹,

Mehmood²,

Siddiqa³

2020

AJMCR

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Coronavirus disease-19 (COVID-19) is a novel contagious infection initially thought to be a respiratory pathogen, but there is increasing evidence of multisystem involvement. Here, we report a 43-year-old male who presented with acute abdominal pain associated with fever and chills and was diagnosed with acute appendicitis. He was tested positive for COVID-19, and because of elevated inflammatory markers, the patient was successfully managed non-operatively with remdesiver and intravenous (IV) antibiotics. Our patient had predominantly abdominal findings, and we believe that that there is a possibility that appendicitis may be associated with COVID-19.

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“…According to the APPAC conservative therapy with antibiotics was non-inferior to surgery [17]. At 5 years, the majority (61%) of antibiotic group patients did not undergo appendicectomy and the overall costs of the surgical arm were 1.4 times higher [18,19]. No information was provided concerning the time from surgery to discharge [17].…”

Section: Discussionmentioning

confidence: 99%

Immediate effects of urgent reorganisation of emergency department-based treatment pathway in nonperforated appendicitis: a retrospective study

et al. 2020

View full text Add to dashboard Cite

Background: Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. Postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess, whether this reorganisation was feasible and safe, i.e. did it affect the length of in-hospital stay (LOS) and the 30-day complication rate. Methods: This is a retrospective pre-and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-h observation unit of the ED instead of surgical ward. Patients operated during the first 3 months after the reorganisation were compared to those operated during the 3 months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age < 18 years and perforated disease. Results: Appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7 h for all patients after the reorganisation compared to 24.4 h before the reorganisation (standard error 6.2 h, 95% confidence interval 2.3-15.2 h, p < 0.01). There were no more complications in the group treated postoperatively in the ED. Conclusions: Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the EDinstead of the surgical wardoccurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.

show abstract

Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial

Cited by 35 publications

References 33 publications

Immediate Effects of Urgent Reorganisation of Emergency Department-Based Treatment Pathway in Nonperforated Appendicitis: A Retrospective Study

Immediate Effects of Urgent Reorganisation of Emergency Department-Based Treatment Pathway in Nonperforated Appendicitis: A Retrospective Study

Appendicitis: In the Times of COVID-19

Immediate effects of urgent reorganisation of emergency department-based treatment pathway in nonperforated appendicitis: a retrospective study

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