Current management of appendicitis at a community center—how can we improve?

Piper, Hannah G.; Rusnak, Conrad; Orrom, W. J.; Hayashi, Allen; Cunningham, Johann

doi:10.1016/j.amjsurg.2007.12.033

Cited by 15 publications

(27 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We agree with them in principle, but we feel that availability, cost, radiation exposure, and time required are factors precluding its use in all patients of suspected AA. Similar concerns have been raised by other authors [9,22,23,25]. Although CT is not infallible [26,27], it has considerably higher sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 56%

“…Various studies recommend preoperative CT scan to decrease NAR [16,23,24]. We agree with them in principle, but we feel that availability, cost, radiation exposure, and time required are factors precluding its use in all patients of suspected AA.…”

Section: Discussionmentioning

confidence: 78%

“…While USG, CT, MRI scan, and DL have been advocated to improve accuracy in the diagnosis of appendicitis, the benefits of these modalities in clinical trials have not been realized in general practice [8,22,23]. USG is cheap and easily available, but the results are operator dependent and at times the appendix may not be visualized due to overlying bowel gas limiting the use of this modality.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

Negative appendectomy remains a concern in current surgical practice. Data from the developing world is scarce. Data of appendectomies during the last 5 years were analyzed. Interval and incidental appendectomies were excluded. The demographic details, presenting complaints, clinical signs, and investigations performed were recorded in a predesigned proforma. The data were critically analyzed. Six hundred eighty-five appendectomies were performed during the period. One hundred eighty-five patients with a normal appendix were identified on histopathology. Sixty-seven patients with incidental or interval appendectomies were excluded. Thus, 118 patients had appendectomies performed erroneously. All these patients with presumed diagnosis of acute appendicitis were operated on by resident surgeons. Records of 17 patients could not be retrieved. The most common symptom was abdominal pain (100 %), and the commonest sign was right iliac fossa tenderness (93 %). Most of the patients underwent USG to supplement the diagnosis. CT scan and diagnostic laparoscopy were not performed. The negative appendectomy rate was 17.2 % (12.4 % in males; 33.3 % in females). The highest incidence of negative appendectomy was in females aged 11-20 years (66.7 %). The rate of negative appendectomy at our institute is comparable with the world statistics. More diligence is required in making the clinical diagnosis of acute appendicitis, especially in young females. The use of C-reactive protein and CT scan may decrease the negative appendectomy rate.

show abstract

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

show abstract

“…One reason may be that these patients did not present with the “classic” story for appendicitis, requiring a more extensive workup before the emergency room physician felt the need to consult the surgical team, thus increasing the EDR to OR time. [19–22] The time of the patient's arrival to the ED may have played a role, although this aspect was not examined in our study. If a patient presents late at night in our institution with appendicitis, their surgery is often held over to the next day while they are treated with antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Ideal timing of surgery for acute uncomplicated appendicitis

et al. 2013

View full text Add to dashboard Cite

Background:Early surgery for appendicitis is thought to avoid complications associated with appendiceal rupture.Aims:This study was to evaluate the effect of timing of surgery on complications, length of stay (LOS) and cost in patients undergoing appendectomy.Materials and Methods:Retrospective review of 396 patients with appendectomies from January 1, 2005 to December 31, 2007 was performed. Demographic data, time of presentation, physical findings, diagnostic data, operating room times, LOS, cost and complications were collected. Patients were divided into 4 groups based on time from presentation to appendectomy.Results:Pathology confirmed appendicitis in 354 (89%) patients. Most patients (90%) had surgery within 18 h of presentation. Timing of surgery did not affect the incidence of purulent peritonitis (P = 0.883), abscess (P = 0.841) or perforation (P = 0.464). LOS was significantly shorter for patients with emergency department registration to operating room times less than 18 h (P < 0.0001). Costs were significantly higher for patients with times to operating room greater than 18 h (P < 0.001).Conclusion:Timing of surgery did not affect the incidence of complications or perforated appendicitis. However, delay in surgical consultation and surgery are associated with increased LOS and increased hospital costs. The optimal timing of appendectomy for uncomplicated acute appendicitis appears to be within 18 h of emergency department presentation.

show abstract

“…Hannah et al analyzed the imagination studies as a factor of a delay in surgery and could not show any difference between non-imaging group and imaging group except a reduce of NAR from 10% to 3% favoring the latter [14]. Recent studies are showing short delays due to radiologic examinations have no bad effect on outcome for AA patients but they reduce NAR ratios [15,16].…”

Section: Discussionmentioning

confidence: 99%

The value of preoperative diagnostic tests in acute appendicitis, retrospective analysis of 196 patients

et al. 2010

View full text Add to dashboard Cite

BackgroundIn this study our aim was to evaluate the diagnostic value of preoperative laboratory and radiological studies for appendicitis.MethodsThe clinical data of 196 patients who have undergone conventional appendectomy between March 2007 and April 2008 were collected retrospectively. Patients were examined for age, sex, white blood cell count, ultrasonography results, histopathological diagnosis and hospital stay.ResultsNegative appendectomy rate was 17.3% (27% for female, 11.5% for male). White blood cell counts were found to be high in 83% for acute appendicitis group and %61 for negative appendectomy group. There were 66 (34%) patients who had negative USG findings for acute appendicitis. Of these patients, histopathological examination revealed acute appendicitis in 46 patients whereas 20 patients had normal appendix. Hospital stays were 2.79 +/- 1.9 and 2.66 +/- 1.7 days for negative and positive appendicectomies respectively.ConclusionsBesides the improvement of diagnostic tests for acute appendicitis, we could not sufficiently reduce the negative appendectomy rate.

show abstract

Current management of appendicitis at a community center—how can we improve?

Cited by 15 publications

References 14 publications

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Ideal timing of surgery for acute uncomplicated appendicitis

The value of preoperative diagnostic tests in acute appendicitis, retrospective analysis of 196 patients

Contact Info

Product

Resources

About