Early appendectomy reduces costs in children with perforated appendicitis

Church, John; Klein, Edwin J.; Carr, Benjamin; Bruch, Steven W.

doi:10.1016/j.jss.2017.07.001

Cited by 17 publications

(16 citation statements)

References 18 publications

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“…However, the results of this medical therapy, which is an alternative to surgery, are still controversial [5] . The early appendectomy and antibiotic treatment protocol have been shown to be associated with lower hospital stay, cost, recurrent abscess, small bowel obstruction, and frequency of hospital readmission after discharge in patients with perforated appendicitis than those in patients undergoing delayed appendectomy after antibiotic treatment [1,[6][7][8] . Therefore, early and accurate detection of perforated appendicitis in patients monitored with an initial diagnosis of acute appendicitis in the emergency room is important in determining the appropriate antibiotic therapy and timing of surgery.…”

Section: Original Articlementioning

confidence: 99%

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Predictive value of serum sodium level in determining complicated appendicitis risk in children

Besli¹

2019

Haydarpasa Numune Med J

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Introduction: Acute appendicitis is one of the most common surgical emergencies in childhood. Early recognition and treatment of children with complicated appendicitis, especially perforated and gangrenous, is very crucial. The aim of the present study was to determine the predictive value of simple blood tests, such as serum sodium (Na) level, C-reactive protein (CRP) level, and blood leukocyte and neutrophil counts, in complicated appendicitis. Methods: A total of 403 patients who underwent operation with the initial diagnosis of acute appendicitis that was confirmed by surgery and histopathology were evaluated retrospectively. Patients with perforated or gangrenous appendix, generalized peritonitis, and intra-abdominal abscess were identified as complicated appendicitis. Basal serum Na and CRP levels and blood leukocyte and neutrophil counts of patients with complicated and non-complicated appendicitis were compared. Results: Of the 403 patients, 158 (39.2%) had non-complicated, and 245 (60.8%) had complicated appendicitis. No difference was found between the two groups with regard to hyponatremia, leukocytosis, and neutrophilia (p>0.05). The risk of complicated appendicitis increased 2.5-fold in patients with elevated CRP (odds ratio: 2.498; 95% confidence interval: 1.558-4.004). Patients with complicated appendicitis had lower baseline serum Na levels (p=0.004; p<0.05). For diagnosis of complicated appendicitis, the cutoff value for Na was ≤138 mEq/L (sensitivity 82.5% and specificity 31.1%). Discussion and Conclusion: It was concluded that blood leukocyte and neutrophil counts in patients with suspected acute appendicitis in the emergency department were not helpful in determining the risk of complicated appendicitis. Although a basal serum Na level ≤138 mEq/L has a high sensitivity in predicting complicated appendicitis, its specificity is low.

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Section: Original Articlementioning

confidence: 99%

“…A ppendicitis is the most common non-traumatic surgical emergency in childhood. The risk of perforation in childhood is higher than that in adults and is reported to be between 20% and 74% [1][2][3] . The clinical course can progress from simple (non-perforated) acute appendicitis to complicated conditions, such as perforation and intraabdominal abscess.…”

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confidence: 99%

Predictive value of serum sodium level in determining complicated appendicitis risk in children

Besli¹

2019

Haydarpasa Numune Med J

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“…The optimal treatment for perforated appendicitis remains controversial and complex. 4 , 6 , 18 , 19 , 22 , 23 , 32 , 59 – 61 Although most authors concur on the importance of fluid resuscitation and antibiotics, one study in 1980 reported minimal morbidity with close observation and no administration of antibiotics for pediatric patients who present with greater than 5 days of symptoms with a palpable mass and no generalized peritonitis. 59 Current standard of care and practice guidelines advocate for the early initiation of antibiotics in treatment algorithms.…”

Section: Managementmentioning

confidence: 99%

“…Many surgeons and studies advocate for early appendectomy in the setting of perforated appendicitis. 4 , 6 , 15 , 22 , 23 , 32 , 64 , 71 , 93 , 95 , 100 , 103 , 108 , 112 , 117 – 120 The best quality of evidence is found in two separate randomized trials. 6 , 95 St Peter et al performed a pilot study with 40 patients aged 7–18 years with a diagnosis of perforated appendicitis with an abscess that were randomized to early appendectomy (n=20) and non-operative management that consisted of intravenous antibiotics, percutaneous drainage when feasible, and interval appendectomy (n=20).…”

Section: Managementmentioning

confidence: 99%

Perforation risk in pediatric appendicitis: assessment and management

Howell

Dubina

Lee

2018

PHMT

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Perforated appendicitis, as defined by a visible hole in the appendix or an appendicolith free within the abdomen, carries significant morbidity in the pediatric population. Accurate diagnosis is challenging as there is no single symptom or sign that accurately predicts perforated appendicitis. Younger patients and those with increased duration of symptoms are at higher risk of perforated appendicitis. Elevated leukocytosis, bandemia, high C-reactive protein, hyponatremia, ultrasound, and CT are all useful tools in diagnosis. Distinguishing patients with perforation from those without is important given the influence of a perforation diagnosis on the management of the patient. Treatment for perforated appendicitis remains controversial as several options exist, each with its indications and merits, illustrating the complexity of this disease process. Patients may be managed non-operatively with antibiotics, with or without interval appendectomy. Patients may also undergo appendectomy early in the course of their index hospitalization. Factors known to predict failure of non-operative management include appendicolith, leukocytosis greater than 15,000 white blood cells per microliter, increased bands, and CT evidence of disease beyond the right lower quadrant. In this review, the indications and benefits of each treatment strategy will be discussed and an algorithm to guide treatment decisions will be proposed.

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“…However, some researchers disapprove of the use of ILA because of increased hospital costs, risk of recurrence, and strong in ammatory adhesion [13][14][15]. However, with the recent technical improvements in laparoscopic surgery, ELA has been reported to be equivalent to ILA in terms of the frequency of complications [16][17][18].…”

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confidence: 99%

Defining treatment strategy for uncomplicated appendicitis based on patient satisfaction feedback: A cross-sectional study

Tatsuta

Miyazaki

Ogiku

et al. 2020

Preprint

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Background Two surgical strategies are available for appendicitis: emergency laparoscopic appendectomy and interval laparoscopic appendectomy. However, timing of surgical intervention remains debatable. This study aimed to compare the surgical outcomes of emergency laparoscopic appendectomy (ELA) and interval laparoscopic appendectomy (ILA) and conduct a questionnaire survey to investigate the use of ELA and patient satisfaction with regard to treatment. Methods We included 162 patients who underwent laparoscopic appendectomy at our hospital. Outcomes were assessed by operation time, blood loss, postoperative fasting time, length of hospital stay, and complication rate. Patient satisfaction was measured by questionnaire addressing degree of satisfaction, pre-surgery anxiety, and length of hospital stay. Continuous variables were compared by Student’s t-test, and discrete variables, expressed as percentages, were analyzed via chi-squared test. Results Of 162 patients, 74 (46%) and 88 (54%) received emergency and ILA, respectively. No significant difference was observed in the operation time, blood loss, length of hospital stay, or complication rate. Among 66 patients who responded to the questionnaire (28 emergency, 38 interval), a significant difference was observed only in the degree of satisfaction regarding the timing of the surgical intervention (p = 0.04). Conclusions Surgical outcomes of emergency and interval appendectomy were equivalent; however, patient satisfaction favored emergency appendectomy, suggesting it is a preferable approach for the treatment of uncomplicated appendicitis. Trial registration: NA

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Early appendectomy reduces costs in children with perforated appendicitis

Cited by 17 publications

References 18 publications

Predictive value of serum sodium level in determining complicated appendicitis risk in children

Predictive value of serum sodium level in determining complicated appendicitis risk in children

Perforation risk in pediatric appendicitis: assessment and management

Defining treatment strategy for uncomplicated appendicitis based on patient satisfaction feedback: A cross-sectional study

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