Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

Almström, Markus; Svensson, Jan F.; Svenningsson, Anna; Hagel, Eva; Wester, Tomas

doi:10.1002/bjs5.52

Cited by 33 publications

(31 citation statements)

References 19 publications

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“…This may reflect a decrease in patients presenting with acute appendicitis and/ or a decrease in the number of patients treated surgically. The decrease in incidence observed in this study seems to be in line with results from a recently published populationwide study among children in Sweden that demonstrated a significant decline in incidence of appendicitis over time [31]. Then again, a nationwide epidemiological study on appendicitis in the USA published in 2012 reported a significant increase in incidence between 1993 and 2008 [32].…”

Section: Discussionsupporting

confidence: 90%

“…Then again, a nationwide epidemiological study on appendicitis in the USA published in 2012 reported a significant increase in incidence between 1993 and 2008 [32]. The literature on incidence of appendicitis is not clear [31,[33][34][35]. In a systematic review on the global incidence of appendicitis, pooled incidence of appendicitis or appendectomy in the Western World was estimated at 151 per 100 000 person years and reported to be stable in most Western countries [23].…”

Section: Discussionmentioning

confidence: 99%

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Disease burden of appendectomy for appendicitis: a population-based cohort study

2019

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Background Few large-scale epidemiologic studies evaluate the clinical and economic burden of appendicitis. These data may impact future research and treatment strategies. In this study, the objective was to determine the burden of appendectomy for appendicitis in terms of incidence rates, length of hospital stay (LOS) and hospital costs on a national level. In addition, outcomes were compared for subgroups based on surgical treatment, age and hospital setting. Methods Observational retrospective population-based cohort study using the national Dutch healthcare reimbursement registry, which covers hospital registration and reimbursement for 17 million inhabitants. Patients with a diagnosis of appendicitis who underwent appendectomy between 2006 and 2016 were included. Primary outcomes were incidence rates, LOS and hospital costs. Results A total of 135,025 patients were included. Some 53% of patients was male, and 64% was treated in a general hospital. The overall incidence rate of appendectomy was 81 per 100,000 inhabitants and showed a significant decreasing trend across time and age. Mean ± SD LOS per patient was 3.66 ± 3.5 days. LOS showed a significant increase with age and was significantly longer for open versus minimally invasive appendectomy. Mean ± SD hospital costs per patient were €3700 ± 1284. Costs were initially lower for open compared to minimally invasive appendectomy, but were similar from 2012 onward. Compared to non-university hospitals, patients treated in university hospitals had a significantly longer LOS and higher costs. Conclusions Appendectomy for appendicitis represents a substantial clinical and economic burden in the Netherlands. A preference for minimally invasive technique seems justified. Keywords Appendicitis • Appendectomy • Length of stay • Hospital costs Although acute appendicitis is highly prevalent among adults and children worldwide, literature on the clinical and economic burden of the disease is scarce. Emergent appendectomy remains the cornerstone of treatment and is nowadays mostly performed via the minimally invasive approach in Western countries [1-3]. It is known as a low-risk surgical procedure, with reported mortality rates between 0.03 and 0.24% [4-6]. Depending on the intraoperative classification, patients may be discharged within 24-48 h, or after a few days of prolonged antibiotic prophylaxis [7, 8]. Infectious complications occur in some 9-20% of patients, accompanied by a hospital readmission rate of 6% [5, 9]. Whereas morbidity and mortality are estimators of the burden of

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Disease burden of appendectomy for appendicitis: a population-based cohort study

2019

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“…The majority of studies found a decreasing or stable incidence but findings have been inconsistent. 1,[11][12][13][14][15] Globally, the incidence of acute appendicitis in developing countries seems to be increasing. 15 Recent studies also found that the likelihood of perforation has increased during the last decades meaning that the clinical presentation of appendicitis may be changing.…”

Section: Introductionmentioning

confidence: 99%

Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

Hansen

Kleif²,

Jakobsen

et al. 2020

Eur J Pediatr Surg

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Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

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“…AAp is one of the most common acute surgical emergencies, with an incidence of approximately 100 per 100.000 people (1,2). The incidence varies with different age groups and in different countries, and is lower in populations where a high-fiber diet is consumed (1,12). The pathogenesis of AAp is believed to reflect an initial insult to the mucosa, resulting from luminal obstruction, followed by bacterial infection that progressively spreads from the mucosa into the appendix wall.…”

Section: Discussionmentioning

confidence: 99%

Unusual infectious agents detected in appendectomy specimens: A retrospective analysis of 42 cases

et al. 2020

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Objective: The aim of this study was to evaluate the clinical and histopathological features of 42 patients with unusual infectious agents detected in their appendectomy specimens. Material and Methods: Between January 1999 and November 2018, 2.754 patients underwent emergency or incidental appendectomy in our clinic, and their pathology reports were retrospectively reviewed. Unusual infectious agents or eosinophilic infiltration of the appendix were reported in the initial pathological examinations of 57 patients. The pathological slides of these patients were reexamined by histopathologists. The examinations revealed that 15 of these patients had no microscopic findings suggestive of parasitic infections. The remaining 42 patients with unusual appendiceal infectious agents were included into the study. Results: A total of 42 patients (25 females and 17 males) aged 18 to 75 years were included into this study. While 32 of these patients (76%) underwent emergency appendectomy with a presumed diagnosis of acute appendicitis (AAp), the remaining 10 patients underwent incidental appendectomy for various reasons. Twenty-two patients (52.4%) had histopathological changes consistent with AAp while 20 patients had no evidence of AAp. Histopathological examination revealed infection with Enterobius vermicularis in 38 of the patients, Taenia species in 2, and Ascaris lumbricoides and Actinomyces species in 1 patient each. A total of 24 patients were treated for infections with mebendazole (n= 20), albendazole (n= 1), niclosamide (n= 2), and amoxicillin (n= 1). Conclusion: Unusual infectious agents should be considered as factors potentially triggering AAp, especially in patients living in endemic areas. The appendiceal stump should be inspected for parasite residues.

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Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

Cited by 33 publications

References 19 publications

Disease burden of appendectomy for appendicitis: a population-based cohort study

Disease burden of appendectomy for appendicitis: a population-based cohort study

Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

Unusual infectious agents detected in appendectomy specimens: A retrospective analysis of 42 cases

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