Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Abstract

BackgroundAcute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.MethodsThis prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016–September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.ResultsA total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.ConclusionsThe results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

“…The overall NAR in UK adults aged 16–45 years was 20·0 per cent, significantly higher than the rate recorded in other countries that participated in the RIFT Study. This represents one of the world's highest NARs. Although simple and complex appendicitis may represent distinct pathologies, some surgeons believe that delaying surgery may increase the risk of appendiceal perforation.…”

“…The UK has one of the world's highest NARs, so the predefined aim for this study was to evaluate the potential for routine risk scoring to identify low‐risk UK patients who are unlikely to have appendicitis. It was predicted that the NAR would be lower in the other participating countries and there would be no need for appendicitis risk scoring.…”

“…National differences in clinical pathways mean that analyses must be stratified by country. At the time of planning the analysis, the NAR was anticipated to be around 20 per cent in the UK, but under 5 per cent in other European countries. Given the low baseline NAR, there is little clinical need for risk scoring in European populations, so validation of risk scores in those patients would be unlikely to change clinical practice.…”

Variations and morphometric features of the vermiform appendix: A systematic review and meta‐analysis of 114,080 subjects with clinical implications

“…Appendicitis is a global disease that is commonly diagnosed and a stable reported incidence rate (Ferris et al ). Although the number of performed appendectomies has been steadily decreasing due to the increased acceptance of non‐operative management of non‐complicated appendicitis, it remains one of the most commonly performed procedures in general surgery and is often regarded as a training procedure for beginning surgeons (Bethlehem et al ; Gosemann et al ; Sartelli et al ). Understanding the anatomy of the VA, which can vary from patient to patient, is a key prerequisite for both diagnosis of appendicitis and a successful appendectomy (Barlow et al ; Baird et al ).…”

Clinical Management of Appendicitis

“…In 2016, a study investigated the treatment strategy applied in more than 4,000 patients with acute uncomplicated appendicitis, demonstrating a dominance of surgical management with a rate of 96%. Interestingly, almost 45% of operations were open appendectomy [39]. This reflects the ongoing notion that operative management of uncomplicated appendicitis is still considered to be superior by surgeons.…”