Risk factors for postoperative morbidity, prolonged length of stay and hospital readmission after appendectomy for acute appendicitis

Laverde, Bruno Leonardo Bancke; Maak, Matthias; Langheinrich, Melanie; Kersting, Stephan; Denz, Axel; Krautz, Christian; Weber, Georg F.; Grützmann, Robert; Brunner, Maximilian

doi:10.1007/s00068-023-02225-9

Cited by 5 publications

(3 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further identified risk factors for postoperative morbidity in our analysis were a higher age, a higher preoperative WBC count and CRP level and a lower preoperative hemoglobin, which is in line with previous reports [ 24 , 25 , 26 , 27 , 28 ].…”

Section: Discussionsupporting

confidence: 92%

Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Laverde

Maak

Langheinrich

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

(1) Background: Since its introduction in the 1990s, laparoscopic appendectomy has become established over the years and is today considered the standard therapy for acute appendicitis. In some cases, however, a conversion to the open approach is still necessary. The primary aim of this study was to identify risk factors for the need to convert from the laparoscopic to an open approach during appendectomy for acute appendicitis. (2) Methods: A retrospective analysis of 1220 adult patients who underwent laparoscopic appendectomy for acute appendicitis from 2010 to 2020 at the University Hospital Erlangen was performed. Data, including patient demographics and pre-, intra-, and postoperative findings, were collected and compared between patients with and without conversion. (3) Results: The conversion rate in our cohort was 5.5%. A higher preoperative WBC count and CRP (OR 1.9, p = 0.042, and OR 2.3, p = 0.019, respectively), as well as the presence of intraoperative perforation, necrosis or gangrene, perityphlitic abscess and peritonitis (OR 3.2, p = 0.001; OR 2.3, p = 0.023; OR 2.6, p = 0.006 and OR 2.0, p = 0.025, respectively) were identified as independent risk factors for conversion from the laparoscopic to the open approach. Conversion was again independently associated with higher morbidity (OR 2.2, p = 0.043). (4) Conclusion: The laparoscopic approach is feasible and safe in the majority of patients with acute appendicitis. Only increased inflammatory blood markers could be detected as the preoperative risk factors potentially influencing the choice of surgical approach but only with low specificity and sensitivity. For the decision to convert, intraoperative findings are additionally crucial. However, patients with conversion should receive special attention in the postoperative course, as these have an increased risk of developing complications.

show abstract

Section: Discussionsupporting

confidence: 92%

Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Laverde

Maak

Langheinrich

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Simple and complicated appendicitis patients have significantly different postoperative recovery trajectories due to the greater disease severity in the case of complicated appendicitis, which more frequently requires additional inpatient treatments (e.g. antibiotics, intravenous fluids), prolonged return to normal bowel function, increased pain, and occasionally additional invasive procedures (percutaneous drainage of abscess), compared to simple appendicitis 79 , 80 .…”

Section: Methodsmentioning

confidence: 99%

Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy

Ghomrawi,

O’Brien,

Carter

et al. 2023

npj Digit. Med.

View full text Add to dashboard Cite

When children are discharged from the hospital after surgery, their caregivers often rely on subjective assessments (e.g., appetite, fatigue) to monitor postoperative recovery as objective assessment tools are scarce at home. Such imprecise and one-dimensional evaluations can result in unwarranted emergency department visits or delayed care. To address this gap in postoperative monitoring, we evaluated the ability of a consumer-grade wearable device, Fitbit, which records multimodal data about daily physical activity, heart rate, and sleep, in detecting abnormal recovery early in children recovering after appendectomy. One hundred and sixty-two children, ages 3–17 years old, who underwent an appendectomy (86 complicated and 76 simple cases of appendicitis) wore a Fitbit device on their wrist for 21 days postoperatively. Abnormal recovery events (i.e., abnormal symptoms or confirmed postoperative complications) that arose during this period were gathered from medical records and patient reports. Fitbit-derived measures, as well as demographic and clinical characteristics, were used to train machine learning models to retrospectively detect abnormal recovery in the two days leading up to the event for patients with complicated and simple appendicitis. A balanced random forest classifier accurately detected 83% of these abnormal recovery days in complicated appendicitis and 70% of abnormal recovery days in simple appendicitis prior to the true report of a symptom/complication. These results support the development of machine learning algorithms to predict onset of abnormal symptoms and complications in children undergoing surgery, and the use of consumer wearables as monitoring tools for early detection of postoperative events.

show abstract

“…Complicated appendicitis is seen in approximately 30% of all patients that undergo appendectomy and is characterized by transmural inflammation with features like necrosis (gangrenous), perforation, and/or the formation of abscesses in the pelvic or intraabdominal region [ 3 ]. Patients with complicated appendicitis tend to experience more postoperative morbidity including infectious complications, longer hospital stays and a higher likelihood of readmission [ 4 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections

Laverde,

Maak,

Langheinrich

et al. 2024

Langenbecks Arch Surg

View full text Add to dashboard Cite

Introduction The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis. Materials and methods In this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed. Results The two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4–21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2–29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4–20.0), p = 0.016) were identified as independent risk factors for wound infections. Conclusion The duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred.

show abstract

Risk factors for postoperative morbidity, prolonged length of stay and hospital readmission after appendectomy for acute appendicitis

Cited by 5 publications

References 44 publications

Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy

Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections

Contact Info

Product

Resources

About