scholarly journals Patient backgrounds and short‐term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis

2021 ◽  
Author(s):  
Takuya Oba ◽  
Takeshi Yamada ◽  
Akihisa Matsuda ◽  
Makoto Otani ◽  
Shinya Matsuda ◽  
...  
Keyword(s):  
Complicated Appendicitis ◽  
Short Term ◽  
Uncomplicated Appendicitis

scholarly journals Does Serum Bilirubin Add Value in the Diagnosis of Appendicitis? A Multi-Institution Analysis of 2024 Patients

2021 ◽  
Author(s):  
Andrew Phillip Maurice ◽  
Benjamin David Swinson ◽  
Eduardo Miguel Apellaniz ◽  
Sarah Emily King ◽  
Thomas Grant Mackay ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Neutrophil Count ◽  
Serum Bilirubin ◽  
White Cell Count ◽  
Delayed Diagnosis ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
Operative Findings

Abstract BACKGROUNDEven with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis.METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count.RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p<0.0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p<0.001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p<0.0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy.CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.

scholarly journals Management of appendicitis during COVID-19 pandemic; short-term outcomes

2020 ◽  
Vol 65 (4) ◽  
pp. 144-148
Author(s):  
Radhakrishnan Ganesh ◽  
James Lucocq ◽  
Neville Ogbonnia Ekpete ◽  
Noor Ul Ain ◽  
Su Kwan Lim ◽  
...  
Keyword(s):  
Conservative Management ◽  
Short Term ◽  
Mri Scan ◽  
Operative Outcomes ◽  
Uncomplicated Appendicitis ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Surgical Conditions

Background and aim COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. Methods Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. Results One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. Conclusion CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.

scholarly journals Logistic regression model to predict acute uncomplicated and complicated appendicitis

2019 ◽  
Vol 101 (2) ◽  
pp. 107-118 ◽  
Author(s):  
MMR Eddama ◽  
KC Fragkos ◽  
S Renshaw ◽  
M Aldridge ◽  
G Bough ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Web Application ◽  
Univariate Analysis ◽  
Complicated Appendicitis ◽  
Regression Equation ◽  
Normal Appendix ◽  
Uncomplicated Appendicitis ◽  
Logistic Regression Equation

Introduction While patients with acute uncomplicated appendicitis may be treated conservatively, those who suffer from complicated appendicitis require surgery. We describe a logistic regression equation to calculate the likelihood of acute uncomplicated appendicitis and complicated appendicitis in patients presenting to the emergency department with suspected acute appendicitis. Materials and methods A cohort of 895 patients who underwent appendicectomy were analysed retrospectively. Depending on the final histology, patients were divided into three groups; normal appendix, acute uncomplicated appendicitis and complicated appendicitis. Normal appendix was considered the reference category, while acute uncomplicated appendicitis and complicated appendicitis were the nominal categories. Multivariate and univariate regression models were undertaken to detect independent variables with significant odds ratio that can predict acute uncomplicated appendicitis and complicated appendicitis. Subsequently, a logistic regression equation was generated to produce the likelihood acute uncomplicated appendicitis and complicated appendicitis. Results Pathological diagnosis of normal appendix, acute uncomplicated appendicitis and complicated appendicitis was identified in 188 (21%), 525 (59%) and 182 patients (20%), respectively. The odds ratio from a univariate analysis to predict complicated appendicitis for age, female gender, log2 white cell count, log2 C-reactive protein and log2 bilirubin were 1.02 (95% confidence interval, CI, 1.01, 1.04), 2.37 (95% CI 1.51, 3.70), 9.74 (95% CI 5.41, 17.5), 1.57 (95% CI 1.40, 1.74), 2.08 (95% CI 1.56, 2.76), respectively. For the same variable, similar odds ratios were demonstrated in a multivariate analysis to predict complicated appendicitis and univariate and multivariate analysis to predict acute uncomplicated appendicitis. Conclusions The likelihood of acute uncomplicated appendicitis and complicated appendicitis can be calculated by using the reported predictive equations integrated into a web application at www.appendistat.com. This will enable clinicians to determine the probability of appendicitis and the need for urgent surgery in case of complicated appendicitis.

scholarly journals Leucocyte count in children with complicated and uncomplicated acute appendicitis: a comparative study

2019 ◽  
Vol 6 (12) ◽  
pp. 4308
Author(s):  
Liya Joseph
Keyword(s):  
Acute Appendicitis ◽  
Leucocyte Count ◽  
Tertiary Care ◽  
Age Groups ◽  
Complicated Appendicitis ◽  
Total Leucocyte Count ◽  
Chi Square ◽  
Uncomplicated Appendicitis ◽  
Uncomplicated Acute Appendicitis ◽  
Complicated Acute Appendicitis

Background: Identification of complicated and uncomplicated acute appendicitis is important in children. In acute appendicitis, along with clinical evaluation and staging, many laboratory tests have been used. The aim of the study was to compare total leucocyte count in children with uncomplicated and complicated acute appendicitis in different age groups.Methods: Retrospective cohort study was performed in children who underwent appendicectomy, in a Government tertiary care institution between January 2017 and December 2018. 206 patients were divided into complicated and uncomplicated appendicitis. Total leucocyte count at time of admission was compared according to age. Unpaired t test and Chi-square test were used for statistical analysis.Results: There were 136 males and 70 females. 107 patients (51.94%) had complicated and 99 (48.06%) had uncomplicated appendicitis. Mean leucocyte count per µl in uncomplicated appendicitis was 18993±3540 in <5 years, 17155±3386 in 5-10 years and 15833±3613 in 10-15 years. The mean leucocyte count for complicated appendicitis was 19974±3658 in <5 years, 17727±4487 in 5-10 years and 17220±3411 in 10-15 years age group. In 10-15 years group, patients with complicated acute appendicitis had statistically significant higher values of mean total leucocyte count.Conclusions: Total leucocyte count can be used as marker of severity of acute appendicitis in children older than 10 years. In children with clinical suspicion of acute appendicitis, total leucocyte count >20000 per µl signifies complicated appendicitis in all age groups.

scholarly journals Predictive Factors of Acute Complicated Appendicitis: A Retrospective Study

2021 ◽  
Author(s):  
Sawako Hiroi ◽  
Michinori Hamaoka ◽  
Masashi Miguchi ◽  
Toshihiro Misumi ◽  
Yuji Yamamoto ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Complicated Appendicitis ◽  
Fluid Retention ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Preoperative Prediction ◽  
Uncomplicated Appendicitis ◽  
Operating Characteristic Curve

Abstract Background: Complicated appendicitis is an indication for emergency surgery. Therefore, the predictive factors for appendicitis based on the patient background needs identification. Previously, factors predicting non-complicated and complicated appendicitis were reported. However, most of those reports were deemed unsuitable as a standard for emergency use, since those comprised too many items as predictors. We previously reported three items that preoperatively predicted complicated appendicitis (body temperature, C-reactive protein, and fluid retention around the appendix). In this study, we re-evaluated different cases to confirm the usefulness of these three items can for accurately predicting complicated appendicitis preoperatively. In addition, we compared the effectiveness of these predictor items with those reported by other researchers.Methods: We retrospectively evaluated 417 adult patients who underwent surgery for acute appendicitis between January 2013 and December 2019, and compared our predictor items with those used in previous reports on the preoperative prediction of complicated appendicitis (criteria A consisting of eight predictor items and criteria B consisting of seven predictor items). Results: The area under the receiver operating characteristic curve (AUC) for the sensitivity to diagnose complicated appendicitis according to our criteria, criteria A, and criteria B were 0.823, 0.839, and 0.856, respectively. The AUC of our criteria and criteria A were similar (P = 0.356); those of criteria A and B were also similar (P = 0.352). However, the AUC of criteria B was statistically higher than that of our criteria (P < 0.05).Conclusion: Diagnostic criteria B were statistically the best predictor items for characterizing complicated and uncomplicated appendicitis. However, like criteria A and B, the AUC of our criteria exceeded 0.8, and only involved three predictor items; therefore, they can be considered useful predictors.

scholarly journals SP4.1.13 Management of appendicitis during COVID-19 pandemic; short-term outcomes

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Lucocq ◽  
Ganesh Radhakishnan
Keyword(s):  
Conservative Management ◽  
Short Term ◽  
Mri Scan ◽  
Operative Outcomes ◽  
Uncomplicated Appendicitis ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Surgical Conditions

Abstract Aims COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. Methods Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. Results One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p &lt; 0.00001). There was no significant difference in the outcomes between the two groups. Conclusion CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.

scholarly journals Can neutrophil-to-lymphocyte ratio be used as a predictor in acute appendicitis?

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Chirag Pereira ◽  
Manohar Martis ◽  
Rohan D'Souza ◽  
Leo F. Tauro
Keyword(s):  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
Abdominal Ultrasound ◽  
Complicated Appendicitis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Characteristic Analysis ◽  
Lymphocyte Ratio ◽  
Medical College ◽  
Uncomplicated Appendicitis ◽  
Ethical Approval

Background: To determine if neutrophil-to-lymphocyte ratio (NLR) can be used to diagnose appendicitis and distinguish complicated from uncomplicated appendicitis. The secondary aim was to determine if the appendix cut-off size on ultrasound matches that of existing literature. Methods: We retrospectively analyzed all cases that underwent appendectomy in Father Muller medical college and hospital from 2014 to 2019. The NLR, histopathology, and ultrasound reports for all patients were reviewed. Recommended cut-off values for NLR and appendicular size on ultrasound were determined using receiver operating characteristic analysis (ROC). Data was analyzed using SPSS version 25. Ethical approval was obtained for this study. Results: We included 1623 patients in this study. The patients’ median age was 24 years, with appendicitis being more common in males than females. NLR>2.4 was statistically associated with appendicitis with sensitivity of 70.1% and specificity of 43.2%. NLR>4.3 was statistically associated with complicated appendicitis with sensitivity of 72.25% and specificity of 54.09%. An appendicular diameter >6.1 mm was suggestive of appendicitis on abdominal ultrasound based on our analysis. Conclusions: NLR is a simple adjunct that can be used to diagnose appendicitis and identify complicated appendicitis.

scholarly journals Complications after Laparoscopic Appendectomy for Complicated Appendicitis

2020 ◽  
Vol 19 (1-2) ◽  
pp. 34-41
Author(s):  
Andrej Nikolovski ◽  
Shenol Tahir ◽  
Dragoslav Mladenovikj
Keyword(s):  
Postoperative Complications ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Open Appendectomy ◽  
Laparoscopic Group ◽  
Complicated Appendicitis ◽  
Open Group ◽  
Uncomplicated Appendicitis ◽  
Low Incidence

Background. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis.

scholarly journals Nomogram for predicting complicated appendicitis and aiding decision-making regarding antibiotic therapy for acute appendicitis

2020 ◽  
Author(s):  
peng zhang ◽  
Tianlei Xu ◽  
Qian Zhang ◽  
Hongwei Zhao ◽  
Yiting Meng ◽  
...  
Keyword(s):  
Decision Making ◽  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Failure Rate ◽  
Risk Score ◽  
Validation Cohort ◽  
Complicated Appendicitis ◽  
Uncomplicated Appendicitis ◽  
Ct Features

Abstract Background Antibiotic therapy is a feasible treatment option for uncomplicated appendicitis, but the preoperative diagnosis of uncomplicated appendicitis is challenging. This study aimed to develop a nomogram to predict complicated appendicitis based on laboratory data and CT features and to guide antibiotic treatment decision-making. Methods Patients with pathologically confirmed acute appendicitis (AA) were randomly split into the primary and validation cohorts. The nomogram model for predicting complicated appendicitis was constructed based on the results of the multivariate logistic analysis in the primary cohort and transformed into a nomogram risk score. The nomogram was validated in a validation cohort and an independent antibiotic therapy cohort. Results A total of 375 patients were included in the primary cohort, 168 patients were included in the validation cohort, and 169 patients were included in the antibiotic treatment cohort. In the primary cohort, multivariate analysis confirmed that periappendiceal fat stranding (PFS, p < 0.001, OR = 67.80), the C-reactive protein level (CRP ≥ 38, p < 0.001, OR = 5.77) and the neutrophil-to-lymphocyte ratio (NLR ≥ 7, p < 0.001, OR = 3.51) were independent risk factors for complicated appendicitis. The PFS, CRP and NLR scores were 10.0, 4.0 and 3.0 points, respectively, based on the nomogram. Each patient was assigned a score obtained with the nomogram, called the nomogram risk score, and the best cutoff value for the nomogram risk score was 11.0 points. Fourteen patients (3.7%, 14/375) and seven patients (4.2%, 7/168) with complicated appendicitis were classified as having uncomplicated appendicitis in the primary and validation cohorts, respectively. When the nomogram risk score was greater than 11, the failure rate of antibiotic treatment was 49.2%; when the nomogram risk score was less than 11, the failure rate of antibiotic treatment was only 5.3%. Furthermore, the predictive accuracy of the nomogram risk score for antibiotic treatment failure as measured by the area under the curve (AUC) was 0.823 (95% CI: 0.757–0.878). Conclusion We found that the proposed nomogram risk score based on clinical and CT features not only enables the accurate identification of complicated appendicitis patients before surgery but also serves to guide management decisions.

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