Factors Associated with Failure of Nonoperative Management for Complicated Appendicitis

2019 ◽  
Vol 85 (8) ◽  
pp. 865-870
Author(s):  
Charles Walker ◽  
Ali Moosavi ◽  
Katelyn Young ◽  
Marcus Fluck ◽  
Denise Torres ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Nonoperative Management ◽  
Operative Management ◽  
Complicated Appendicitis ◽  
Symptom Duration ◽  
Hospital System ◽  
Duration Of Symptoms ◽  
Failure Group ◽  
Non Operative Management

In recent years, nonoperative management of complicated appendicitis has become more common. Patients managed nonoperatively do well, but there is a paucity of literature on patients who fail nonoperative management. The purpose of this study was to examine the overall failure rate, morbidity associated with failure, and potential predictors of failure in nonop management of appendicitis. This is a descriptive retrospective review of patients from a single hospital system who were diagnosed with advanced appendicitis and underwent nonop management between January 1, 2007, and November of 2017. The data were obtained through review of patient charts from the electronic medical record. Failure was defined as requirement of an operation due to ongoing infection secondary to appendicitis. There were 183 patients initially managed non-operatively, with 70 patients failing nonoperative management. Patients failing nonoperative management experienced longer hospitalization (6.2 vs 2.9 days, P < 0.0001), and more patients in the failure group required admission to the ICU (10.0% vs 1.8%, P = 0.028). Multivariate analysis revealed that longer duration of symptoms reduced the likelihood of failure (odds ratio: 0.77 [0.64–0.92]). In this retrospective review, 38 per cent of patients failed nonop management of appendicitis. Symptom duration could provide insight for clinicians in assessing the role of non-operative management because increasing symptom duration reduced the likelihood of failure.

The Role of Angioembolization in Hepatic Trauma

2020 ◽  
pp. 000313482097372
Author(s):  
Ali Cadili ◽  
Jonathan Gates
Keyword(s):  
Gold Standard ◽  
Management Strategy ◽  
Operative Management ◽  
Hepatic Trauma ◽  
Anatomy And Physiology ◽  
Liver Injuries ◽  
Hepatic Injuries ◽  
Non Operative Management ◽  
Type Of Injury

The liver is one of the most commonly injured solid organs in blunt abdominal trauma. Non-operative management is considered to be the gold standard for the care of most blunt liver injuries. Angioembolization has emerged as an important adjunct that is vital to the success of the non-operative management strategy for blunt hepatic injuries. This procedure, however, is fraught with some possible serious complications. The success, as well as rate of complications of this procedure, is determined by degree and type of injury, hepatic anatomy and physiology, and embolization strategy among other factors. In this review, we discuss these important considerations to help shed further light on the contribution and impact of angioembolization with regards to complex hepatic injuries.

scholarly journals Non-operative Management of Blunt abdominal trauma in a Tertiary Care Hospital of Nepal

2013 ◽  
Vol 2 (1) ◽  
pp. 38-41 ◽  
Author(s):  
P Ghimire ◽  
N Yogi ◽  
P Ghimire
Keyword(s):  
Teaching Hospital ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Bowel Injury ◽  
Care Hospital ◽  
Failure Group ◽  
Management Group ◽  
Clinical Instability ◽  
Non Operative Management

Background: To assess the feasibility of Non-operative management of Blunt abdominal trauma in a teaching hospital of Nepal. Methods: A prospective observational study was carried out over a period of 3 years including 52 cases of blunt abdominal trauma in a teaching hospital in western part of Nepal. Patient and trauma characteristics of the cases, different modalities of treatment and outcomes were evaluated. All the cases were divided in 3 groups: Operative group, Non-Operative Management and Non-Operative Failure group. Operative group and non-operative management group were compared using Fischer Exact Test for categorical variable and student’s “t” test for continuous variable. Results: There were 36% of cases in operative group, 61% in non-operative management group and 2% in non-operative management failure group. Non-operative management was successful in 97% of cases. Injury severity score, admission hematocrit and hemodynamic status were significantly different between non-operative management and Operative group. Non-operative management failure occurred in 1 case and was secondary to delayed hepatic hemorrhage. Conclusion: Non-operative management of Blunt abdominal trauma can be attempted with high degree of success. Hemodynamic and clinical instability rather than severity of the organ injury is the predictor of failure in non-operative management. Spleen and bowel injury are the most common organ that usually land up in operative group because of hemodynamic instability in splenic injury and peritoneal contamination in bowel injury. Close surveillance in an intensive care unit is always desirable. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 38-41 DOI: http://dx.doi.org/10.3126/njms.v2i1.7650

scholarly journals The role of grade of injury in non-operative management of blunt hepatic and splenic trauma

Medicine ◽  
2019 ◽  
Vol 98 (35) ◽  
pp. e16746 ◽  
Author(s):  
Paolo Ruscelli ◽  
Alessandro Gemini ◽  
Massimiliano Rimini ◽  
Sergio Santella ◽  
Roberto Candelari ◽  
...  
Keyword(s):  
Operative Management ◽  
Splenic Trauma ◽  
Non Operative Management

scholarly journals The role of non-operative management (NOM) in blunt hepatic trauma

2013 ◽  
Vol 49 (3) ◽  
pp. 223-227
Author(s):  
Ayman Zaki Azzam ◽  
Abdel Hamid Gazal ◽  
Mohammed I. Kassem ◽  
Magdy A. Souror
Keyword(s):  
Operative Management ◽  
Hepatic Trauma ◽  
Non Operative Management

scholarly journals Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Keiichi Suzuki ◽  
Tomoshige Umeyama ◽  
Kenshi Omagari ◽  
Takeo Hashimoto ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Laparoscopic Appendectomy ◽  
Nonoperative Management ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Operative Management ◽  
Complicated Appendicitis ◽  
Effective Strategy ◽  
Threshold Analysis

Abstract Background The evidence regarding the safety and efficacy of nonoperative management is growing. However, the best treatment strategy for acute complicated appendicitis remains controversial. We aimed to evaluate the cost-effectiveness of treatment strategies for complicated appendicitis patients. This study sought to determine the most cost-effective strategy from the health care-payer’s perspective. Methods The primary outcome was an incremental cost effectiveness ratio (ICER) using nonoperative management with or without interval laparoscopic appendectomy (ILA) as the intervention compared with operative management with emergency laparoscopic appendectomy (ELA) alone as the control. Model variables were abstracted from a literature review, and from data obtained from the hospital records of Tochigi Medical Center. Cost-effectiveness was evaluated using an ICER. We constructed a Markov model to compare treatment strategies for complicated appendicitis in otherwise-healthy adults, over a time horizon of a single year. Uncertainty surrounding model parameters was assessed via one-way- and probabilistic-sensitivity analyses. Threshold analysis was performed using the willingness-to-pay threshold set at the World Health Organization’s criterion of $107,690. Results Three meta-analysis were included in our analysis. Operative management cost $6075 per patient. Nonoperative management with interval laparoscopic appendectomy (ILA) cost $984 more than operative management and produced only 0.005 more QALYs, resulting in an ICER of $182,587. Nonoperative management without ILA cost $235 more than operative management, and also yielded only 0.005 additional QALYs resulting in an ICER of $45,123 per QALY. Probabilistic sensitivity analysis with 1000 draws resulted in average ICER of $172,992 in nonoperative management with ILA and $462,843 in Nonoperative management without ILA. The threshold analysis demonstrated that regardless of willingness-to-pay, nonoperative management without ILA would not be most cost-effective strategy. Conclusions Nonoperative management with ILA and Nonoperative management without ILA were not cost-effective strategies compared with operative management to treat complicated appendicitis. Based on our findings, operative management remains the standard of care and nonoperative management would be reconsidered as a treatment option in complicated appendicitis from economic perspective.

scholarly journals Trends in Management of Radial Head and Olecranon Fractures

2017 ◽  
Vol 11 (1) ◽  
pp. 239-247 ◽  
Author(s):  
Matthew Motisi ◽  
Jennifer Kurowicki ◽  
Derek D. Berglund ◽  
Jacob J. Triplet ◽  
Shanell Disla ◽  
...  
Keyword(s):  
Radial Head ◽  
Retrospective Review ◽  
Surgical Techniques ◽  
Operative Management ◽  
Open Reduction Internal Fixation ◽  
Significant Trend ◽  
Office Visits ◽  
Radial Head Arthroplasty ◽  
Non Operative Management ◽  
Olecranon Fractures

Background: Advancement in surgical techniques and implants has improved the ability to manage radial head and olecranon fractures. However, trends in management of these fractures are largely unstudied. Objective: This purpose of this study is to evaluate management trends for these common fractures. Methods: A retrospective review of a comprehensive Humana database was performed using Pearl Diver supercomputer (Warsaw, IN, USA) for radial head and neck (RHNF) and olecranon fractures (OF) between 2007 and 2014. Treatment methods including open reduction internal fixation (ORIF), radial head arthroplasty (RHA), and non-operative treatment were reviewed. Total reported incidence of office visits and utilization of each treatment modality were investigated. Sub-analysis with stratification by age 15-74 and greater than 75-years was performed for OF. Results: A total of 10,609 OF and 20,400 RHNF were identified between 2007 and 2014. A significant trend increase in the annual incidence of RHNF (266 cases/year, p<0.001) and OF (133.9 cases/year, p=0.001) was observed. A significant trend increase in annual percent utilization of RHA (0.22% per year, p=0.011) and a significant trend decrease in the annual percent utilization of ORIF (-1.0% per year, p=0.004) and non-operative management (-0.53% per year, p=0.046) was observed for RHNF. A significant trend increase was observed in percent utilization (0.40% per year, p=0.022) for OF non-operative management, especially in patients over 75 years (66% per year, p=0.034). Conclusion: The percentage of patients being treated with RHA is increasing. Non-operative management of OF has increased, specifically in the patients who are over 75 years.

THE ROLE OF COMPUTED TOMOGRAPHY IN PATIENTS WITH GUNSHOT WOUNDS TO THE ABDOMEN SELECTED FOR NON-OPERATIVE MANAGEMENT

2004 ◽  
Vol 57 (2) ◽  
pp. 438
Author(s):  
George C. Velmahos ◽  
Constantinos Constantinou ◽  
Ali Salim ◽  
George Kasotakis ◽  
Carlos V. Brown ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives

Surgery Today ◽  
2020 ◽  
Author(s):  
Luigi Romeo ◽  
Francesco Bagolini ◽  
Silvia Ferro ◽  
Matteo Chiozza ◽  
Serafino Marino ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Current Knowledge ◽  
Operative Management ◽  
Current Status ◽  
Splenic Trauma ◽  
Future Perspectives ◽  
Encapsulated Bacteria ◽  
Non Operative Management

AbstractThe spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM.

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