Complication analysis in acute appendicitis, results from an international multicenter study.
Age
Appendicitis
Complication
Diagnosis
Female
Infections
Mortality
Outcomes
Treatment
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
18 Oct 2023
18 Oct 2023
Historique:
received:
05
01
2023
accepted:
27
08
2023
medline:
18
10
2023
pubmed:
18
10
2023
entrez:
18
10
2023
Statut:
aheadofprint
Résumé
Acute appendicitis (AA) is frequent, its diagnosis is challenging, and the surgical intervention is not risk free. An accurate diagnosis will reduce unnecessary surgeries and associated risks. This study aimed to analyze the rate of appendectomies' postoperative complications. Multicenter, prospective, observational study conducted at three large hospitals (Pisa University Hospital, Italy; Henri Mondor University Hospital, Paris, France; and Valencia University Hospital, Spain). A total of 3070 patients with a median age of 28 years (IQR 20-43) were enrolled. 1403 (45.7%) were females. Eight hundred ninety patients (29%) did not undergo preoperative imaging. Ultrasound and CT scans were performed in 1465 (47.7%) and 715 (23.3%) patients. Patients requiring CT scan were older [median 38 (IQR 26-53) vs. no imaging median 24 (IQR 16-35), Ultrasound median 28 (IQR 20-41); p < 0.0001]. Laparoscopic appendectomy was performed in 58.6%. Complications developed in 1279 (41.7%) patients: Clavien-Dindo grades I-II in 1126 (33.9%); Clavien-Dindo grades III-IV in 146 (5.2%). Overall mortality was 0.2%. Following resection of a normal appendix, 15% experienced major complications (Clavien-Dindo grades IIIb and above). Multivariable analysis revealed that age, Charlson comorbidity index, histopathology, and Alvarado score over 7 were associated with a higher risk of Clavien-Dindo complication grades IIIa and higher. Appendectomy may be associated with serious postoperative complications. Complications were associated with older age, Charlson comorbidity index, histopathology, and high Alvarado scores. The definition of accurate diagnostic and therapeutic pathways may improve results. The association between clinical scores and radiology is recommended.
Identifiants
pubmed: 37851023
doi: 10.1007/s00068-023-02361-2
pii: 10.1007/s00068-023-02361-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007;25(5):489–93.
doi: 10.1016/j.ajem.2006.08.020
pubmed: 17543650
Reddy SB, Kelleher M, Bokhari SAJ, Davis KA, Schuster KM. A highly sensitive and specific combined clinical and sonographic score to diagnose appendicitis. J Trauma Acute Care Surg. 2017;83(4):643–9.
doi: 10.1097/TA.0000000000001551
pubmed: 28459797
Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27. https://doi.org/10.1186/s13017-020-00306-3 .
doi: 10.1186/s13017-020-00306-3
pubmed: 32295644
pmcid: 7386163
Ohle R, et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.
doi: 10.1186/1741-7015-9-139
pubmed: 22204638
pmcid: 3299622
Scott AJ, et al. Risk stratification by the Appendicitis Inflammatory response score to guide decision-making in patients with suspected appendicitis. Br J Surg. 2015;102(5):563–72.
doi: 10.1002/bjs.9773
pubmed: 25727811
Podda M, Pisanu A, Sartelli M, Coccolini F, Damaskos D, Augustin G, et al. Diagnosis of acute appendicitis based on clinical scores: is it a myth or reality? Acta Biomed. 2021;92(4): e2021231.
pubmed: 34487066
pmcid: 8477120
Ahmed HO, Muhedin R, Boujan A, Aziz AHS, Abdulla AM, Hardi RA, Abdulla AA, Sidiq TA. A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq. Sci Rep. 2020;10(1):2028.
doi: 10.1038/s41598-020-58847-1
pubmed: 32029830
pmcid: 7005033
Wu T, Yang Y, Wu Y, Lu L, Dong S. Complications after appendectomy in patients with treated appendicitis: results from a retrospective study. Ann Palliat Med. 2021;10(12):12546–53.
doi: 10.21037/apm-21-3295
pubmed: 35016452
Fujishiro J, Watanabe E, Hirahara N, Terui K, Tomita H, Ishimaru T, Miyata H. Laparoscopic Versus Open Appendectomy for acute appendicitis in children: a nationwide retrospective Study on Postoperative Outcomes. J Gastrointest Surg. 2021;25(4):1036–44.
doi: 10.1007/s11605-020-04544-3
pubmed: 32128682
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557–64. https://doi.org/10.1016/s0196-0644(86)80993-3 . (PMID: 3963537).
doi: 10.1016/s0196-0644(86)80993-3
pubmed: 3963537
Charlson CS, Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83 ([PubMed: 3558716]).
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
Clavien-Dindo DD, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34(28):3661–79.
doi: 10.1002/sim.6607
pubmed: 26238958
pmcid: 4626409
Wooldridge J. Inverse probability weighted estimation for general missing data problems. J Econom. 2007;141(2):1281–301.
doi: 10.1016/j.jeconom.2007.02.002
Al-Khayal KA, Al-Omran MA. Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. a meta-analysis. Saudi Med J. 2007;28(2):173–80.
pubmed: 17268692
Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307–14.
doi: 10.1016/j.ijsu.2018.07.003
pubmed: 30017607
Kularatna M, Lauti M, Haran C, MacFater W, Sheikh L, Huang Y, McCall J, MacCormick AD. Clinical prediction rules for appendicitis in adults: which is best? World J Surg. 2017;41(7):1769–81.
doi: 10.1007/s00268-017-3926-6
pubmed: 28258458
Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;10(12):29.
doi: 10.1186/s13017-017-0141-6
Gwynn LK. The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med. 2001;21(2):119–23.
doi: 10.1016/S0736-4679(01)00353-5
pubmed: 11489398
Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic Accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017;24(5):523–51.
doi: 10.1111/acem.13181
pubmed: 28214369
Ebell MH, Shinholser J. What are the most clinically useful cutoffs for the Alvarado and Pediatric Appendicitis Scores? a systematic review. Ann Emerg Med. 2014;64(4):365–72.
doi: 10.1016/j.annemergmed.2014.02.025
pubmed: 24731432