The burden of the knowledge-to-action gap in acute appendicitis.
Acute appendicitis
Compliance
Evidence-based surgery
Guidelines
Knowledge transfer
Knowledge-to-action gap
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
05
06
2023
accepted:
05
09
2023
pubmed:
27
10
2023
medline:
27
10
2023
entrez:
26
10
2023
Statut:
ppublish
Résumé
The burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance. Data were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG. From 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%). Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units. We confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required.
Sections du résumé
BACKGROUND
BACKGROUND
The burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance.
METHODS
METHODS
Data were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG.
RESULTS
RESULTS
From 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%). Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units.
CONCLUSIONS
CONCLUSIONS
We confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required.
Identifiants
pubmed: 37884735
doi: 10.1007/s00464-023-10449-4
pii: 10.1007/s00464-023-10449-4
pmc: PMC10709474
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
9617-9632Investigateurs
Giulia Arianna Abruzzese
(GA)
Francesca Albanesi
(F)
Erika Andreatta
(E)
Ludovica Baldari
(L)
Laura Benuzzi
(L)
Emanuele Bevilaqua
(E)
Alessandro Michele Bonomi
(AM)
Greta Brachetti
(G)
Giulia Cannavale
(G)
Andrea Piero Chierici
(AP)
Riccardo Cirelli
(R)
Gaia Colletti
(G)
Vera D'abrosca
(V)
Piergiorgio Danelli
(P)
Luca Del Prete
(L)
Francesco Di Capua
(F)
Francesca Di Vittorio
(F)
Davide Ferrari
(D)
Luca Ferrario
(L)
Laura Fiore
(L)
Colomba Frattaruolo
(C)
Caterina Froiio
(C)
Ludovica Gibelli
(L)
Irene Giusti
(I)
Ugo Giustizieri
(U)
Samuele Grandi
(S)
Giulio Iacob
(G)
Alessia Kersik
(A)
Pietro Lombardi
(P)
Marco Longhi
(M)
Leonardo Lorusso
(L)
Michele Manara
(M)
Elena Manzo
(E)
Jacopo Nicolo Marin
(JN)
Marianna Maspero
(M)
Valentina Messina
(V)
Pamela Milito
(P)
Mattia Molteni
(M)
Eleonora Monti
(E)
Vincenzo Nicastro
(V)
Giorgio Novelli
(G)
Sissi Paleino
(S)
Silvia Pavesi
(S)
Carolina Perali
(C)
Isabella Pezzoli
(I)
Roberta Ragozzino
(R)
Giuliano Santolamazza
(G)
Luca Scaravilli
(L)
Gilda Tornatore
(G)
Francesco Toti
(F)
Vincenzo Tripodi
(V)
Elisa Vaterlini
(E)
Barbara Vignati
(B)
Cecilia Maina
(C)
Alessandra Borghi
(A)
Marco Realis Luc
(MR)
Paolo Pizzini
(P)
Riccardo Masserano
(R)
Marta Maistri
(M)
Laura Traballi
(L)
Francesco Cammarata
(F)
Alvino Boero
(A)
Davide Socci
(D)
Margherita Carbonaro
(M)
Martina Pellegrini
(M)
Informations de copyright
© 2023. The Author(s).
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