Appendectomy: comparative study between a public and a private hospital (original) (raw)
Related papers
2016
Appendicitis is the most common abdominal emergency and accounts for nearly or more than 40,000 hospital admissions in England each year(1,2,3). Since 1940s the incidence of hospital admission for acute appendicitis has been falling, but the reason for this decline is not clear (1). An USA study says that appendicitis is most common between the ages of 10 and 20 years; sex, race and geography play a role in incidence (4). A male preponderance exists, with a male to female ratio of 1.4:1; the overall lifetime risk is 8.6% for males and 6.7% for females in the United States. The lifetime risk of appendectomy is 12.0% for males and 23.1% for females.(4) The diagnosis of acute appendicitis is predominantly a clinical one; many patients present with a typical history and examination findings(1).The diagnostic sequence of colicky central abdominal pain followed by vomiting with migration of the pain to the right iliac fossa may only be present in 50% of patients.(1) Profuse vomiting may indicate development of generalized peritonitis after perforation but is rarely a major feature in simple appendicitis(1,5) . A meta-analysis of the symptoms and signs of acute appendicitis could not demonstrate a single diagnostic feature although it showed that migration of pain was associated with acute appendicitis.(6) In the Sri Lankan setting, mean age of presentation for appendicitis was 22 years where it was 27 years in GH Trincomalee. More patients underwent open appendicectomy in the SL studies. Laparoscopic approach was used less commonly in a study at Faculty of Medicine, University of Kelaniya Vs GH - Trincomalee (11.9% Vs 11%),however it was utilized more often in the western population (50.5%)(7).Post-operative complications were similarly represented in both UK and comparative Sri Lankan (SL) study, but significantly lesser in our study. More Readmissions were observed in our study (2.5%) than in the comparative SL study (0%) (7). Histologically confirmed appendicitis was seen in a significant greater proportion of SL patients - SL study Vs GH - Trincomalee(93.1%vs. 87.1%). Clinical history and examination with haematological investigations & ultrasound scanning play the main roles in managing acute appendicitis in SL preoperative setup. CT is used more commonly in western population(7). Appendicectomy is the treatment of choice and is increasingly carried out as a laparoscopic procedure.(1,8,9). This article reviews the presentation, investigation, diagnostic accuracy, treatment, and complications of acute appendicitis and appendicectomy.
Acute Appendicitis and Its Management: A Hospital Based Study
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.10\_Oct2021/IJRR-Abstract045.html, 2021
Background: Acute appendicitis is the most common acute surgical condition of the abdomen, which if complicated by perforation or peritonitis has high morbidity and mortality. Aim: The aim of this study is to analyze the presentation, diagnosis and management of acute appendicitis along with the role of conservative management in uncomplicated cases. Materials and Methods: This study was conducted in Govt. Medical College Jammu over a period of one year w.e.f. September 2017 to August 2018 and included 120 patients. Diagnosis in the suspected patients was based on history, clinical examination coupled with laboratory investigations and imaging modalities like ultrasound/ CT Scan wherever required. Results: 120 patients of acute appendicitis were treated over the period of one year at our center. Abdominal pain was the most common and constant presentation seen in 112 patients followed by vomiting (82), history of fever (60), history of constipation and distension (20) and another 12 had history of diarrhoea. Six patients (5%) responded favorably to conservative management. Conclusion: Acute appendicitis is a common surgical emergency requiring detailed history and meticulous examination coupled with X-ray and ultrasonography for diagnosis. Appendectomy is the standard procedure of choice and wherever feasible laparoscopic appendectomy offers the advantage of less pain, short hospital stay, earlier return to work and overall cost.
International Journal of Surgery, 2014
Background: In the past decade there has been an exponential increase in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom. Methods: Data was collected prospectively from 400 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 200 at University Kelaniya Sri Lanka (SL group), and 200 at University College London Hospital (UK group). Results: The groups were similar with respect to gender, but the SL group was younger. Preoperative work-up included ultrasound more commonly in SL patients, and CT more commonly in UK patients. More patients underwent appendicectomy in the SL group, however a laparoscopic approach was utilised more often in the UK group (50.5% vs. 11.9%). Post-operative complications were similarly represented in both groups, but re-admission occurred with greater frequency in the UK group (16.2% vs. 0%). Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (93.1% vs. 79.8%). Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with positive appendicitis. Discussion: Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation.
Early versus delayed appendectomy for uncomplicated acute appendicitis
The Professional Medical Journal
Study Design: Sectional study. Setting: Madina Teaching Hospital Faisalabad. Period: July 2018 to June 2019. Material & Methods: A sample of 107 patients was selected using non-probability purposive sampling out of all the patients presenting with acute appendicitis. Study population was divided into Groups A and B, former undergoing appendectomy within 8 hours of admission and later undergoing surgery more than 8 hours after admission. Spinal and general anesthesia was used and both Laparoscopic and open surgical techniques were employed. Results: Out of total 107 patients, 62 (57.94%)were placed in group A and 45 (42.06%) in group B. Age and gender related distribution in both groups were similar. 5 patients in group A had perforated appendix and 3 patients in Group B were found to have perforated appendix. The difference between incidence of perforation between the two groups was not statistically significant. Conclusion: in-hospital delay before appendectomy does not significant...
2020
Materials and Methods: In this study a total of 195 patients were observed. All patients were subjected to detailed history and examination. Standard pre-operative procedures were adopted. All the surgeries were conducted by single experienced general surgeon fellow of CPSP who was detected presence or absence of perforated appendix. All the above mentioned information including name, age, gender, height, weight, BMI were recorded in the proforma. Exclusion criteria were strictly followed to control effect modifiers and bias in study results. Results: In this study mean age was 30 years with SD± 12.54. Sixty two percent patients were male and 38% patients were female. Nine percent patients had perforated appendicitis while 91% patients didn't had perforated appendicitis. Conclusion: Our study concludes that the frequency of perforated appendicitis was 9% among patients subjected to appendectomy for acute appendicitis.
Revista do Colégio Brasileiro de Cirurgiões, 2014
Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA) to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ) and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95) and 54 hours in group B (SD = 54.5). Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55), while group B, 90 hours (SD = 59.58). After the operation, patients...
Comparison of operative and non operative management of acute appendicitis
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
In this prospective study, operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness. Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospective study. Nonoperative medical therapy was performed in 107 patients (Group 1), and 183 patients were treated surgically (Group 2). Routine follow-up controls were done on the 10th day, at the 3rd and 6th months and at the first year after discharge in Group 1. Both groups were compared regarding age, gender, mean hospital stay, modified Alvarado score, morbidity, mortality, and cost effectiveness. The male/female ratio of Groups 1 and 2 were 65/42 (mean age: 30.98+/-1.30) and 125/58 (mean age: 26.25+/-0.79), respectively. In Group 1, 19 patients were operated. Operation indications were resistance to therapy, patient's request, and operation in another hospital. Although the mea...
Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study
World Journal of Emergency Surgery, 2019
Introduction: Prompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality. Our study was designed to examine whether the time from the beginning of symptoms to operation correlates with the pathological degree of appendicitis, incidence of postoperative complications, or increased length of hospital stay. Methods: A prospective study of 171 patients who underwent emergent appendectomy for acute appendicitis in the course of 2 years was conducted in a single tertiary medical center. The following parameters were monitored and correlated: demographics, time from the onset of symptoms until the arrival to the emergency department (patient interval (PI)), time from arrival to the emergency department (ED) until appendectomy (hospital interval (HI)), time from the onset of symptoms until appendectomy (total interval (TI)), physical examination, preoperative physical findings, laboratory data, pathologic findings, complications, and length of hospital stay. Results: The degree of pathology and complications were analyzed according to the time intervals. The time elapsed from the onset of symptoms to surgery was associated with higher pathology grade (p = 0.01). We found that longer time from the onset of symptoms to hospital arrival correlates with higher pathology grade (p = 0.04), while there was no correlation between the hospital interval and pathology grade (p = 0.68). A significant correlation was found between the pathology grade and the incidence of postoperative complications as well as with increased length of hospital stay (p = 0.000). Conclusion: Time elapsed from the symptom onset to appendectomy correlates with increased pathology grade and complication rate. This correlation was not related to the HI. Since the HI in our study was short, we recommend an early appendectomy in adults in order to shorten the TI and the resulting complications.
Incidence of Acute Nonperforated and Perforated Appendicitis: Age-specific and Sex-specific Analysis
World Journal of Surgery, 1997
This prospective study was performed to investigate epidemiological characteristics in terms of the age-and sex-specific incidence in patients with perforated and nonperforated appendicitis. The study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993. Two patient cohorts [n ؍ 544 (37%)] were analyzed with regard to prehospitalization duration of symptoms and in-hospital observation time. The crude incidence of acute appendicitis was 86 per 100,000 per year. Although the incidence of nonperforated appendicitis was highest among adolescents and young adults (13-40 years of age), perforated appendicitis occurred at almost the same incidence in all sex and age groups. The diagnostic accuracy was 76%. Perforated appendicitis occurred in 19%, with higher rates in small children and the elderly, irrespective of gender. A high diagnostic accuracy was not associated with an increased rate of perforation. In small children and the elderly, the diagnostic accuracy was low and the perforation rate high. Patients with perforation had a significantly longer duration of symptoms as well as in-hospital observation time than did patients with nonperforated appendicitis. Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in-hospital observation time, probably due to patientrelated factors. We suggest this observation deserves attention regarding clinical diagnosis and treatment decision-making for patients with suspected acute appendicitis.
Journal of Nepal Medical Association, 2023
Introduction: The prevalence of appendicitis is widespread among both adult and pediatric populations. Despite being so common, its diagnosis remains difficult. Initially, acute appendicitis is managed conservatively. To reduce morbidity and mortality, surgery must be performed promptly. The main objective of the study is to find out the prevalence of appendicitis among patients admitted to the department of surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery of a tertiary care centre from 1 July 2021 to 1 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 202/2079/80). Convenience sampling was done. The patient admitted to the Department of Surgery during the study period was included. Point estimate and 95% Confidence Interval were calculated. Results: Out of 2452 patients, the prevalence of appendicitis was 321 (13.09%) (11.75-14.43, 95% Confidence Interval). The mean age of the patients with appendicitis was 31.57±14.14 years and among them, males were 176 (54.83%). Conclusions: The prevalence of appendicitis among patients admitted to the department of surgery of a tertiary care centre was lower compared to other studies conducted in similar settings.