Non-patient factors related to rates of ruptured appendicitis (original) (raw)
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A Study of Non-Patient Factors Contributing to Ruptured Appendicitis in Swat
Journal of Saidu Medical College, Swat
Background: Ruptured appendicitis is still prevalent. Adult rates of ruptured appendicitis vary from 13.2to 41.9 percent in bigger hospitals, despite controlling for individual factors like age, sex, co morbidity andsocioeconomic status. This suggests an effect of hospital organization. Surgeons report thatappendicectomies may be delayed because of lack of access to operating theater.Methods: Combining interviews with hospital personnel and information from the medical record, foryear 2011, a cross sectional study was conducted on 4305 patients. Four hospitals were included in thestudy. The diagnostic information was recorded to ensure inter hospital validity. Results: Hospital withhigh activity and volume of patients, but without an operation theatre designated for urgent surgery, wasassociated with a significant higher rate of peritonitis (P=< 0.050). Time to surgery after departure fromAccident and Emergency department, was very long in hospital having no operating theater for...
Appendicitis: What does really make the difference between private and public hospitals?
BMC Emergency Medicine, 2013
Background: Appendicitis is one of the most common surgical emergencies and is also a time-sensitive condition. Delays in treatment increase the risk of appendiceal perforation (AP), and thus AP rates have been used as a proxy to measure access to surgical care. It is very well known that in Brazil there are big differences between the public and private healthcare systems. Those differences can reflect in the treatment of what are considered simple cases, like appendicitis. As far as we know, it has no known links to behavioral or social risk factors, and has only one treatment optionappendectomy. The purpose of this study was to compare treatment received by Brazilian people, both by those who depend on the public and private healthcare system, and how it affects their outcome. Methods: Data was collected from the records of all patients submitted to appendectomy, in a public and in a private Sao Paulo city's hospitals, during January to April of 2010. Results: Patients admitted by the public hospital present symptoms for a longer period of time than those treated by the private one. It took a significantly higher amount of time for the patients from the public hospital undergo surgery, and their length of stay is also significantly higher. Conclusions: Appendicitis in a public scenario is associated with increased time from onset of symptoms to operative intervention and the main reason is the delayed presentation. Clinical polices for abdominal pain should be instituted by the public healthcare system, based on population education, healthcare professionals training and establishment of strategies that can speed the diagnosis process up.
Appendectomy: comparative study between a public and a private hospital
Revista da Associação Médica Brasileira, 2010
Acute appendicitis is the most common cause of acute abdominal pain and appendectomy is the most frequently performed emergency surgery in the world 1,2. Although acute appendicitis mortality is low, morbidity remains high 3,4. The complication rate is related mainly with appendiceal perforation 3. and increases 10 times after appendiceal perforation 2,5,6. Diagnosis of acute appendicitis is established primarily on patient's history and physical examination supported by laboratory and imaging exams 7-10. Delay in the diagnosis and treatment is by far the main cause of appendiceal perforation 11-16. Some international studies have demonstrated that medical evaluation, appendiceal perforation and postoperative complication of patients with acute appendicitis who have undergone appendectomy are related with type of hospital assistance, physician's specialty, geographic area and patients' socioeconomic status 1,17-19. Emergency department consultation for evaluation of patients with acute appendicitis may be related to the socioeconomic status of the patient 18. In the USA , waiting time for consultation in the emergency department to evaluate patients with acute appendicitis is longer for those in a lower socioeconomic bracket 18. Furthermore, in some countries,
Incidence of Complicated Appendicitis as a Metric of Health Care Delivery
The American Surgeon, 2020
Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P ...
Background: Identification of variation in practice is a key step towards standardization of service and determination of reliable quality markers. This study aimed to investigate variation in provision and outcome of emergency appendicectomy. Methods: A multicentre, trainee-led, protocol-driven, prospective observational cohort study was performed duringMay and June 2012. The main outcome of interest was the normal histopathology rate; secondary outcomes were laparoscopy and 30-day adverse event rates. Analysis included funnel plots and binary logistic regression models to identify patient- and hospital-related predictors of outcome. Results: A total of 3326 patients from 95 centres were included. An initial laparoscopic approach was performed in 66·3 per cent of patients (range in centres performing more than 25 appendicectomies over the study period: 8·7–100 per cent). A histologically normal appendix was removed in 20·6 per cent of patients (range in centres performing more than 25 procedures: 3·3–36·8 per cent). Funnel plot analysis revealed that 22 centres fell below three standard deviations of the mean for laparoscopy rates. Higher centre volume, consultant presence in theatre and daytime surgery were independently associated with an increased use of laparoscopy, which in turn was associated with a reduction in 30-day morbidity (adjusted for disease severity). Daytime surgery further reduced normal appendicectomy rates. Increasing volume came at the cost of higher negative rates, and low negative rates came at the cost of higher perforation rates. Conclusion: This study reveals the extremely wide variation in practice patterns and outcomes among hospitals. Organizational factors leading to this variation have been identified and should be addressed to improve performance.
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.
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...
The Risk of Appendiceal Rupture Based on Hospital Admission Source
Academic Emergency Medicine, 1999
Objective: To determine whether admission source is a potential risk factor for appendiceal rupture. Methods: Administrative data were obtained from the California Office of Statewide Health Planning and Development for all patients in San Diego County with the primary diagnosis of appendicitis during 1993. The appendiceal rupture ratio was defined as those coded as ruptured (ICD-9-CM codes 540.0 and 540.1) divided by both ruptured and nonruptured cases (540.9). The odds ratio of appendiceal rupture from routine outpatient office or clinic venues vs those admitted through the ED were calculated using multivariate logistic regression analysis to adjust for age, sex, race, comorbidity, insurance status, and home address to hospital proximity. Results: There were a total of 1,906 patients, of whom 663 (34.8%) had appendiceal ruptures. Of the 1,360 (71.4%) admitted from the ED, 422 (31.0%) had ruptures, compared with 211 (43.3%) of the 487 admitted from outpatient sources (p < 0.0001). Patients with appendicitis directly admitted from outpatient sources were more likely to be complicated by appendiceal rupture than were those admitted through the hospital ED (adjusted odds ratio 1.62, 95% CI = 1.28 to 2.05, p < 0.0001). Conclusion: Patients with appendicitis admitted from outpatient sources are more likely to have appendiceal rupture than are those admitted from the ED.
Journal of Pediatric Surgery, 1993
0 To determine whether the current "gatekeeper" controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a lo-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1.1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30,198O. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (82.2% Y 48.5%. P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (P = .05). No change existed between the groups in the time to a physician; however, a significant (P = 64) difference existed in the time to surgeon (41.2 hours in the earlier group v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3% Y 6.5%, P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.