Christopher P Childers1, Jill Q Dworsky2, Melinda Maggard-Gibbons3, Marcia M Russell4. 1. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA. Electronic address: cchilders@mednet.ucla.edu. 2. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA. 3. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. 4. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, CA.
Abstract
BACKGROUND: Epidemiologic data related to the surgical management of appendicitis are out of date. As we contemplate the role of nonoperative therapy in uncomplicated appendicitis, a contemporary profile of the risks and benefits of operative appendectomy is needed. METHODS: This study merged the 2016 National Surgical Quality Improvement Program essential and appendectomy-targeted participant use files. The appendectomy-targeted file provides procedure-specific variables related to imaging, approach, and outcomes. Epidemiologic data were generated across five domains for adults with uncomplicated appendicitis: patient characteristics/severity, imaging patterns, operative characteristics, pathologic outcomes, and postoperative morbidity/mortality. RESULTS: The merged data file contained 12,376 adult appendectomies from 115 National Surgical Quality Improvement Program sites. After exclusions, 7,778 cases were analyzed. Almost all patients (96.1%) received preoperative imaging, with most (79.2%) receiving a computed tomography scan only. Only 2.6% of appendectomies were performed open, and the laparoscopic to open conversion rate was 0.5%. Most patients (87.3%) were discharged the day of or the day after their operation. The rate of finding an incidental tumor was 1.1%, with greater rates in the elderly (2.7% among patients aged ≥65 years). The overall rate of a negative appendectomy (NA) was 3.8%; the negative appendectomy rate was 1.7% for patients with any positive imaging study and 19.4% for patients with no imaging. The 30-day mortality was 0.04%; 30-day rates of any complication and serious complications were 3.0% and 2.2%, respectively. CONCLUSION: Preoperative imaging, a laparoscopic approach, and excellent clinical outcomes have become the norm for the surgical management of uncomplicated appendicitis. As surgeons contemplate the role of nonoperative therapy for uncomplicated appendicitis, the data presented here should be used to inform the ongoing debate.
BACKGROUND: Epidemiologic data related to the surgical management of appendicitis are out of date. As we contemplate the role of nonoperative therapy in uncomplicated appendicitis, a contemporary profile of the risks and benefits of operative appendectomy is needed. METHODS: This study merged the 2016 National Surgical Quality Improvement Program essential and appendectomy-targeted participant use files. The appendectomy-targeted file provides procedure-specific variables related to imaging, approach, and outcomes. Epidemiologic data were generated across five domains for adults with uncomplicated appendicitis: patient characteristics/severity, imaging patterns, operative characteristics, pathologic outcomes, and postoperative morbidity/mortality. RESULTS: The merged data file contained 12,376 adult appendectomies from 115 National Surgical Quality Improvement Program sites. After exclusions, 7,778 cases were analyzed. Almost all patients (96.1%) received preoperative imaging, with most (79.2%) receiving a computed tomography scan only. Only 2.6% of appendectomies were performed open, and the laparoscopic to open conversion rate was 0.5%. Most patients (87.3%) were discharged the day of or the day after their operation. The rate of finding an incidental tumor was 1.1%, with greater rates in the elderly (2.7% among patients aged ≥65 years). The overall rate of a negative appendectomy (NA) was 3.8%; the negative appendectomy rate was 1.7% for patients with any positive imaging study and 19.4% for patients with no imaging. The 30-day mortality was 0.04%; 30-day rates of any complication and serious complications were 3.0% and 2.2%, respectively. CONCLUSION: Preoperative imaging, a laparoscopic approach, and excellent clinical outcomes have become the norm for the surgical management of uncomplicated appendicitis. As surgeons contemplate the role of nonoperative therapy for uncomplicated appendicitis, the data presented here should be used to inform the ongoing debate.
Authors: Maciej Walędziak; Anna Lasek; Michał Wysocki; Michael Su; Maciej Bobowicz; Piotr Myśliwiec; Kamil Astapczyk; Mateusz Burdzel; Karolina Chruściel; Rafał Cygan; Wojciech Czubek; Natalia Dowgiałło-Wnukiewicz; Jakub Droś; Paula Franczak; Wacław Hołówko; Artur Kacprzyk; Wojciech Konrad Karcz; Jakub Kenig; Paweł Konrad; Arkadiusz Kopiejć; Adam Kot; Karolina Krakowska; Maciej Kukla; Agnieszka Leszko; Leszek Łozowski; Piotr Major; Wojciech Makarewicz; Paulina Malinowska-Torbicz; Maciej Matyja; Maciej Michalik; Adam Niekurzak; Damian Nowiński; Radomir Ostaszewski; Małgorzata Pabis; Małgorzata Polańska-Płachta; Mateusz Rubinkiewicz; Tomasz Stefura; Anna Stępień; Paweł Szabat; Rafał Śmiechowski; Sebastian Tomaszewski; Viktor von Ehrlich-Treuenstätt; Maciej Wasilczuk; Mateusz Wierdak; Anna Wojdyła; Jan Wojciech Wroński; Leszek Zwolakiewicz; Michał Pędziwiatr Journal: Sci Rep Date: 2019-10-15 Impact factor: 4.379
Authors: Lindsay A Sceats; Seul Ku; Alanna Coughran; Britainy Barnes; Emily Grimm; Matthew Muffly; David A Spain; Cindy Kin; Douglas K Owens; Jeremy D Goldhaber-Fiebert Journal: MDM Policy Pract Date: 2019-08-17