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2012 | 84 | 10 | 509-520
Article title

Surgical Determinants, Perioperative Course and Outcome of a Representative Patient Cohort with Acute Appendicitis Undergoing Appendectomy over 3 Decades

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Abstracts
EN
Acute appendicitis, one of the most frequent emergencies in general surgery, has been repeatingly investigated with regard to specific aspects such as medical history, clinical symptoms, the perioperative management and follow up.was to investigate relevant and combined determinants for the perioperative management of acute appendicitis a systematic clinical prospective unicenter observational study was conducted. A representative patient cohort was studied (n=9,991; middle Europe) to reflect daily surgical practice through a time period of 27 years divided into 3 separate periods and the frequency of specific categories (e.g., characteristics of the medical history, clinical and intraoperative findings as well as complications), their correlation and relative risk factors for the disease as well as prognosis. Results. 1. The wound abscess rate was 10.9%. Perforation, surgical intervention in time, acute, gangrenous and chronic appendicitis, age, accompanying diseases such as obesity, arterial hypertension, diabetes mellitus, sex, and missing pathological finding intraoperatively had a significant impact on the postoperative development of a wound abscess. 2. The longer the specific appendicitis-associated medical history was, the more frequent a perforated appendicitis occurred, greater the appendectomy (AE) rate in a non-inflamed appendix and higher the rate of required second interventions. 3. The average hospital stay was 11 days. 4. There was a significantly decreased percentage of patients with no pathological finding intraoperatively at the appendix vermiformis (p<0.001), who underwent AE, in particular, through the last investigation period from 1997 to 2000 onto only 6.8% (1974-1985, 15.5%; 1986-1996, 10.3%). 5. The mortality was 0.6%, with no significant difference comparing male and female patients (p=1), the three investigation periods (p=0.077), or the patients with AE in non-inflamed appendix (0.4%) and AE in acute appendicitis (0.6%; p=0.515). The study showed a positive, partially significant quality improvement within the presenting clinic with regard to a decreased rate of AE in non-inflamed appendix, wound abscess rate and, in particular, to mortality. Despite this, there is a trendy increase of the perforation rate in the investigated cohort.Conclusion. Quality control remains indispensable for the assessment of the disease´s surgical treatment. A further significant improval of this control might be achieved by multicenter studies and multifactorial evaluations.
Publisher

Year
Volume
84
Issue
10
Pages
509-520
Physical description
Dates
published
1 - 12 - 2012
online
28 - 12 - 2012
Contributors
author
  • Department of Surgery, Municipal Hospital (Teaching Hospital of the Charité at Berlin), Cottbus, Germany
author
  • Department of Surgery, University Hospital, Magdeburg, Germany
author
  • Department of Surgery, Municipal Hospital (Teaching Hospital of the Charité at Berlin), Cottbus, Germany
  • Department of Surgery, Municipal Hospital (Teaching Hospital of the Charité at Berlin), Cottbus, Germany
References
  • 1. Hinkel M, Hoffmann C,Teutsch W: Appendicitis 1965 to 1971, local study. Zentralbl Chir 1973; 98: 1683-88.
  • 2. Horntrich J, Hinkel M: How can the incidence of perforated appendicitis be reduced? ZA rztl Fortbild 1978; 72: 176-79.
  • 3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV : The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132: 910-25.
  • 4. Andersson R, Hugander A, Thulin A et al.: Indications for operation in suspected appendicitis and incidence of perforation. BMJ 1994; 308: 107-10.
  • 5. Andersson RE, Hugander A, Thulin AJ: Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate. Eur J Surg 1992; 158: 37-41.
  • 6. Bakken IJ, Skjeldestad FE, Mjaland O, JohnsonE: Appendicitis and appendectomy in Norway 1990-2001. Tidsskr Nor Laegeforen 2003; 123: 3185-88.
  • 7. Barker DJ, Liggins A: Acute appendicitis in nine British towns. Br Med J (Clin Res Ed). 1981; 283: 1083-85.
  • 8. Blomqvist P, Ljung H, Nyren O, Ekbom A: Appendectomy in Sweden 1989-1993 assessed by the Inpatient Registry. J Clin Epidemiol 1998; 51(10): 859-65.
  • 9. Donnelly NJ, Semmens JB, Fletcher DR , HolmanCD: Appendicectomy in Western Australia: profile and trends, 1981-1997. Med J Aust 2001; 175: 15-18.
  • 10. Kang JY, Hoare J, Majeed A et al.: Decline in admission rates for acute appendicitis in England. Br J Surg 2003; 90: 1586-92.
  • 11. Kang JY, Hoare J, Tinto A et al.: Diverticular disease of the colon - on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003; 17: 1189-95.
  • 12. Luckmann R: Incidence and case fatality rates for acute appendicitis in California. A populationbased study of the effects of age. Am J Epidemiol 1989; 129: 905-18
  • 13. McCahy P: Continuing fall in the incidence of acute appendicitis. Ann R Coll Surg Engl 1994; 76,: 282-83.
  • 14. Noer T: Decreasing incidence of acute appendicitis. Acta Chir Scand 1975; 141: 431- 32.
  • 15. Primatesta P, Goldacre MJ: Appendicectomy for acute appendicitis and for other conditions: an epidemiological study. Int J Epidemiol 1994; 23: 155-60.
  • 16. Ricci MA, Cuasay RS, Beck WC: Appendicitis: the perforation rate when reviewed by decades in a general hospital. Am Surg 1988; 54: 273-25.
  • 17. Styrud J, Eriksson S, Segelman J, GranstromL: Diagnostic accuracy in 2,351 patients undergoing appendicectomy for suspected acute appendicitis: A retrospective study 1986-1993. Dig Surg 1999; 16: 39-44.
  • 18. Williams NM, Jackson D, Everson NW, JohnstoneJM: Is the incidence of acute appendicitis really falling? Ann R Coll Surg Engl 1998; 80: 122- 24.
  • 19. Gastinger I, Koch A, Lippert H, Lorenz D: Current status of treatment of appendicitis. Results of 2 prospective multicenter studies in East Germany. East German Working Group „Outcome Assessment and Quality Assurance in Surgery” of the CAQ of the German Society of Surgery. ZentralblChir 1998; 123 (Suppl 4): 8-10.
  • 20. Koch A, Marusch F, Schmidt U et al.: Appendicitis in the last decade of the 20th century - Analysis of two prospective multicenter clinical observational studies. Zentralbl Chir 2002; 127: 290-96.
  • 21. Körner H, Soreide JA, Pedersen EJ et al.: Stability in incidence of acute appendicitis. A population- based longitudinal study. Dig Surg 2001; 18: 61-66.
  • 22. Sahm M, Koch A, Schmidt U et al.: Acute Appendicitis - Clinical Health-Service Research on the Current Surgical Therapy. Zentralbl Chir 2012; March 16 Epub ahead of print.
  • 23. Wen SW, Demissie K, August D, Rhoads GG: Level of aggregation for optimal epidemiological analysis: the case of time to surgery and unnecessary removal of the normal appendix. J EpidemiolCommunity Health 2001; 55(3): 198-203.
  • 24. Albrecht R, Koch H, Bochmann C: „Matchedpair“- Analyse der laparoskopischen (LA) vs. Single- Port-Appendektomie (SP) zur initialen Evaluation im Rahmen der Etablierung einer neuen Operationsmethode. Zentralbl Chir 2012; Epub ahead of print.
  • 25. Schreiner M, Spazier M, Wayand W: Diagnosis of acute appendicitis over two decades - effects of increasing number of imaging procedures on costs, preoperative reliability and patient outcome. ZentralblChir 2010; 135: 336-39.
  • 26. Gastinger I Eckhardt W: A prospective multicenter study of appendicitis treatment). ZentralblChir. 1991; 116: 267-80.
  • 27. Gastinger I, Lippert H, Sroka T: Current treatment status in juvenile appendicitis. A quality assessment. Zentralbl Chir 1992; 117: 13-17.
  • 28. Koch A, Marusch F, Gastinger I, Lippert H: Chirurgische Qualitätssicherung am Beispiel der Tracerdiagnose Appendizitis. In: Ekkernkamp A, Scheibe O (eds.): Qualitätsmanagement in der Medizin - Handbuch für Klinik und Praxis, 1997; Volume IV - 2.1.1.5.1.
  • 29. Sahm M, Pross M, Lippert H: Acute appendicitis - changes in epidemiology, diagnosis and therapy. Zentralbl Chir 2011; 136: 18-24.
  • 30. Raguveer-Saran MK, Keddie NC: The falling incidence of appendicitis. Br J Surg 1980; 67: 681.
  • 31. Gilmore OJ, Browett JP, Griffin PH et al.: Appendicitis and mimicking conditions. A prospective study. Lancet 1975; 2: 421- 24.[PubMed][Crossref]
  • 32. Lauschke G: Indications for appendectomy. Zentralbl Chir 1986; 111: 761-68.
  • 33. De Dombal FT: Comment and reply. A study of diagnostic accuracy in suspected acute appendicitis. Aust N Z J Surg 1989; 59: 409-10.
  • 34. Horntrich J, Schneider W: Appendicitis from an epidemiological viewpoint. Zentralbl Chir 1990; 115: 1521-29.
  • 35. Hontschick B: Indikation zur Appendektomie in der Praxis zu wenig restriktiv? Chir Prax 1989; 40: 221-27.
  • 36. Welcker ER: Perforated appendicitis 1962. Z Arztl Fortbild (Jena). 1965; 59: 113-22.
  • 37. Lau WY, Fan ST., Yiu TF et al.: Acute appendicitis in the elderly. Surg Gynecol Obstet 1985; 161: 157-60.
  • 38. Lau WY, Fan ST., Yiu TF et al.: The clinical significance of routine histopathologic study of the resected appendix and safety of appendiceal inversion. Surg Gynecol Obstet 1986; 162: 256-58.
  • 39. Körner H, Sondenaa K, Soreide JA et al.: Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 1997; 21: 313-17.
  • 40. Mann WA: Impact of lifestyle changes on hypertension and diabetes. MM W Fortschr Med 2004; 146: 28-30.
  • 41. Low M, Stegmaier C, Ziegler H et al.: Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study). Dtsch Med Wochenschr 2004; 129: 2643-47.
  • 42. Thomas EJ, Goldman L, Mangione CM et al.: Body mass index as a correlate of postoperative complications and resource utilization. Am J Med 1997; 102: 277-83.
  • 43. Karim H, Chafik K, Karim K et al.: Risk factors for surgical wound infection in digestive surgery. Retrospective study of 3,000 surgical wounds. TunisMed 2000; 78: 634-40.
  • 44. Margenthaler JA, Longo WE, Virgo KS et al.: Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg 2003; 238: 59-66.
  • 45. Lau WY, Fan ST, Yiu TF et al.: Negative findings at appendectomy. Am J Surg 1984; 148: 375-78.
  • 46. Zoguereh DD, Lemaitre X, Ikoli JF et al.: Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects. Sante 2001; 11: 117-25.[PubMed]
  • 47. Jacob D, Raakow AP: Transumbilical Single- Port Appendectomy: Initial Experience and Technical Report. Zentralbl Chir 2012 April 06 (Epub ahead of print)
  • 48. Magdeburg R, Kähler G: Neue Wege in der operativen Behandlung der akuten Appendizitis? Zentralbl Chir 2012 (Epub ahead of print)
  • 49. Partecke LI, Kessler W, Dietrich S, et al: Disease- Adapted Closure of the Appendicular Stump in Laparoscopic Appendectomy. Zentralbl Chir 2012 March 16 (Epub ahead of print)
  • 50. Sesia S, Frech M, Häcker F, Mayr J: Laparoscopic „single-port” appendectomy in children. Zentralbl Chir 2011; 136: 50-55.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-012-0086-0
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