Appendicitis Research Today is a free monthly online journal that collates and summarizes the latest research about Appendicitis, including details on symptoms, surgery, causes, treatment.

Diagnosis of Acute Appendicitis over Two Decades - Effects of Increasing Number of Imaging Procedures on Costs, Preoperative Reliability and Patient Outcome.

Schreiner M, Spazier M, Wayand W

Ludwig Boltzmann Institut für operative Laparoskopie, Chirurgie 2 AKh Linz, Linz, Osterreich.

BACKGROUND: An increasing number of modern imaging procedures are being applied for the diagnosis of appendicitis. We compared one hundred consecutive appendectomies of the years 1988, 1998 and 2008 concerning reliability of preoperative diagnosis and resulting costs. METHODS: We analysed the first one hundred consecutive patients undergoing appendectomy during the years 1988, 1998 and 2008, 59 % were female and 41 % male. The average age was 26 years, the average BMI 21.09. The costs and results of radiological investigations (US, CT, MRI, X-ray) have been compared in all patients. The sensitivity of ultrasound and CT scan in preoperative diagnosis has been analysed. RESULTS: The number of preoperative imaging procedures for the diagnosis of appendicitis has increased over the last two decades. Simultaneously increased the costs (total costs and costs per partient) for imaging procedures. 2008 the costs were 10 times higher than 1988. CT had a higher sensitivity (77 %) in the diagnosis of appendicitis than ultrasound (33 %). The number of operations because of subacute and chronic appendicitis was lower in 2008 (34 of 100) compared with 1988 (80 of 100) and 1998 (60 of 100). In 2008 (14) we found a higher number of gangrenous and perforated appendicitis compared to 1988 (2) and 1998 (5). The majority (50 of 100) of patients in the group with acute and phlegmonous appendicitis was found in 2008. CONCLUSION: There has been an increase in the use of preoperative imaging procedures in the diagnosis of appendicitis during the last 20 years. This causes more costs in the public health system. Ultrasound as the standard imaging method for diagnosing appendicitis showed poor sensitivity. CT scans had good results concerning sensitivity, but are expensive and involve exposure to radiation for the patient.

Published 31 August 2010 in Zentralbl Chir, 135(4): 336-339.
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Articles on Appendicitis published 30 August 2010:

Post-appendectomy visits to the emergency department within the global period: a target for cost containment.   Am J Surg, 200(3): 357-362.

BACKGROUND: Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost. HYPOTHESIS: Postoperative ED visits can be avoided. SETTING: Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine. PATIENTS: Retrospective analysis of 597 consecutive patients with appendectomies over a 4-year period. METHODS: Demographic and medical data, at initial presentation, surgery, and ED visit were ... [Abstract] [Full-text]

Articles on Appendicitis published 27 August 2010:

Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals.   Surgery.

BACKGROUND: The benefit of laparoscopic (LA) versus open (OA) appendectomy, particularly for complicated appendicitis, remains unclear. Our objectives were to assess 30-day outcomes after LA versus OA for acute appendicitis and complicated appendicitis, determine the incidence of specific outcomes after appendectomy, and examine factors influencing the utilization and duration of the operative approach with multi-institutional clinical data. METHODS: Using the American College of Surgeons ... [Abstract] [Full-text]

Articles on Appendicitis published 26 August 2010:

Gangrenous intrathoracic appendicitis, a rare cause of right-sided chest pain: Report of a case.   Surg Today, 40(9): 874-7.

Diaphragmatic hernias are becoming increasingly common due to radiofrequency ablation of malignant liver tumors. Most patients eventually present with symptoms caused by bowel obstruction. A 54-year-old woman with pleuritic pain and fever had a right-sided enterothorax probably caused by hemihepatectomy several years before. The patient was diagnosed with perforated gangrenous intrathoracic appendicitis during an emergency laparotomy for suspected incarceration of her diaphragmatic hernia. She ... [Abstract] [Full-text]

Articles on Appendicitis published 25 August 2010:

Incidence of Parkinson's disease among hospital patients with methamphetamine-use disorders.   Mov Disord.

Because methamphetamine exposure to experimental animals can damage brain dopamine neurones, we examined whether hospital patients diagnosed with methamphetamine-related disorders might have greater risk of subsequent admission with a Parkinson's disease diagnosis. This was a population-based cohort study using all statewide inpatient hospital discharge records from July 1, 1990, through June 30, 2000, in California, USA, in which subjects aged at least 50 years were followed for up to 10 ... [Abstract] [Full-text]

Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option.   Surg Endosc.

BACKGROUND: At the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or ... [Abstract] [Full-text]

Does access to care affect outcomes of appendicitis in children? - a population-based cohort study.   BMC Health Serv Res, 10(1): 250.

ABSTRACT: BAckground: The annual number of pediatric appendectomies in Ontario was stable throughout the study period, but with a significant level of regional variations across regions. The objective of this study is to use population-based data to measure the associations and to explain the variations of appendectomy rates with population socio-demographic indicators. METHODS: Appendectomy rates in children aged less than 19 years were calculated from Ontario hospital discharge data from 1993 ... [Abstract] [Full-text]

Pylephlebitis: An overview of non-cirrhotic cases and factors related to outcome.   Scand J Infect Dis.

Abstract Pylephlebitis is a condition with significant morbidity and mortality. We review herein 100 relevant case reports published since 1971. Eighty-one patients were reported with acute pylephlebitis, while the remaining patients had chronic pylephlebitis. The most common predisposing infections leading to pylephlebitis were diverticulitis and appendicitis. Cultures from blood or other tissues were positive in 77%. The infection was polymicrobial in half of the patients and the most common ... [Abstract] [Full-text]

Articles on Appendicitis published 24 August 2010:

Slowing the Increase in the Population Dose Resulting from CT Scans.   Radiat Res.

Abstract The annual number of CT scans in the U.S. is now over 70 million. The concern is that organ doses from CT are typically far larger than those from conventional X-ray examinations, and there is epidemiological evidence of a small but significant increased cancer risk at typical CT doses. Because CT is a superb diagnostic tool and because individual CT risks are small, the CT benefit/risk balance is generally by far in the patient's favor. Nevertheless, CT should operate under the ALARA ... [Abstract] [Full-text]

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