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World Journal of Surgery
Published in: World Journal of Surgery 2/2019

Open Access 01-02-2019 | Original Scientific Report

Variation in Classification and Postoperative Management of Complex Appendicitis: A European Survey

Authors: Elisabeth M. L. de Wijkerslooth, Anne Loes van den Boom, Bas P. L. Wijnhoven

Published in: World Journal of Surgery | Issue 2/2019

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Abstract

Background

Data on common practice in the management of patients with complex appendicitis are scarce, especially for the adult population. Variation in the definition of complex appendicitis, indications for and the type of prolonged antibiotic prophylaxis have not been well studied yet. The aim of this study was to document current practice of the classification and postoperative management of complex appendicitis on an international level.

Methods

An online survey was dispersed among practicing surgeons and surgical residents. Survey questions pertained to the definition of a complex appendicitis, indications for antibiotic prophylaxis after appendectomy, the duration, route of administration and antibiotic agents used.

Results

A total of 137 survey responses were eligible for analysis. Most respondents were from Northern or Western Europe and were specialized in gastrointestinal surgery. Opinion varied substantially regarding the management of appendicitis, in particular for phlegmonous appendicitis with localized pus, gangrenous appendicitis and iatrogenic rupture of appendicitis. The most common duration of postoperative antibiotics was evenly spread over <3, 3, 5 and 7 days. Whereas most respondents indicated a combined intravenous and oral route of administration was common practice, 28% answered a completely intravenous route of administration was standard practice.

Conclusion

Current practice patterns in the classification and postoperative management of complex appendicitis are highly variable.
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Literature
1.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925CrossRefPubMed
2.
Ohmann C, Franke C, Kraemer M, Yang Q (2002) Status report on epidemiology of acute appendicitis. Chirurg 73(8):769–776CrossRefPubMed
3.
Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F et al (2014) Global disease burden of conditions requiring emergency surgery. Br J Surg 101(1):e9–e22CrossRefPubMed
4.
D’Souza N, Nugent K (2016) Appendicitis. Am Fam Phys 93(2):142–143
5.
Salminen P, Paajanen H, Rautio T, Nordstrom P, Aarnio M, Rantanen T et al (2015) Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 313(23):2340–2348CrossRefPubMed
6.
Harnoss JC, Zelienka I, Probst P, Grummich K, Muller-Lantzsch C, Harnoss JM et al (2017) Antibiotics versus surgical therapy for uncomplicated appendicitis: systematic review and meta-analysis of controlled trials (PROSPERO 2015: CRD42015016882). Ann Surg 265(5):889–900CrossRefPubMed
7.
Gorter RR, The SML, Gorter-Stam MAW, Eker HH, Bakx R, van der Lee JH et al (2017) Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis. J Pediatr Surg 52(8):1219–1227CrossRefPubMed
8.
Andersen BR, Kallehave FL, Andersen HK (2005) Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev 3:CD001439
9.
Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M et al (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis review. World J Emerg Surg 11:34CrossRefPubMedPubMedCentral
10.
Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR et al (2017) The surgical infection society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt) 18(1):1–76CrossRef
11.
12.
Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M et al (2016) Diagnosis and management of acute appendicitis. In: EAES consensus development conference 2015. Surgical endoscopy
13.
Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M et al (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg WJES 11:34CrossRefPubMed
14.
15.
van den Boom AL, de Wijkerslooth EML, Mauff KAL, Dawson I, van Rossem CC, Toorenvliet BR et al (2018) Interobserver variability in the classification of appendicitis during laparoscopy. Br J Surg 105(8):1014–1019CrossRefPubMedPubMedCentral
16.
van Rossem CC, Schreinemacher MH, van Geloven AA, Bemelman WA (2016) Snapshot appendicitis collaborative study G. Antibiotic duration after laparoscopic appendectomy for acute complicated appendicitis. JAMA Surg 151(4):323–329CrossRefPubMed
17.
18.
Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 386(10000):1278–1287CrossRefPubMed
19.
Siribumrungwong B, Chantip A, Noorit P, Wilasrusmee C, Ungpinitpong W, Chotiya P et al (2018) Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis: a randomized controlled trial. Ann Surg 267(4):631–637CrossRefPubMed
20.
21.
van Rossem CC, Schreinemacher MH, Treskes K, van Hogezand RM, van Geloven AA (2014) Duration of antibiotic treatment after appendicectomy for acute complicated appendicitis. Br J Surg 101(6):715–719CrossRefPubMed
22.
23.
Gross TS, McCracken C, Heiss KF, Wulkan ML, Raval MV (2016) The contribution of practice variation to length of stay for children with perforated appendicitis. J Pediatr Surg 51(8):1292–1297CrossRefPubMed
24.
Tian Y, Heiss KF, Wulkan ML, Raval MV (2015) Assessment of variation in care and outcomes for pediatric appendicitis at children’s and non-children’s hospitals. J Pediatr Surg 50(11):1885–1892CrossRefPubMed
25.
Ponsky TA, Hafi M, Heiss K, Dinsmore J, Newman KD, Gilbert J (2009) Interobserver variation in the assessment of appendiceal perforation. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S15–S18CrossRefPubMed
26.
Chen C, Botelho C, Cooper A, Hibberd P, Parsons SK (2003) Current practice patterns in the treatment of perforated appendicitis in children. J Am Coll Surg 196(2):212–221CrossRefPubMed
27.
28.
van Rossem CC, Bolmers MD, Schreinemacher MH, Bemelman WA, van Geloven AA, Pinkney TD et al (2016) Diagnosing acute appendicitis: surgery or imaging? Colorectal Dis 18(12):1129–1132CrossRefPubMed
29.
Yousef Y, Youssef F, Homsy M, Dinh T, Pandya K, Stagg H et al (2017) Standardization of care for pediatric perforated appendicitis improves outcomes. J Pediatr Surg 52(12):1916–1920CrossRefPubMed
30.
Skarda DE, Schall K, Rollins M, Andrews S, Olson J, Greene T et al (2014) Response-based therapy for ruptured appendicitis reduces resource utilization. J Pediatr Surg 49(12):1726–1729CrossRefPubMed
31.
Daskalakis K, Juhlin C, Påhlman L (2014) The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review. Scand J Surg 103(1):14–20CrossRefPubMed
32.
Yu TC, Hamill JK, Evans SM, Price NR, Morreau PN, Upadhyay VA et al (2014) Duration of postoperative intravenous antibiotics in childhood complicated appendicitis: a propensity score-matched comparison study. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg [et al] = Zeitschrift fur Kinderchirurgie 24(4):341–349
33.
Hughes MJ, Harrison E, Paterson-Brown S (2013) Post-operative antibiotics after appendectomy and post-operative abscess development: a retrospective analysis. Surg Infect (Larchmt) 14(1):56–61CrossRef
34.
Willis ZI, Duggan EM, Bucher BT, Pietsch JB, Milovancev M, Wharton W et al (2016) Effect of a clinical practice guideline for pediatric complicated appendicitis. JAMA Surg 151(5):e160194CrossRefPubMedPubMedCentral
35.
Romano A, Parikh P, Byers P, Namias N (2014) Simple acute appendicitis versus non-perforated gangrenous appendicitis: is there a difference in the rate of post-operative infectious complications? Surg Infect (Larchmt) 15(5):517–520CrossRef
36.
McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN et al (2016) Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. Lancet Infect Dis 16(8):e139–e152CrossRefPubMed
37.
Sartelli M, Weber DG, Ruppe E, Bassetti M, Wright BJ, Ansaloni L et al (2016) Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World J Emerg Surg 11:33CrossRefPubMedPubMedCentral
38.
Alamili M, Gogenur I, Rosenberg J (2010) Oral antibiotics for perforated appendicitis is not recommended review. Dan Med Bull 57(9):A4177PubMed
39.
Muehlstedt SG, Pham TQ, Schmeling DJ (2004) The management of pediatric appendicitis: a survey of North American Pediatric Surgeons. J Pediatr Surg. 39(6):875–879 (discussion-9) CrossRefPubMed
40.
Reid F, Choi J, Williams M, Chan S (2017) Prospective evaluation of the sunshine appendicitis grading system score. ANZ J Surg 87(5):368–371CrossRefPubMed
41.
42.
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 11(1):79–109CrossRef
43.
Van den Boom AL, De Wijkerslooth EML, Van Rosmalen J, Beverdam FH, Boerma EG, Boermeester MA et al (2018) Two versus five days of antibiotics after appendectomy for complex acute appendicitis (APPIC): study protocol for a randomized controlled trial. Trials 19:263CrossRefPubMedPubMedCentral
Metadata
Title
Variation in Classification and Postoperative Management of Complex Appendicitis: A European Survey
Authors
Elisabeth M. L. de Wijkerslooth
Anne Loes van den Boom
Bas P. L. Wijnhoven
Publication date
01-02-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 2/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4806-4

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