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1. In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

Author

Bolmers, M. D. M., de Jonge, J., Bom, W. J., van Rossem, C. C., van Geloven, A. A. W., Bemelman, W. A., van Acker, G. J., Akkermans, B., Akkersdijk, G. J., Algie, G. D., Allema, J. H., Andeweg, C. S., Appeldoorn, N., van Baal, J. G., Bakker, C. M. den, Bartels, S. A., van den Berg, C., Boekestijn, B., Boer, F. C. den, Boerma, D., van den Boom, A. L., Boute, M. C., Bouwense, S. A., Bransen, J., van Brussel, F. A., Busch, O. R., de Castro, S. M., Cense, H. A., Croese, C., van dalen, T., Dawson, I., van Dessel, E., Dettmers, R., Dhar, N., Dohmen, F. Y., van Dongen, K. W., van Duijvendijk, P., Dulfer, R. R., Dwars, B. J., Eerenberg, J. P., van der Elst, M., van den Ende, E., Fassaert, L. M., Fikkers, J. T., Foppen, J. W., Furnee, E. J., Garssen, F. P., Gerhards, M. F., van Goor, H., de Graaf, J. S., Graat, L. J., Grootr, J., van der Ham, A. C., Hamming, J. F., Hamminga, J. T., van der Harst, E., Heemskerk, J., Heijne, A., Heikens, J. T., Heineman, E., Hertogs, R., van Heurn, E., van den Hil, L. C., Hooftwijk, A. G., Hulsker, C. C., Hunen, D. R., Ibelings, M. S., Klaase, J. M., Klicks, R., Knaapen, L., Kortekaas, R. T., Kruyt, F., Kwant, S., Lases, S. S., Lettinga, T., Loupatty, A., Matthijsen, R. A., Minnee, R. C., Mirck, B., Mitalas, L., Moes, D., Moorman, A. M., Nieuwenhuijs, V. B., Nieuwenhuizen, G. A., Nijk, P. D., Omloo, J. M., Ottenhof, A. G., Palamba, H. W., van der Peet, D. L., Pereboom, I. T., Plaisier, P. W., van der Ploeg, A. P., Raber, M. H., Reijen, M. M., Rijna, H., Rosman, C., Roumen, R. M., Scmitz, R. F., Schouten van der Velden, A. P., Scheurs, W. H., Sigterman, T. A., Smeets, H. J., Sonnevled, D. J., Sosef, M. N., Spoor, S. F., Stassen, L. P., van Steensel, L., Stortelder, E., Straatman, J., van Susante, H. J., Suykerbuyk de Hoog, D. E., Terwisscha van Scheltinga, C., Toorenvliet, B. R., Verbeek, P. C., Verseveld, M., Volders, J. H., Vriens, M. R., Vriens, P. W., Vrouenraets, B. C., van de wall, B. J., Wegdam, J. A., Westerduin, E., Wever, J. J., Wijfels, N. A., Wijnhoven, B. P., Winkel, T. A., van der Zee, D. C., Zeillemaker, A. M., Zietse, C., Amsterdam Reproduction & Development (AR&D), Pediatrics, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and quality of life, Other Research, Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Graduate School, AII - Infectious diseases, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Paediatric Surgery, and ARD - Amsterdam Reproduction and Development

Subjects
Delay in surgery, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Gastroenterology, Surgery, Appendicitis, Complicated
Abstract

Item does not contain fulltext BACKGROUND: Present theory is that uncomplicated and complicated appendicitis are different entities. Recent studies suggest it is safe to delay surgery in patients with uncomplicated appendicitis. We hypothesize that patients with complicated appendicitis are at higher risk for postoperative complications when surgery is delayed. METHODS: Data was used from the multicenter, prospective SNAPSHOT appendicitis study of 1975 patients undergoing surgery for suspected appendicitis. Adult patients (≥ 18 years) who underwent appendectomy for appendicitis were included in this study. The primary outcome was the difference in postoperative complications between patients with complicated appendicitis who were operated within and after 8 h after hospital presentation. Secondary outcomes were the incidence of both uncomplicated and complicated appendicitis in relationship to delay of appendectomy. Follow-up was 30 days. A multivariable analysis was performed. RESULTS: Of 1341 adult patients with appendicitis, 34.3% had complicated appendicitis. In patients with complicated appendicitis, 22.8% developed a postoperative complication compared to 8.2% for uncomplicated appendicitis (P 8 h) increased the complication rate in patients with complicated appendicitis (28.1%) compared to surgery within 8 h (18.3%; P = 0.01). Multivariate analysis showed a delay in surgery as an independent predictor for a postoperative complication in patients with complicated appendicitis (OR 1.71; 95%CI 1.01-2.68, P = 0.02). CONCLUSION: In-hospital delay of surgery (> 8 h) in patients with complicated appendicitis is associated with a higher risk of a postoperative complication. It is important that we recognize and treat these patients early.

Published
2022
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2. Prospective nationwide outcome audit of surgery for suspected acute appendicitis

Author

van Rossem, C. C., Bolmers, M. D. M., Schreinemacher, M. H. F., van Geloven, A. A. W., Bemelman, W. A., van Acker, G. J. D., Akkermans, B., Akkersdijk, G. J. M., Algie, G. D., Allema, J. H., Andeweg, C. S., Appeldorn, N., van Baal, J. G., den Bakker, C. M., Bartels, S. A. L., van den Berg, C., Boekestijn, B., den Boer, F. C., Boerma, D., van den Boom, A. L., Boute, M. C., Bouwense, S. A. W., Bransen, J., van Brussel, F. A., Busch, O. R. C., de Castro, S. M. M., Cense, H. A., Croese, C., van Dalen, T., Dawson, I., van Dessel, E., Dettmers, R., Dhar, N., Dohmen, F. Y. M., van Dongen, K. W., van Duijvendijk, P., Dulfer, R. R., Dwars, B. J., Eerenberg, J. P., van der Elst, M., van den Ende, E., Fassaert, L. M. M., Fikkers, J. T., Foppen, J. W., Furnee, E. J. B., Garssen, F. P., Gerhards, M. F., van Goor, H., Gorter, R. R., de Graaf, J. S., Graat, L. J., Groote, J., van der Ham, A. C., Hamming, J. F., Hamminga, J. T. H., van der Harst, E., Heemskerk, J., Heij, H. A., Heijne, A., Heikens, J. T., Heineman, E., Hertogs, R., van Heurn, E., van den Hil, L. C. L., Hoofwijk, A. G. M., Hulsker, C. C. C., Hunen, D. R. M., Ibelings, M. S., Klaase, J. M., Klicks, R., Knaapen, L., Kortekaas, R. T. J., Kruyt, F., Kwant, S., Lases, S. S., Lettinga, T., Loupatty, A., Matthijsen, R. A., Minnee, R. C., Mirck, B., Mitalas, L., Moes, D., Moorman, A. M., Nieuwenhuijs, V. B., Nieuwenhuijzen, G. A. P., Nijk, P. D., Omloo, J. M. T., Ottenhof, A. G., Palamba, H. W., van der Peet, D. L., Pereboom, I. T. A., Plaisier, P. W., van der Ploeg, A. P. T., Raber, M. H., Reijnen, M. M. P. J., Rijna, H., Rosman, C., Roumen, R. M. H., Schmitz, R. F., van der Velden, Schouten A. P., Schreurs, W. H., Sigterman, T. A., Smeets, H. J., Sonneveld, D. J. A., Sosef, M. N., Spoor, S. F., Stassen, L. P. S., van Steensel, L., Stortelder, E., Straatman, J., van Susante, H. J., de Hoog, Suykerbuyk D. E. N. M., van Scheltinga, Terwisscha C., Toorenvliet, B. R., Verbeek, B. M., Verbeek, P. C. M., Verseveld, M., Volders, J. H., Vriens, M. R., Vriens, P. W. H. E., Vrouenraets, B. C., van de Wall, B. J. M., Wegdam, J. A., Westerduin, E., Wever, J. J., Wijffels, N. A. T., Wijnhoven, B. P. L., Winkel, T. A., van der Zee, D. C., Zeillemaker, A. M., and Zietse, C.

Published
2016
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3. Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis

Author

de Jonge, J., Scheijmans, J. C. G., van Rossem, C. C., van Geloven, A. A. W., Boermeester, M. A., Bemelman, W. A., van Acker, G. J., Akkermans, B., Akkersdijk, G. J., Algie, G. D., Allema, J. H., Andeweg, C. S., Appeldoorn, N., van Baal, J. G., den Bakker, C. M., Bartels, S. A., van den Berg, C., Boekestijn, B., den Boer, F. C., Boerma, D., van den Boom, A. L., Boute, M. C., Bouwense, S. A., Bransen, J., van Brussel, F. A., Busch, O. R., de Castro, S. M., Cense, H. A., Croese, C., van Dalen, T., Dawson, I., van Dessel, E., Dettmers, R., Dhar, N., Dohmen, F. Y., van Dongen, K. W., van Duijvendijk, P., Dulfer, R. R., Dwars, B. J., Eerenberg, J. P., van der Elst, M., van den Ende, E., Fassaert, L. M., Groot, J., van Heurn, E., Lases, S. S., Mirck, B., van der Peet, D. L., Terwisscha van Scheltinga, C., Westerduin, E., Graduate School, Surgery, AII - Inflammatory diseases, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Paediatric Surgery, and ARD - Amsterdam Reproduction and Development

Subjects
Adult, medicine.medical_specialty, Inflammatory markers, Peritonitis, 030230 surgery, Gastroenterology, Sensitivity and Specificity, C-reactive protein, Cohort Studies, 03 medical and health sciences, Leukocyte Count, 0302 clinical medicine, Internal medicine, White blood cell, medicine, Humans, Prospective Studies, Prospective cohort study, Retrospective Studies, Complicated appendicitis, biology, business.industry, Incidence (epidemiology), Hepatology, medicine.disease, Appendicitis, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], medicine.anatomical_structure, 030220 oncology & carcinogenesis, Acute Disease, biology.protein, Original Article, business, Biomarkers, Cohort study
Abstract

Purpose For the diagnosis of acute appendicitis, the combination of clinical and laboratory variables achieves high diagnostic accuracy. Nevertheless, appendicitis can present with normal laboratory tests of inflammation. The aim of this study was to investigate the incidence of normal inflammatory markers in patients operated for acute appendicitis. Methods This is an analysis of data from a prospective, multicentre SNAPSHOT cohort study of patients with suspected acute appendicitis. Only patients with histopathologically proven acute appendicitis were included. Adult patients with acute appendicitis and normal preoperative inflammatory markers were explored further in terms of abdominal complaints, preoperative imaging results and intraoperative assessment of the degree of inflammation and compared to those with elevated inflammatory markers. Results Between June and July 2014, 1303 adult patients with histopathologically proven acute appendicitis were included. In only 23 of 1303 patients (1.8%) with proven appendicitis, both preoperative white blood cell count and C-reactive protein levels were normal. Migration of pain was reported less frequently in patients with normal inflammatory markers compared to those with elevated inflammatory marker levels (17.4% versus 43.0%, p = 0.01). Characteristics like fever, duration of symptoms and localized peritonitis were comparable. Only 4 patients with normal inflammatory markers (0.3% overall) had complicated appendicitis at histopathological evaluation. Conclusion Combined normal WBC and CRP levels are seen in about 2 per 100 patients with confirmed acute appendicitis and can, although rarely, be found in patients with complicated appendicitis.

Published
2021

4. Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis

Author

Bolmers, M. D. M., de Jonge, J., van Rossem, C. C., van Geloven, A. A. W., Bemelman, W. A., van Acker, G. J., Akkermans, B., Akkersdijk, G. J., Algie, G. D., Allema, J. H., Andeweg, C. S., Appeldoorn, N., van Baal, J. G., den Bakker, C. M., Bartels, S. A., van den Berg, C., Boekestijn, B., den Boer, F. C., Boerma, D., van den Boom, A. L., Boute, M. C., Bouwense, S. A., Bransen, J., van Brussel, F. A., Busch, O. R., de Castro, S. M., Cense, H. A., Croese, C., van Dalen, T., Dawson, I., van Dessel, E., Dettmers, R., Dhar, N., Dohmen, F. Y., van Dongen, K. W., van Duijvendijk, P., Dulfer, R. R., Dwars, B. J., Eerenberg, J. P., van der Elst, M., van den Ende, E., Fassaert, L. M., Fikkers, J. T., Foppen, J. W., van Heurn, E., Lases, S. S., Mirck, B., van der Peet, D. L., Terwisscha van Scheltinga, C., Westerduin, E., Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Paediatric Surgery, and Amsterdam Reproduction & Development (AR&D)

Subjects
medicine.medical_specialty, Neuroendocrine tumors, Appendix, Malignancy, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Internal medicine, medicine, Appendectomy, Humans, Neoplasm, Prospective Studies, Acute appendicitis, business.industry, Incidence (epidemiology), Gastroenterology, Hepatology, Appendicitis, medicine.disease, musculoskeletal system, Surgery, Neuroendocrine Tumors, medicine.anatomical_structure, Acute Disease, embryonic structures, Laparoscopy, Original Article, business, Neuroendocrine tumors (NET), Cohort study
Abstract

Introduction In patients treated with an appendectomy for acute appendicitis, the specimen is generally sent for histological evaluation. In an era of increasing non-operative treatment for acute appendicitis, it is important to know the incidence, the diagnostic accuracy, and treatment consequences of appendicular neoplasms that are found in acute appendicitis. We hypothesize that pre- and intra-operative parameters might predict an appendicular neoplasm. Methods Data was used from our previous prospective observational cohort study. All patients undergoing surgery for suspected acute appendicitis were included. The primary outcome was the incidence of appendicular neoplasms in patients operated for acute appendicitis. Secondary outcomes were pre-operative diagnostics and imaging outcomes, intra-operative surgical judgment, and postoperative management and outcome. Possible predictors of an appendicular neoplasm were identified and used in multivariable logistic regression. Patients with an appendicular neoplasm were followed for 3 years after initial appendectomy. Results A total of 1975 patients underwent surgery for suspected acute appendicitis and in 98.3% (1941/1975) the appendix was removed. In 1.5% (30/1941) of these patients, an appendicular neoplasm was found. Among the malignant neoplasms, the majority were grade 1 neuroendocrine tumors (NET) in 65% (13/20). On pre-operative imaging, there was no suspicion of malignancy. In three cases, there was an intra-operative suspicion of malignancy. Multivariable analysis showed only age as an independent predictor for appendicular neoplasms. No recurrent or new malignancy was found during follow-up. Discussion The incidence of appendicular neoplasm in patients undergoing an acute appendectomy is very low and clinical risk factors could not be identified.

Published
2020
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5. Prospective nationwide outcome audit of surgery for suspected acute appendicitis

Author

van Rossem, C C, primary, Bolmers, M D M, additional, Schreinemacher, M H F, additional, van Geloven, A A W, additional, Bemelman, W A, additional, Acker, G J D, additional, Akkermans, B, additional, Akkersdijk, G J M, additional, Algie, G D, additional, Allema, J H, additional, Andeweg, C S, additional, Appeldorn, N, additional, Baal, J G, additional, Bakker, C M, additional, Bartels, S A L, additional, Berg, C, additional, Boekestijn, B, additional, Boer, F C, additional, Boerma, D, additional, Boom, A L, additional, Boute, M C, additional, Bouwense, S A W, additional, Bransen, J, additional, Brussel, F A, additional, Busch, O R C, additional, Castro, S M M, additional, Cense, H A, additional, Croese, C, additional, Dalen, T, additional, Dawson, I, additional, Dessel, E, additional, Dettmers, R, additional, Dhar, N, additional, Dohmen, F Y M, additional, Dongen, K W, additional, Duijvendijk, P, additional, Dulfer, R R, additional, Dwars, B J, additional, Eerenberg, J P, additional, Elst, M, additional, Ende, E, additional, Fassaert, L M M, additional, Fikkers, J T, additional, Foppen, J W, additional, Furnee, E J B, additional, Garssen, F P, additional, Gerhards, M F, additional, Goor, H, additional, Gorter, R R, additional, Graaf, J S, additional, Graat, L J, additional, Groote, J, additional, Ham, A C, additional, Hamming, J F, additional, Hamminga, J T H, additional, Harst, E, additional, Heemskerk, J, additional, Heij, H A, additional, Heijne, A, additional, Heikens, J T, additional, Heineman, E, additional, Hertogs, R, additional, Heurn, E, additional, Hil, L C L, additional, Hoofwijk, A G M, additional, Hulsker, C C C, additional, Hunen, D R M, additional, Ibelings, M S, additional, Klaase, J M, additional, Klicks, R, additional, Knaapen, L, additional, Kortekaas, R T J, additional, Kruyt, F, additional, Kwant, S, additional, Lases, S S, additional, Lettinga, T, additional, Loupatty, A, additional, Matthijsen, R A, additional, Minnee, R C, additional, Mirck, B, additional, Mitalas, L, additional, Moes, D, additional, Moorman, A M, additional, Nieuwenhuijs, V B, additional, Nieuwenhuijzen, G A P, additional, Nijk, P D, additional, Omloo, J M T, additional, Ottenhof, A G, additional, Palamba, H W, additional, Peet, D L, additional, Pereboom, I T A, additional, Plaisier, P W, additional, Ploeg, A P T, additional, Raber, M H, additional, Reijnen, M M P J, additional, Rijna, H, additional, Rosman, C, additional, Roumen, R M H, additional, Schmitz, R F, additional, Velden, A P Schouten, additional, Schreurs, W H, additional, Sigterman, T A, additional, Smeets, H J, additional, Sonneveld, D J A, additional, Sosef, M N, additional, Spoor, S F, additional, Stassen, L P S, additional, Steensel, L, additional, Stortelder, E, additional, Straatman, J, additional, Susante, H J, additional, Hoog, D E N M Suykerbuyk, additional, Scheltinga, C Terwisscha, additional, Toorenvliet, B R, additional, Verbeek, B M, additional, Verbeek, P C M, additional, Verseveld, M, additional, Volders, J H, additional, Vriens, M R, additional, Vriens, P W H E, additional, Vrouenraets, B C, additional, Wall, B J M, additional, Wegdam, J A, additional, Westerduin, E, additional, Wever, J J, additional, Wijffels, N A T, additional, Wijnhoven, B P L, additional, Winkel, T A, additional, Zee, D C, additional, Zeillemaker, A M, additional, and Zietse, C, additional

Published
2015
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