Clinical practice selectively follows acute appendicitis guidelines
© 2023. The Author(s)..
INTRODUCTION: Acute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps.
METHODS: We undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications.
RESULTS: Four thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1-4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p < 0.001).
CONCLUSIONS: The observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
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| Enthalten in: |
European journal of trauma and emergency surgery : official publication of the European Trauma Society - 49(2023), 1 vom: 01. Feb., Seite 45-56 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bass, Gary Alan [VerfasserIn] |
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| Links: |
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| Themen: |
Acute appendicitis |
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| Anmerkungen: |
Date Completed 15.02.2023 Date Revised 15.02.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00068-022-02208-2 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352298103 |
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| 100 | 1 | |a Bass, Gary Alan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical practice selectively follows acute appendicitis guidelines |
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| 500 | |a Date Revised 15.02.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a INTRODUCTION: Acute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps | ||
| 520 | |a METHODS: We undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications | ||
| 520 | |a RESULTS: Four thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1-4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p < 0.001) | ||
| 520 | |a CONCLUSIONS: The observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute appendicitis | |
| 650 | 4 | |a Appendectomy | |
| 650 | 4 | |a Guidelines | |
| 650 | 4 | |a Observational cohort | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Mohseni, Shahin |e verfasserin |4 aut | |
| 700 | 1 | |a Ryan, Éanna J |e verfasserin |4 aut | |
| 700 | 1 | |a Forssten, Maximilian Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Tolonen, Matti |e verfasserin |4 aut | |
| 700 | 1 | |a Cao, Yang |e verfasserin |4 aut | |
| 700 | 1 | |a Kaplan, Lewis J |e verfasserin |4 aut | |
| 700 | 0 | |a ESTES SnapAppy Group |e verfasserin |4 aut | |
| 700 | 1 | |a Ahl Hulme, Rebecka |e investigator |4 oth | |
| 700 | 1 | |a Biloslavo, Alan |e investigator |4 oth | |
| 700 | 1 | |a Kurihara, Hayato |e investigator |4 oth | |
| 700 | 1 | |a Martinez-Casas, Isidro |e investigator |4 oth | |
| 700 | 1 | |a Pereira, Jorge |e investigator |4 oth | |
| 700 | 1 | |a Pourlotfi, Arvid |e investigator |4 oth | |
| 700 | 1 | |a Louri, Nayef |e investigator |4 oth | |
| 700 | 1 | |a Cao, Yang |e investigator |4 oth | |
| 700 | 1 | |a Nedham, Fatema |e investigator |4 oth | |
| 700 | 1 | |a Walsh, Thomas Noel |e investigator |4 oth | |
| 700 | 1 | |a Hashem, Jamal |e investigator |4 oth | |
| 700 | 1 | |a Corbally, Martin |e investigator |4 oth | |
| 700 | 1 | |a Farhan, Abeer |e investigator |4 oth | |
| 700 | 1 | |a Al Hamad, Hamad |e investigator |4 oth | |
| 700 | 1 | |a Elhennawy, Rawan |e investigator |4 oth | |
| 700 | 1 | |a AlKooheji, Mariam |e investigator |4 oth | |
| 700 | 1 | |a AlYusuf, Manar |e investigator |4 oth | |
| 700 | 1 | |a Aknouche, Wissal |e investigator |4 oth | |
| 700 | 1 | |a Zeidan, Anas A |e investigator |4 oth | |
| 700 | 1 | |a Alsaffar, Yusuf S |e investigator |4 oth | |
| 700 | 1 | |a Lipping, Edgar |e investigator |4 oth | |
| 700 | 1 | |a Talving, Peep |e investigator |4 oth | |
| 700 | 1 | |a Saar, Sten |e investigator |4 oth | |
| 700 | 1 | |a Graumann, Katrina |e investigator |4 oth | |
| 700 | 1 | |a Kibuspuu, Liis |e investigator |4 oth | |
| 700 | 1 | |a Harkov, Eduard |e investigator |4 oth | |
| 700 | 1 | |a Aaltonen, Gisele |e investigator |4 oth | |
| 700 | 1 | |a Sillman, Iines S |e investigator |4 oth | |
| 700 | 1 | |a Haapanen, Sami |e investigator |4 oth | |
| 700 | 1 | |a Lampela, Hanna |e investigator |4 oth | |
| 700 | 1 | |a Sammalkorpi, Henna |e investigator |4 oth | |
| 700 | 1 | |a Eskola, Sofia |e investigator |4 oth | |
| 700 | 1 | |a Laakso, Altti |e investigator |4 oth | |
| 700 | 1 | |a Back, Johan |e investigator |4 oth | |
| 700 | 1 | |a Kettunen, Ulla |e investigator |4 oth | |
| 700 | 1 | |a Nummi, Antti M |e investigator |4 oth | |
| 700 | 1 | |a Szwedyc, Anika |e investigator |4 oth | |
| 700 | 1 | |a Nykänen, Taina |e investigator |4 oth | |
| 700 | 1 | |a Rantala, Rolle |e investigator |4 oth | |
| 700 | 1 | |a Mäkäräinen-Uhlbäck, Elisa J |e investigator |4 oth | |
| 700 | 1 | |a Meriläinen, Sanna A |e investigator |4 oth | |
| 700 | 1 | |a Huhta, Heikki I |e investigator |4 oth | |
| 700 | 1 | |a Rintala, Jukka M J |e investigator |4 oth | |
| 700 | 1 | |a Laitakari, Kirsi E M |e investigator |4 oth | |
| 700 | 1 | |a Lietzen, Elina |e investigator |4 oth | |
| 700 | 1 | |a Salminen, Paulina |e investigator |4 oth | |
| 700 | 1 | |a Rapola, Risto K A |e investigator |4 oth | |
| 700 | 1 | |a Zangouri, Vahid |e investigator |4 oth | |
| 700 | 1 | |a Karami, Mohammad Y |e investigator |4 oth | |
| 700 | 1 | |a Tahmasebi, Sedigheh |e investigator |4 oth | |
| 700 | 1 | |a Akrami, Majid |e investigator |4 oth | |
| 700 | 1 | |a Golchini, Alireza |e investigator |4 oth | |
| 700 | 1 | |a Bahrami, Faranak |e investigator |4 oth | |
| 700 | 1 | |a Johnston, Sean M |e investigator |4 oth | |
| 700 | 1 | |a Lim, Sean T |e investigator |4 oth | |
| 700 | 1 | |a Ahonkhai, Irele Ifijeh |e investigator |4 oth | |
| 700 | 1 | |a Eltagani, Eltahir |e investigator |4 oth | |
| 700 | 1 | |a Ryan, Odhran K |e investigator |4 oth | |
| 700 | 1 | |a O'Driscoll-Collins, Ailbhe |e investigator |4 oth | |
| 700 | 1 | |a O'Neill, Aine |e investigator |4 oth | |
| 700 | 1 | |a Penny, Zakiya |e investigator |4 oth | |
| 700 | 1 | |a Kelly, Orlaith |e investigator |4 oth | |
| 700 | 1 | |a Cullinane, Carolyn |e investigator |4 oth | |
| 700 | 1 | |a Reynolds, Ian |e investigator |4 oth | |
| 700 | 1 | |a Heneghan, Helen |e investigator |4 oth | |
| 700 | 1 | |a Martin, Sean |e investigator |4 oth | |
| 700 | 1 | |a Winter, Des |e investigator |4 oth | |
| 700 | 1 | |a Davey, Matthew |e investigator |4 oth | |
| 700 | 1 | |a Alkhattab, Maha |e investigator |4 oth | |
| 700 | 1 | |a Lowery, Aoif J |e investigator |4 oth | |
| 700 | 1 | |a Kerin, Michael J |e investigator |4 oth | |
| 700 | 1 | |a Hogan, Aisling M |e investigator |4 oth | |
| 700 | 1 | |a Davey, Martin S |e investigator |4 oth | |
| 700 | 1 | |a Oh, Ke En |e investigator |4 oth | |
| 700 | 1 | |a Kabir, Syed Mohammad Umar |e investigator |4 oth | |
| 700 | 1 | |a Huan, Huilun |e investigator |4 oth | |
| 700 | 1 | |a Aziz, Charlotte |e investigator |4 oth | |
| 700 | 1 | |a Sugrue, Michael |e investigator |4 oth | |
| 700 | 1 | |a Ryan, Jessica M |e investigator |4 oth | |
| 700 | 1 | |a Connelly, Tara M |e investigator |4 oth | |
| 700 | 1 | |a Alhazmi, Mohammad |e investigator |4 oth | |
| 700 | 1 | |a Al-Mukhaizeem, Youssef |e investigator |4 oth | |
| 700 | 1 | |a Cooke, Fiachra |e investigator |4 oth | |
| 700 | 1 | |a Neary, Peter M |e investigator |4 oth | |
| 700 | 1 | |a Hill, Arnold D K |e investigator |4 oth | |
| 700 | 1 | |a Boland, Michael R |e investigator |4 oth | |
| 700 | 1 | |a Lloyd, Angus J |e investigator |4 oth | |
| 700 | 1 | |a Fallon, Frances |e investigator |4 oth | |
| 700 | 1 | |a Cleere, Eoin F |e investigator |4 oth | |
| 700 | 1 | |a Toale, James |e investigator |4 oth | |
| 700 | 1 | |a Boland, Patrick A |e investigator |4 oth | |
| 700 | 1 | |a Devine, Michael |e investigator |4 oth | |
| 700 | 1 | |a Keady, Conor |e investigator |4 oth | |
| 700 | 1 | |a Hunter, Sarah |e investigator |4 oth | |
| 700 | 1 | |a Barry, M Kevin |e investigator |4 oth | |
| 700 | 1 | |a Kelly, Michael E |e investigator |4 oth | |
| 700 | 1 | |a O'Dowling, Aidan T |e investigator |4 oth | |
| 700 | 1 | |a Creavin, Ben |e investigator |4 oth | |
| 700 | 1 | |a Kavanagh, Dara O |e investigator |4 oth | |
| 700 | 1 | |a Neary, Paul |e investigator |4 oth | |
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