Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
ObjectiveTo study the diagnostic significance of modified Alvarado Score System for different types of acute appendicitis. MethodsClinical data of 1 930 cases of acute appendicitis, who underwent appendicectomy in The First Hospital of Yulin from Jan. 2004 to Jan. 2014, were retrospectively collected. Then the diagnostic significance of Modified Alvarado Score System was detected and evaluated by receiver operating characteristic (ROC) curve, and its correlation with postoperative pathological results was calculated. ResultsThe modified Alvarado score of cases in progressive group was higher than that of simplex group (7.5±1.3 vs. 3.6±0.7, P < 0.001). The areas under ROC curve of modified Alvarado Score System was 0.943 (95% CI:0.929-0.958, P < 0.001). The critically diagnostic points of Modified Alvarado Score System for differential diagnosis of simplex acute appendicitis and progressive acute appendicitis was 6 score, with sensitivity of 92.9%, specificity of 86.3%, positive predictive value of 96.9%, negative predictive value of 72.6%, positive likelihood ratio of 6.8, negative likelihood ratio of 0.1, and Youden index of 91.7%. ConclusionThis Modified Alvarado Score System has a certain significance for the type diagnosis of acute appendicitis.
ObjectiveTo investigate the efficacy and safety of laparoscopic surgery for overweight/obese patients with acute perforated or gangrenous appendicitis. MethodsFrom January 2007 to December 2014, patients with acute perforated or gangrenous appendicitis underwent laparoscopic (152 cases) or open (60 cases) appendectomy were collected, who were retrospectively classified into overweight/obese group (BMI≥25 kg/m2, n=69) or normal weight group (BMI < 25 kg/m2, n=143). Conversion rate, operation time, hospital stay, readmission, reoperation, and postoperative complications such as incision infection, abdominal abscess, and lung infection were analyzed. Results①The rate of conversion to open surgery had no significant difference between the overweight/obese group and the normal weight group[4.2% (2/48) versus 6.7% (7/104), χ2=0.06, P > 0.05].②The operation time of laparoscopic surgery in the overweight/obese group was significantly shorter than that of the open surgery in the overweight/obese group[(41.6±11.7) min versus (63.1±23.3) min, P < 0.01], which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[(41.6±11.7) min versus (39.6±12.7) min, P > 0.05].③The total complications rate and incision infection rate of the laparoscopic surgery in the overweight/obese group were significantly lower than those of the open surgery in the overweight/obese group[total complications rate:16.7% (8/48) versus 52.4% (11/21), χ2=9.34, P < 0.01; incision infection rate:4.2% (2/48) versus 33.3% (7/21), χ2=8.54, P < 0.01]. Although the total complications rate of all the patients in the overweight/obese group was increased as compared with all the patients in the normal weight group[27.5% (19/69) versus 14.7% (21/143), χ2=5.02, P < 0.01], but which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[16.7% (8/48) versus 12.5% (13/104), χ2=0.45, P > 0.05].④The reoperation rate of all the patients performed laparoscopic surgery was significantly lower than that of all the patients performed open operation[1.3% (2/152) versus 10.0% (6/60), χ2=6.7, P < 0.01].⑤The abdominal abscess rate, lung infection rate, and hospital stay after discharge had no significant differences among all the patients (P > 0.05). ConclusionLaparoscopic appendectomy could be considered a safe technique for overweight/obese patients with acute perforated or gangrenous appendicitis, which could not increase the difficulty of laparoscopic surgery and the perioperative risk.
ObjectiveTo evaluate the manifestations and diagnostic value of pediatric acute appendicitis with dual-source CT (DSCT). MethodsRetrospectively analysis of CT features of 97cases of surgically and pathologically confirmed pediatric acute appendicitis in our hospital were performed. ResultsAmong 97 patients, 7 cases were diagnosed acute simple appendicitis, 20 cases with acute suppurative appendicitis, perforated and gangrenous appendicitis in 58 cases, and appendiceal abscess in 12 cases. According to the location of appendix confirmed by CT, 28 cases of appendicitis could not be clearly manifested, the cohort of the remaining 69 cases were composed of 20 cases (29.0%) with appendix located in pelvic, 15 cases (21.7%) with appendix in front of ileum, 11 cases (15.9%) with appendix behind ileum, 12 cases (17.4%) with appendix behind cecum, 3 cases (4.3%) with appendix below cecum, 1 case (1.5%) with appendix outside of cecum, and 7 cases (10.2%) with appendix located in other positions. CT and three-dimensional reconstruction findings were as followed:swelling enlarged appendix, appendicoliths, periappendiceal fat fuzzy, peritoneal thickening, ileocecal thickening, mesenteric lymphadenopathy, periappendiceal mass, and abdominal or pelvic fluid. The diagnostic rate of acute simple appendicitis with CT was 85.7% (6/7), acute suppurative appendicitis was 80.0% (16/20), perforated and gangrenous appendicitis was 100% (58/58), appendiceal abscess was also 100% (12/12), the overall diagnostic yield was 94.8% (92/97). ConclusionDSCT can well demonstrate the anatomical location of appendix and pathological changes of surrounding tissues, and has higher diagnostic accuracy, provide powerful information for surgeons.
ObjectiveTo compare the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) for the acute appendicitis patients based on our extensive experiences. MethodsThe data of all the acute appendicitis patients who underwent appendectomy from January 2013 to December 2014 in our department were retrospectively reviewed. A total of 201 patients were enrolled and divided into LA group (n=102) and OA group (n=99). The relevant clinical indexes during and after operation of two groups were compared. ResultsThere were no significant difference in age, gender, and underlying disease between LA and OA patients (P > 0.05). And the abdominal cavity infection rate, abdominal drainage rate and 30-day readmission rate were also similar (P > 0.05). But LA group had less operative time, lower infection operative wound rate, less intestinal function recovery time, shorter inhospital days and higher hospital expenses than OA group (P < 0. 05). In addition, perforated appendix and LA could increase the rate of abdominal drainage[OR=2.710, 95% CI(1.129, 6.507), P=0.026]. ConclusionsBoth LA and OA are safe and effective methods for the treatment of acute appendicitis. But LA has several advantages over OA on less operative time and postoperative complications, earlier recovery, and shorter inhospital days. While LA have higher hospital cost than OA, it still should be considered as a prefer way to cure acute appendicitis. LA is a independent risk factor of abdominal drainage.
ObjectiveTo analyze the multidetector computed tomography (MDCT) findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. MethodsSixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from Jun. to Oct. 2016 (acute appendicitis group), and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 (normal appendices group), were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included:location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results① Rate of appendices visualization. In total of 95.5% (63/66) appendices were visualized on MDCT in acute appendicitis group, while 95.0% (38/40) appendices were visualized on MDCT in normal appendices group (P > 0.05). ② Locations of appendices. Acute appendicitis group:appendices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group:appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices (P < 0.05). The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. ③ The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were (11.4±4.2) mm (6.2-21.9) mm and (4.3±2.2) mm (1.1-8.6) mm, respectively, while those in normal appendices group were (6.1±1.4) mm (3.7-8.6) mm and (1.7±0.8) mm (0.5-3.2) mm, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively (P < 0.05). ④ Contents of appendices. Acute appendices group:there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group:there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. ⑤ Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. ConclusionsMDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.
ObjectiveTo systematically review the effectiveness of appendicectomy versus antibiotics for uncomplicated acute appendicitis (UAA). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about appendicectomy versus antibiotics for uncomplicated acute appendicitis from inception to September 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs studies involving 2 028 patients were included. The results of meta-analysis showed that, compared with antibiotics, the appendicectomy could shorten duration of hospital stay (MD=–1.89, 95%CI –2.75 to –1.04, P<0.000 01), the therapeutic time of antibiotics (MD=–4.42, 95%CI –5.06 to –3.79, P<0.000 01), improve the efficiency of clinical treatment (OR=23.48, 95%CI 7.99 to 68.96, P<0.000 01), decrease the recurrence rate (OR=0.02, 95%CI 0.01 to 0.05, P<0.000 01), however, there was no significant difference in the incidence of postoperative complications between two groups (OR=1.35, 95%CI 0.31 to 5.87, P=0.69). ConclusionThe current evidence shows that, compared with antibiotics, the appendicectomy for uncomplicated acute appendicitis can shorten duration of hospital stay and the therapeutic time of antibiotics, improve the efficiency of clinical treatment, decrease the recurrence rate. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.
ObjectivesTo assess the predictive value of neutrophils-to-lymphocytes ratio (NLR) in the diagnosis of children complicated appendicitis.MethodsThe clinical data of patients with acute appendicitis treated in Department of Pediatric Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University from January 2014 to June 2017 were analyzed retrospectively. Based on the pathology results, patients were divided into two groups: simple appendicitis and complicated appendicitis. The differences of age, gender, disease time, fever, highest temperature, emesis, right lower abdominal pain, blood indicators, and ultrasound results between the two groups were analyzed. Useful parameters to aid in the diagnosis of children complicated appendicitis were screened through single-factor and multiple-factor analysis. The predictive value of the parameters was evaluated by ROC analysis, sensitivity and specificity.ResultsA total of 235 patients was evaluated and divided into simple appendicitis group (179 patients) and complicated appendicitis group (56 patients). Logistic regression analysis revealed that NLR was the independent risk factor for diagnosis of children complicated appendicitis. When NLR>11.74, the Youden index for predictive complicated appendicitis was the biggest, reaching 0.325, and the sensitivity and specificity were 47.8% and 84.7%, respectively (OR=3.121, 95%CI 2.036 to 4.783).ConclusionsThe preoperative NLR is a certain indicator for predicting children complicated appendicitis, and can be used as reference to whether or not receive an operation.