Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.</p

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.info:eu-repo/semantics/publishedVersio

Optimisation de la prise en charge de l'appendicectomie pour appendicite aiguë non compliquée en ambulatoire chez l'adulte

Acute appendicitis (AA) is a surgical emergency which represents about 83.000 procedures per year in France. Day case appendectomy (DCA) is a modern medical-surgical treatment with a hospital length of stay inferior to 12 hours (without a night spent in the hospital), supported by the General Direction of the Offer of Care (DGOS). The pathologies applying to this new modality of management are associated with short operating time and hospital stay and a low rate of postoperative complications. The appendectomy for AA is, therefore, an ideal candidate for this new modality of management in adult patients. The objectives of this thesis were initially to evaluate in a retrospective and prospective ways, the feasibility of the management of the appendectomy for uncomplicated AA (UAA) in DCA through the conduct of a review of the literature and through the course of the « AppendAmbu » study (NCT01839435). In a second step, we have been interested in the applicability of the recommendations of the « AppendAmbu » study in a retrospective study under non-research protocol conditions (real-life study). Besides, we have had the plan to conduct a non-interventional, « hors Loi Jardé », retrospective, monocentric study to assess the feasibility of appendectomy for AA in DCA in adults between 2011 and 2016 in France thanks to the data of the National Information Health Insurance Scheme (Sniiram). The study protocol of this study could be finalized but the data could not be exploited and will be the subject of further work. Finally, in order to strengthen the biological diagnosis of the severity of AA and with the will of strengthening the selection criteria for DCA eligible patients, we have evaluated the diagnosis interest of preoperative levels of procalcitonin (PCT)L'appendicite aiguë (AA) est une urgence chirurgicale qui représente environ 83 000 interventions par an en France. La chirurgie ambulatoire (CA) correspond à une prise en charge médico-chirurgicale moderne d'une durée de moins de 12 heures (sans nuit passée à l'hôpital), soutenue par la Direction Générale de l'Offre de Soins (DGOS). Les pathologies candidates à cette nouvelle modalité de prise en charge sont associées à une durée opératoire et un séjour hospitalier courts ainsi qu'à un faible taux de complications postopératoires. L'appendicectomie pour AA est donc une candidate idéale à cette nouvelle modalité de prise en charge chez des patients adultes. Les objectifs de cette thèse étaient dans un premier temps d'évaluer de manière rétrospective et prospective, la faisabilité de la prise en charge de l'appendicectomie pour AA non compliquée (AANC) en ambulatoire, via la conduite d'une revue de la littérature et grâce à la mise en place et au suivi de l'étude "AppendAmbu" (NCT01839435). Dans un second temps, nous nous sommes intéressés à l'applicabilité des recommandations issues de l'étude "AppendAmbu" dans une étude rétrospective dans des conditions hors protocole de recherche (étude en vie réelle). Ensuite, nous avions le projet de conduire une étude non interventionnelle, hors Loi Jardé, rétrospective, monocentrique, visant à évaluer la faisabilité de la prise en charge en ambulatoire de l'appendicectomie pour AA chez l'adulte entre 2011 et 2016 en France, via les données du Système national d'information inter-régimes de l'assurance maladie (Sniiram). Le protocole de cette étude a pu être finalisé mais les données n'ont pas pu être exploitées et feront l'objet d'un travail ultérieur. Enfin, dans le but de renforcer le diagnostic biologique de la sévérité de l'AA et dans une optique de renforcer les critères de sélection des patients éligibles à une prise en charge en CA, nous avons cherché à déterminer l'intérêt du dosage préopératoire de la procalcitonine (PCT