Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Análisis factorial de tablas mixtas: nuevas equivalencias entre ACP normado y ACM

En este trabajo se pone de manifiesto que es posible el Análisis Factorial de tablas mixtas sin modificar la naturaleza de ninguno de los dos conjuntos, cualitativo y cuantitativo, que las integran. Se propone codificar de manera apropiada las indicadoras de cada variable cualitativa tratando de respetar, en la medida de lo posible, la estructura inicial de ésta última y posteriormente aplicar un Análisis en Componentes Principales (ACP) Normado al conjunto de variables. Los factores obtenidos para el grupo de variables nominales serán iguales a los factores resultantes de un Análisis de Correspondencias Múltiples (ACM) de la Tabla Disyuntiva Completa (TDC)

Análisis factorial de tablas mixtas: nuevas equivalencias entre ACP normado y ACM

En este trabajo se pone de manifiesto que es posible el Análisis Factorial de tablas mixtas sin modificar la naturaleza de ninguno de los dos conjuntos, cualitativo y cuantitativo, que las integran. Se propone codificar de manera apropiada las indicadoras de cada variable cualitativa tratando de respetar, en la medida de lo posible, la estructura inicial de ésta última y posteriormente aplicar un Análisis en Componentes Principales (ACP) Normado al conjunto de variables. Los factores obtenidos para el grupo de variables nominales serán iguales a los factores resultantes de un Análisis de Correspondencias Múltiples (ACM) de la Tabla Disyuntiva Completa (TDC)

Análisis factorial múltiple como técnica de estudio de la estabilidad de los resultados de un análisis de componentes principales

Una característica de los métodos factoriales es que siempre producen resultados y éstos no son una simple descripción, sino que ponen de manifiesto la estructura existente entre los datos, de ahí la necesidad de estudiar la validez de los resultados. Es preciso analizar la naturaleza de esta estructura y estudiar la estabilidad de los resultados. Consideramos que el mejor criterio es el análisis de la estabilidad de los mapas obtenidos en el análisis factorial. El Análisis Factorial Múltiple (AFM), desarrollado por E. Escofier and J. Pages (1992), permite el análisis simultáneo de tablas en las que un mismo conjunto de individuos se describe a través de varios grupos de variables. En este trabajo se muestra la eficacia de este método para el análisis de la estabilidad de los resultados obtenidos mediante Análisis de Componentes Principales

Análisis factorial múltiple como técnica de estudio de la estabilidad de los resultados de un análisis de componentes principales

Una característica de los métodos factoriales es que siempre producen resultados y éstos no son una simple descripción, sino que ponen de manifiesto la estructura existente entre los datos, de ahí la necesidad de estudiar la validez de los resultados. Es preciso analizar la naturaleza de esta estructura y estudiar la estabilidad de los resultados. Consideramos que el mejor criterio es el análisis de la estabilidad de los mapas obtenidos en el análisis factorial. El Análisis Factorial Múltiple (AFM), desarrollado por E. Escofier and J. Pages (1992), permite el análisis simultáneo de tablas en las que un mismo conjunto de individuos se describe a través de varios grupos de variables. En este trabajo se muestra la eficacia de este método para el análisis de la estabilidad de los resultados obtenidos mediante Análisis de Componentes Principales

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas

Delaying surgery for patients with a previous SARS-CoV-2 infection

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The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups. Trial registration number NCT0432364