The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes

Nonparametric bootstrap confidence bands for unfolding sphere size distributions

The stereological inverse problem of unfolding the distribution of spheres radii from measured planar sections radii, known as the Wicksell’s corpuscle problem, is considered. The construction of uniform confidence bands based on the smoothed bootstrap in the Wicksell’s problem is presented. Theoretical results on the consistency of the proposed bootstrap procedure are given, where the consistency of the bands means that the coverage probability converges to the nominal level. The finite-sample performance of the proposed method is studied via Monte Carlo simulations and compared with the asymptotic (non-bootstrap) solution described in literature

Results of a survey concerning atrial fibrillation ablation strategies in Poland

Background: Catheter ablation is an effective treatment for patients with atrial fibrillation (AF). Despite the increasing availability of the procedure, current treatment patterns of invasive AF treatment in Poland are unknown. Aims: The aim of the study was to assess data on the contemporary approaches to AF ablation in Poland, such as: target population, patients’ characteristics, ablation techniques, procedural results, and complication rates. Methods: The survey including 36 questions was conducted among 38 representatives of Polish electrophysiology centers performing AF catheter ablation to test the methods and outcomes in their laboratories. Results: The survey was conducted among 38 out of 69 Polish electrophysiology centers performing AF ablation. There were 88 ablation laboratories in 2018 in Poland. They have performed 16 566 ablations, of which 6680 were AF ablations, according to the Polish National Health Fund data. Therefore, 3745 AF ablations analyzed in this study constituted 22.6% of all ablations and 56% of AF ablations performed in Poland in 2018.Paroxysmal AF was the most common type of AF in all surveyed centers. In 69% of the centers, the preferred method was cryoballoon ablation and in 31%, radiofrequency point‑by‑point circumferential pulmonary vein isolation. The reported complication rate was low (6.4%), with localadverse events being the most frequent. The mean reported incidence of atrial flutter or tachycardia after ablation was low (5%). Repeated procedures were performed mainly with radiofrequency ablation (89%). Procedural techniques and the type of venous access did not vary between the centers. Conclusions: Paroxysmal AF was the most common indication for percutaneous ablation of that arrhythmia in Polish electrophysiology laboratories. The preferred method was cryoballoon ablatio