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      Clinical practice selectively follows acute appendicitis guidelines

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          Abstract

          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.

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          Most cited references56

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          World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

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            The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

            Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies
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              Surviving Sepsis Campaign : International Guidelines for Management of Sepsis and Septic Shock 2021

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                Author and article information

                Contributors
                gary.bass@pennmedicine.upenn.edu
                mohsenishahin@yahoo.com
                Journal
                Eur J Trauma Emerg Surg
                Eur J Trauma Emerg Surg
                European Journal of Trauma and Emergency Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1863-9933
                1863-9941
                31 January 2023
                31 January 2023
                : 1-12
                Affiliations
                [1 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Division of Traumatology, Surgical Critical Care & Emergency Surgery, , Perelman School of Medicine at the University of Pennsylvania, ; Philadelphia, USA
                [2 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, Division of Trauma & Emergency Surgery, Orebro University Hospital and School of Medical Sciences, , Orebro University, ; Örebro, Sweden
                [3 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Center for Perioperative Outcomes Research and Transformation (CPORT), , University of Pennsylvania, ; Philadelphia, USA
                [4 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Leonard Davis Institute of Health Economics (LDI), , University of Pennsylvania, ; Philadelphia, USA
                [5 ]GRID grid.413305.0, ISNI 0000 0004 0617 5936, Tallaght University Hospital, ; Dublin, Ireland
                [6 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Helsinki University Hospital HUS Meilahden Tornisairaala, ; Helsinki, Finland
                [7 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, , Orebro University, ; Orebro, Sweden
                [8 ]GRID grid.410355.6, ISNI 0000 0004 0420 350X, Corporal Michael Crescenz Veterans Affairs Medical Center, ; Philadelphia, USA
                Author information
                http://orcid.org/0000-0001-7097-487X
                Article
                2208
                10.1007/s00068-022-02208-2
                9888346
                36719428
                cb5b6793-679a-40b3-80e0-0025b9723e7e
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 2 December 2022
                : 20 December 2022
                Funding
                Funded by: Örebro University
                Categories
                Original Article

                Emergency medicine & Trauma
                acute appendicitis,observational cohort,appendectomy,guidelines
                Emergency medicine & Trauma
                acute appendicitis, observational cohort, appendectomy, guidelines

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