Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study.

Jie WU; Xinjian XU; Hao XU; Gang MA; Chi MA; Xiaocheng Zhu; Zeqiang Ren; Xudong WU; Xudong WU; Yingjie Chen; Yanhong Weng; Liping HU; Fei Chen; Yonggan Jiang; Hongbin Liu; Ming Wang; Zhenhua Yang; Xiong YU; Liang LI; Xinzeng Zhang; Zhigang Yao; Wei LI; Jianjun Miao; Liguang Yang; Hui Cao; Fan Chen; Jianjun WU; Shichen Wang; Dongzhu Zeng; Jun Zhang; Yongqing HE; Jianliang Cao; Wenxing Zhou; Zhilong Jiang; Dongming Zhang; Jianwei Zhu; Wenming Yue; Yongxi Zhang; Junling Hou; Fei Zhong; Junwei Wang; Chang Cai; Hongyan LI; Weishun Liao; Haiyang Zhang; Getu Zhaori; Qinjie Liu; Zhiwei Wang; Canwen Chen; Jianan Ren

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Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study.

Author: Jie WU ¹ ; Xinjian XU ² ; Hao XU ³ ; Gang MA ⁴ ; Chi MA ⁵ ; Xiaocheng ZHU ⁶ ; Zeqiang REN ⁶ ; Xudong WU ⁷ ; Xudong WU ⁷ ; Yingjie CHEN ⁸ ; Yanhong WENG ⁹ ; Liping HU ¹⁰ ; Fei CHEN ¹⁰ ; Yonggan JIANG ¹¹ ; Hongbin LIU ¹² ; Ming WANG ¹³ ; Zhenhua YANG ¹⁴ ; Xiong YU ¹⁵ ; Liang LI ¹⁶ ; Xinzeng ZHANG ¹⁷ ; Zhigang YAO ¹⁸ ; Wei LI ¹⁹ ; Jianjun MIAO ²⁰ ; Liguang YANG ²¹ ; Hui CAO ²² ; Fan CHEN ²³ ; Jianjun WU ²⁴ ; Shichen WANG ²⁵ ; Dongzhu ZENG ²⁶ ; Jun ZHANG ²⁷ ; Yongqing HE ²⁸ ; Jianliang CAO ²⁹ ; Wenxing ZHOU ³⁰ ; Zhilong JIANG ³¹ ; Dongming ZHANG ³² ; Jianwei ZHU ³³ ; Wenming YUE ³⁴ ; Yongxi ZHANG ³⁵ ; Junling HOU ³⁶ ; Fei ZHONG ³⁷ ; Junwei WANG ³⁸ ; Chang CAI ³⁹ ; Hongyan LI ⁴⁰ ; Weishun LIAO ⁴¹ ; Haiyang ZHANG ⁴² ; Getu ZHAORI ⁴³ ; Qinjie LIU ¹ ; Zhiwei WANG ¹ ; Canwen CHEN ¹ ; Jianan REN ⁴⁴
Author Information

1. Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, Jiangsu Nanjing 210002, China.
2. Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Urumuqi 830054,China.
3. Department of General Surgery, Lu'an People's Hospital, Anhui Lu'an 237005, China.
4. Department of Gastrointestinal Surgery, Tengzhou Central People's Hospital, Shandong Tengzhou 277500,China.
5. Department of General Surgery, Dalian Central Hospital, Liaoning Dalian 116033,China.
6. Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu Xuzhou 221002, China.
7. Department of General Surgery, Dongying People's Hospital, Shandong Dongying 257091, China.
8. Department of Critical Care Medcine, Jinjiang Hospital of Traditional Chinese Medicine, Fujian Jinjiang 362200, China.
9. Department of General Surgery, Huangshan Shoukang Hospital, Anhui Huangshan 245000, China.
10. Department of General Surgery, Xuyi People's Hospital, Jiangsu Xuyi 211700, China.
11. Department of General Surgery, Jiangbei People's Hospital, Jiangsu Nanjing 210048, China.
12. Department of General Surgery, The 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Gansu Lanzhou 730050, China.
13. Department of Gastrointestinal Surgery, Heze Municipal Hospital, Shandong Heze 274031, China.
14. Department of General Surgery, The First College of Clinical Medical Science, China Three Gorges University, Hubei Yichang 443003, China.
15. Department of General Surgery, the Affiliated Jiujiang Hospital of Nanchang University, Jiangxi Jiujiang 332000, China.
16. Department of General Surgery, The Second People's Hospital of Hefei, Anhui Hefei 230011, China.
17. Department of General Surgery, Affiliated Shandong Energy Zaozhuang Mining Group Central Hospital, Shandong Zaozhuang 277011, China.
18. Department of General Surgery, The Third People's Hospital of Kunshan City, Jiangsu Kunshan 215316, China.
19. Department of General Surgery, Xuzhou First People's Hospital, Jiangsu Xuzhou 221002, China.
20. Department of General Surgery, The 81st Group Army Hospital of the Chinese People's Liberation Army, Hebei Zhangjiakou 075000, China.
21. Department of General Surgery, Linyi Central Hospital, Shandong Linyi 276400, China.
22. Department of General Surgery, The General Hospital of Huainan Eastern Hospital Group, Anhui Huainan 232001, China.
23. Department of General Surgery, The 908th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Jiangxi Nanchang 330002, China.
24. Department of General Surgery, Liyang People's Hospital, Jiangsu Liyang 213300, China.
25. Department of General Surgery, The 901th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Anhui Hefei 230031, China.
26. Department of General Surgery, The Digestive Disease Center of The Third Hospital Affiliated to Chongqing Medical University, Chongqing 401120, China.
27. Department of General Surgery, The Fourth Hospital of Jilin University, Jilin Changchun 130011, China.
28. Department of General Surgery, Acheng People's Hospital, Heilongjiang Harbin 150300, China.
29. Department of Critical Care Medcine, the First Affiliated Hospital of Zhengzhou University, Henan Zhengzhou 450052, China.
30. Department of General Surgery, Nanjing Luhe People's Hospital, Jiangsu Nanjing 211500, China.
31. Department of General Surgery, Taixing Municipal People's Hospital, Jiangsu Taixing 225400, China.
32. Department of General Surgery, Baotou Central Hospital, Inner Mongolia Baotou 014040, China.
33. Department of Gastrointestinal Surgery, The Affiliated Hospital Nantong University, Jiangsu Nantong 226001, China.
34. Department of General Surgery, Linyi People's Hospital, Shandong Linyi 276003, China.
35. Department of General Surgery, The 72st Group Army Hospital of the Chinese People's Liberation Army, Zhejiang Hangzhou 313000,China.
36. Department of Gastrointestinal Surgery, Zaozhuang Municipal Hospital, Shandong Zaozhuang 277101, China.
37. Department of General Surgery, People's Hospital of Dayu County, Jiangxi Ganzhou 341500, China.
38. Department of General Surgery, Taixing City Hospital of Traditional Chinese Medicine, Jiangsu Taixing 225400, China.
39. Department of General Surgery, Suzhou Municipal Hospital, Anhui Suzhou 234000, China.
40. Department of General Surgery, Guang'anmen Hospital, Beijing 100053, China.
41. Department of General Surgery, Langxi County Hospital of Traditional Chinese Medicine, Anhui Langxi 242100, China.
42. Department of General Surgery, Nanyang Central Hospital, Henan Nanyang 473009, China.
43. Department of Abdominal Surgery, People's Hospital Affiliated to Inner Mongolia Medical University, Inner Mongolia Hohhot 010017, China.
44. Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, Jiangsu Nanjing 210002, China.Email:JiananR@gmail.com.
Publication Type:Journal Article
MeSH: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; therapeutic use; Appendectomy; Appendicitis; diagnosis; therapy; China; Female; Health Care Surveys; Humans; Laparoscopy; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult
From: Chinese Journal of Gastrointestinal Surgery 2019;22(1):49-58
CountryChina
Language:Chinese
Abstract: OBJECTIVE:To analyze the current status of diagnosis and management of acute appendicitis (AA) in China.
METHODS:Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary.
RESULTS:A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001).
CONCLUSIONS:The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.