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PubMed · 8322345

[Prospective comparative studies as tools for quality assurance. Important when laparoscopic techniques are introduced].

T Buanes·H E Høgevold·M G Raeder
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Abstract

During the first two years of laparoscopic surgery altogether 200 cholecystectomy and 40 appendectomy patients were included in prospective, comparative studies. The stay in hospital averaged two days after laparoscopic versus seven days after open cholecystectomy. Days away from work postoperatively averaged nine days after laparoscopic, versus 28 days after open cholecystectomy. After appendectomy, the stay in hospital was reduced from three to one day and absence from work from 14 days in the open surgery group to seven days in the laparoscopic group. Clear advantages have thus been documented in the groups with mini-invasive treatment, since only 5% experienced postoperative complications after laparoscopic treatment, as against 11% after open cholecystectomy (p < 0.02).

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AppendectomyCholecystectomy, LaparoscopicHumansLaparoscopyLength of StayPostoperative ComplicationsProspective StudiesQuality Assurance, Health CareComparative StudyEnglish AbstractJournal Article

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T Buanes, H E Høgevold, M G Raeder. 1993-06-20. [Prospective comparative studies as tools for quality assurance. Important when laparoscopic techniques are introduced].. https://pubmed.ncbi.nlm.nih.gov/8322345/

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PubMed2007

The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis.

BACKGROUND: The principle of early exploration on wide indications in order to prevent perforation has been the guiding star for the management of patients with suspected appendicitis for over 100 years, dating back to a time when appendicitis was a significant cause of mortality. Since then there has been a dramatic decrease in mortality due to appendicitis. Emerging evidence calls for a new understanding of the natural history of untreated appendicitis. This motivates a reappraisal of the fundamental principles for the management of patients with suspected appendicitis. METHODS: Analysis of epidemiologic and clinical studies that elucidate the natural history of appendicitis, i.e. the possibility of spontaneous resolution or the risk of progression to perforation, the determinants of the proportion of perforations and mortality, and the consequence of in-hospital delay. RESULTS: The results presented in a number of studies suggest that spontaneous resolution of appendicitis is common, that perforation can seldom be prevented, that the risk of perforation has been exaggerated and that in-hospital delay is safe. An alternative understanding of the inverse relationship between the proportion of negative explorations and perforation and the increasing proportion of perforation with length of time is presented, mainly explaining these findings by selection due to spontaneous resolution. CONCLUSION: Evidence suggests that spontaneous resolution of untreated, non-perforated appendicitis is common and that perforation can rarely be prevented and is associated with a lower increase in mortality than was previously thought. This motivates a shift in focus from the prevention of perforation to the early detection and treatment of advanced appendicitis. In order to minimize mortality, morbidity and costs avoidance of negative appendectomies is more important then preventing perforation. In patients with an equivocal diagnosis where advanced appendicitis is deemed less likely a correct diagnosis is more important than a rapid diagnosis. These patients can safely be managed by active observation with an improved diagnostic work-up under observation, which has consistently shown a low proportion of negative appendectomies without an increase in the proportion of perforations or morbidity. A high proportion of perforations can be explained by selection due to undiagnosed resolving appendicitis. The proportion of perforation is therefore a questionable measure of the quality of the management of patients with suspected appendicitis and should be used with caution.

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