Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study.

Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.

Impact of the COVID-19 pandemic on delays in surgical procedures in Germany: a multi-center analysis of an administrative registry of 176,783 patients.

BACKGROUND: While extensive data are available on the postponement of elective surgical procedures due to the COVID-19 pandemic for Germany, data on the impact on emergency procedures is limited. METHODS: In this retrospective case-control study, anonymized case-related routine data of a Germany-wide voluntary hospital association (CLINOTEL association) of 66 hospitals was analyzed. Operation volumes, in-hospital mortality, and COVID-19 prevalence rates in digestive surgery procedure groups and selected single surgical procedures in the one-year periods before and after the outbreak of the COVID-19 pandemic were analyzed. The analysis was stratified by admitting department (direct admission or transfer to the general surgical department, i.e., primary or secondary surgical patients) and type of admission (elective/emergent). RESULTS: The total number of primary and secondary surgical patients decreased by 22.7% and 11.7%, respectively. Among primary surgical patients more pronounced reductions were observed in elective (-25.6%) than emergency cases (-18.8%). Most affected procedures were thyroidectomies (-30.2%), operations on the anus (-24.2%), and closure of abdominal hernias (-23.9%; all P's < 0.001). Declines were also observed in colorectal (-9.0%, P = 0.002), but not in rectal cancer surgery (-3.9%, n.s.). Mortality was slightly increased in primary (1.3 vs. 1.5%, P < 0.001), but not in secondary surgical cases. The one-year prevalence of COVID-19 in general surgical patients was low (0.6%), but a significant driver of mortality (OR = 9.63, P < 0.001). CONCLUSIONS: Compared to the previous year period, the number of patients in general and visceral surgery decreased by 22.7% in the first pandemic year. At the procedure level, a decrease of 14.8% was observed for elective procedures and 6.0% for emergency procedures. COVID-19 infections in general surgical patients are rare (0.6% prevalence), but associated with high mortality (21.8%). TRIAL REGISTRATION: The present study does not meet the ICMJE definition of a clinical trial and was therefore not registered.

Surgical management of uterine fibroids in Hesse, Germany, between 1998 and 2004.

OBJECTIVE: To identify and evaluate surgical management of women with uterine fibroids. DESIGN: Retrospective analysis of mandatory surgical data sent to the Institute for Quality Assurance. SETTING: Data collection from 1998 to 2004 in Hesse, Germany. PATIENT(S): 34,814 women who underwent surgery for uterine fibroids. INTERVENTION(S): Patients were treated with either myomectomy or hysterectomy. MAIN OUTCOME MEASURE(S): Statistical analysis of mandatory surgical parameters. RESULT(S): Altogether, 4975 (14.3%) women had myomectomies, and 29,839 (85.7%) had hysterectomies. Age was an important determinant of surgical procedure; hysterectomy was preferred for patients over 40 (odds ratio 4.3; 95% confidence interval: 4.1-4.5). Laparoscopic myomectomy rates increased from 25.9% in 1998 to 41.9% in 2004; during the same period, the proportion of conversion procedures and abdominal approaches fell from 15.6% to 2.9% and 38.9% to 30.9%, respectively. Intraoperative complication rates were similar for myomectomy (1.1%) and hysterectomy (1.0%), but postoperative complication rates were higher for hysterectomy (5.8%) than myomectomy (3.2%). CONCLUSION(S): The increasing use of endoscopic procedures was an important feature in this series and appeared to be safe. The reduction of conversion rates and intraoperative complications might be related to improvements in surgical skill. Acceptance of the benefits of endoscopic approaches seems to have promoted its steady growth as a primary surgical approach.

Centralizing surgery for gynecologic oncology--a strategy assuring better quality treatment?

OBJECTIVE: The objective of this study was to assess the association between the type of hospital and the previously reported shortcomings in surgical treatment for ovarian and endometrial carcinomas in Hesse, Germany. METHODS: The types of hospitals)primary, secondary, tertiary and central care referral or university clinic) at which patients with endometrial and ovarian cancer were treated were correlates with the following variables: patients' functional status, tumor stage (FIGO), the performance of lymphadenectomy and/or omentectomy, and the frequency of intraoperative and postoperative complications. Data came from the GQH project, which assessed all diagnostic, surgical, and postoperative gynecologic procedures undertaken in Hesse between 1997 and 2001. RESULTS: In 1119 cases of endometrial cancer significantly fewer (P < 0.001) lymphadenectomies were performed in primary care hospitals despite the fact that patients treated in primary care hospitals were younger and had a better functional status and lower tumor stage than patients treated in other types of hospitals. In ovarian cancer too, lymphadenectomy rates varied considerably with the type of hospital (P = 0.010) even when the analyses were restricted to patients whose functional status was good (ASA

Shortcomings and deficits in surgical treatment of gynecological cancers: a German problem only?

OBJECTIVES: The objective of this study was to assess the quality of preoperative diagnostic, primary surgical, and postoperative treatment of ovarian, endometrial, and cervical cancers in women in Hesse, Germany, in relation to current international recommendations. METHODS: Data on all diagnostic, surgical, and postoperative gynecological procedures undertaken in Hesse in 1997-2001 were collected in a standardized form and validated for clinical quality. Databases were generated for cases of endometrial, ovarian, and cervical cancer, and details of treatment were analyzed. RESULTS: There were 1119 cases of endometrial, 824 cases of ovarian, and 472 cases of cervical cancer. The malignancy remained undiagnosed until after surgery in 17.8% (199/1119) of endometrial cancers, 28.5% (245/824) of ovarian cancers, and 15.5% (73/472) of cervical cancers. There was evidence of suboptimal surgical treatment. Lymphadenectomy rates were low in endometrial and ovarian cancers (about 32%), and omentectomy rates in were low in ovarian cancer (about 50%). Furthermore, 10.7% (31/289) of patients with cervical cancer diagnosed before hospital admission did not undergo radical surgery. CONCLUSION: Discrepancies between guidelines and treatment of gynecological cancers in Hesse were striking, particularly for endometrial and ovarian cancer, and this situation may be mirrored internationally. The fact that many guidelines are not supported by results from clinical studies may be a factor in this apparently suboptimal treatment. Clinical collaborative trials are needed to provide the necessary evidence to support current recommendations and benchmarks of survey are required to facilitate future quality assessment.