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Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England
INTRODUCTION: The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections and liver decompensation. This population-based cohort study aimed to determine the 90-day m...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505594/ https://www.ncbi.nlm.nih.gov/pubmed/37718378 http://dx.doi.org/10.1007/s00423-023-03072-3 |
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author | Adiamah, Alfred Rashid, Adil Crooks, Colin J. Hammond, John S. Jepsen, Peter West, Joe Humes, David J. |
author_facet | Adiamah, Alfred Rashid, Adil Crooks, Colin J. Hammond, John S. Jepsen, Peter West, Joe Humes, David J. |
author_sort | Adiamah, Alfred |
collection | PubMed |
description | INTRODUCTION: The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis. METHODS: Adult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink and hospital episode statistics data. Length of stay, re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression. RESULTS: A total of 40,353 patients underwent appendicectomy and of these 75 (0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p < 0.0001) and have comorbidities (p < 0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90 days (20% vs 11%, p = 0.019). Most importantly, their odds of death at 90 days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49). CONCLUSION: Patients with cirrhosis have a threefold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-023-03072-3. |
format | Online Article Text |
id | pubmed-10505594 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-105055942023-09-19 Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England Adiamah, Alfred Rashid, Adil Crooks, Colin J. Hammond, John S. Jepsen, Peter West, Joe Humes, David J. Langenbecks Arch Surg Research INTRODUCTION: The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis. METHODS: Adult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink and hospital episode statistics data. Length of stay, re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression. RESULTS: A total of 40,353 patients underwent appendicectomy and of these 75 (0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p < 0.0001) and have comorbidities (p < 0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90 days (20% vs 11%, p = 0.019). Most importantly, their odds of death at 90 days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49). CONCLUSION: Patients with cirrhosis have a threefold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-023-03072-3. Springer Berlin Heidelberg 2023-09-18 2023 /pmc/articles/PMC10505594/ /pubmed/37718378 http://dx.doi.org/10.1007/s00423-023-03072-3 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This 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/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Research Adiamah, Alfred Rashid, Adil Crooks, Colin J. Hammond, John S. Jepsen, Peter West, Joe Humes, David J. Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England |
title | Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England |
title_full | Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England |
title_fullStr | Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England |
title_full_unstemmed | Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England |
title_short | Outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England |
title_sort | outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from england |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505594/ https://www.ncbi.nlm.nih.gov/pubmed/37718378 http://dx.doi.org/10.1007/s00423-023-03072-3 |
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