Evidence map›Paper›PMID 38883576›Full record

ArticleSurgery open science2024

Interhospital variation in the non-operative management of uncomplicated appendicitis in adults.

Baran Khoraminejad, Sara Sakowitz, Giselle Porter, Nikhil Chervu, Konmal Ali, Saad Mallick, Syed Shahyan Bakhtiyar, Peyman Benharash

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgery open science, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Baran KhoraminejadCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Sara SakowitzCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Giselle PorterCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Nikhil ChervuCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Konmal AliCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Saad MallickCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Syed Shahyan BakhtiyarCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.
Peyman BenharashCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis. Methods: The 2016-2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH). Results: Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission. Conclusions: We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.

Indexed as

AppendectomyAppendicitisInterhospital variationNon-operative managementQuality of care

Identifiers

PMID38883576
PMCPMC11180347

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.