# Non-perforated Appendicitis — GCMD Library living collection

Everything in the library about non-perforated appendicitis — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 41 cited statements

## Episodes
### Surgical Management
- [Perforated Appendicitis](https://library.globalcastmd.com/watch/perforated-appendicitis-2312) — video · 18:22 · [machine version](https://library.globalcastmd.com/watch/perforated-appendicitis-2312.md)

### Evidence & Research
- [Appendicitis Management & APPY Trial: Update Course 2016](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549) — video · 31:55 · [machine version](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549.md)
- [Quick Literature Updates Ep 26](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413) — video · 4:40 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413.md)

### In-Depth Reviews
- [Journal Club: Appendicitis in 2021](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416) — podcast · 15:06 · [machine version](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=0) APPY Trial Design and Background (Ep 1)
- [9:14](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=554) Protocol Details and Early Results (Ep 1)
- [20:45](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1245) Discussion: Antibiotic Stewardship, Fecoliths, and Clinical Applications (Ep 1)
- [0:01](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=1) CT scan accuracy in diagnosing perforated appendicitis (Ep 2)
- [2:28](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=148) Intraoperative assessment variability and standardized perforation definition (Ep 2)
- [10:31](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=631) Irrigation versus suction alone in perforated appendicitis (Ep 2)
- [0:05](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=5) Case presentation and initial assessment (Ep 3)
- [2:53](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=173) Clinical prediction models for appendicitis (Ep 3)
- [4:43](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=283) Standardized ultrasound reporting (Ep 3)
- [6:33](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=393) Non-operative versus surgical management (Ep 3)
- [7:29](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=449) Preoperative antibiotic selection (Ep 3)
- [8:24](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=504) Defining complicated appendicitis (Ep 3)
- [10:33](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=633) Postoperative antibiotics for simple appendicitis (Ep 3)
- [12:05](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=725) Opioid-free discharge protocols (Ep 3)
- [0:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=16) Appendicectomy versus Antibiotics for Acute Uncomplicated Appendicitis in Children (Ep 4)
- [1:51](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=111) VACTERL Screening in Newborns with Anorectal Malformations (Ep 4)
- [3:01](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=181) International Consensus Criteria for Pediatric Sepsis and Septic Shock (Ep 4)
- [4:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=264) Closing (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Recent literature has been supporting treating appendicitis with antibiotics rather than surgery" — Lizzie Lee (host_summary) [Ep 4 · 1:07](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=67)
- "The Saint Peter et al. study was a multi-center randomized trial in Canada, the US, Finland, Sweden, and Singapore investigating whether antibiotic treatment is inferior to appendicectomy" — Lizzie Lee (host_summary) [Ep 4 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=72)
- "34% of children treated with antibiotics for appendicitis eventually required surgery within a year compared to only 7% in the surgery group" — Lizzie Lee (host_summary) [Ep 4 · 1:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=84)
- "There were no deaths in either the antibiotic or surgery group for appendicitis treatment" — Lizzie Lee (host_summary) [Ep 4 · 1:32](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=92)
- "Children in the antibiotic group had a higher risk of mild to moderate adverse events compared to the surgery group" — Lizzie Lee (host_summary) [Ep 4 · 1:32](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=92)
- "Antibiotics were not as effective as surgery for treating non-perforated appendicitis in children, as it did not meet the threshold for non-inferiority" — Lizzie Lee (host_summary) [Ep 4 · 1:39](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=99)
- "Zoo et al. used the PHIS database and performed a multi-institutional cohort study of all ARM patients between 2016 and 2022" — Alex Halpern (host_summary) [Ep 4 · 2:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=136)
- "In ARM patients, the rates of actual diagnoses across all hospital encounters were 45.4% vertebral spinal, 77.4% cardiac, 10.2% TEF, 39.9% renal and 15.7% limb" — Alex Halpern (host_summary) [Ep 4 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=145)
- "25.8% of female patients with anorectal malformations had a congenital gynecologic malformation diagnosed" — Alex Halpern (host_summary) [Ep 4 · 2:40](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=160)
- "The most common anomalies associated with ARMs are cardiac, vertebrospinal, renal, and gynecologic" — Alex Halpern (host_summary) [Ep 4 · 2:45](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=165)
- "The authors of the ARM screening study suggest changing the VACTERL acronym to VACTERL-GS" — Alex Halpern (host_summary) [Ep 4 · 2:53](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=173)
- "The Schlapbach et al. study is a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock" — Cecilia Gigena (host_summary) [Ep 4 · 3:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=200)
- "The Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function" — Cecilia Gigena (host_summary) [Ep 4 · 3:29](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=209)
- "The Phoenix sepsis score helped correlate the definition of sepsis with an actual mortality rate" — Cecilia Gigena (host_summary) [Ep 4 · 3:42](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=222)
- "The definition of sepsis is suspected infection plus 2 points in the Phoenix sepsis score" — Cecilia Gigena (host_summary) [Ep 4 · 3:48](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=228)
- "Septic shock is defined as sepsis plus cardiovascular dysfunction that is seen when there is 1 point in the cardiovascular variable of the Phoenix sepsis score" — Cecilia Gigena (host_summary) [Ep 4 · 3:48](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=228)
- "Sepsis has a mortality rate of 7.1%" — Cecilia Gigena (host_summary) [Ep 4 · 4:06](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=246)
- "Septic shock has a mortality rate of 10.8 to 33.5% according to the research settings" — Cecilia Gigena (host_summary) [Ep 4 · 4:06](https://library.globalcastmd.com/watch/quick-literature-updates-ep-26-11413?t=246)
- "The APPY trial is a multi-center randomized trial comparing appendectomy to non-operative treatment for non-perforated appendicitis." (clinical) [Ep 1 · 0:09](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=9)
- "The initial working group included Agostino Piero, Nigel Hall, Simon Eaton, Thomas Wester, and several others, with the current group joining about 2.5 years ago." (clinical) [Ep 1 · 1:20](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=80)
- "The first two rounds of funding failed, requiring modifications to sample size calculation and study design to make it more pragmatic." (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=120)
- "Appendicitis can be treated without surgery, as demonstrated by experience with complicated appendicitis where patients are treated to completion regardless of perforation severity." (clinical) [Ep 1 · 3:20](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=200)
- "Bob Parry developed appendicitis in Ireland, was treated with antibiotics, and went a full year before having a recurrent bout requiring appendectomy." (clinical) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=240)
- "In adult studies reviewing approximately 300 patients managed non-operatively versus 500 managed operatively, treatment failure trended toward favoring surgical approach, but complications favored non-operative management." (host_summary) [Ep 1 · 5:50](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=350)
- "Adult estimates of non-operative management success revolve around 80%, which was integral in developing the sample size for the randomized trial." (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=420)
- "Thomas Wester's pilot randomized trial in Sweden enrolled 50 patients, with 24 receiving antibiotics. 22 of 24 (92%) had initial resolution of symptoms, and one patient had recurrent appendicitis." (host_summary) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=480)
- "In the preference trial, any appendix that has to come out—even if due to parental preference after symptom resolution—must be considered a treatment failure because that reflects real-world practice." (clinical) [Ep 1 · 8:50](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=530)
- "In the preference trial, parents of sicker-appearing children are less likely to choose non-operative management, even if objective measures like white count are similar." (clinical) [Ep 1 · 10:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=600)
- "At 77 patients in the preference trial, 30 chose non-operative treatment (about one-third), with 90% success at 30 days and fewer disability days, earlier return to school, and improved quality of life versus surgery." (host_summary) [Ep 1 · 10:50](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=650)
- "Patients who respond to antibiotics are literally normal the next day, going to school on Wednesday after discharge on Tuesday, whereas laparoscopic appendectomy patients restrict themselves for several days despite no formal restrictions." (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=700)
- "The APPY trial is designed as a non-inferiority study because non-operative management cannot possibly be superior to appendectomy, which has a 100% cure rate." (clinical) [Ep 1 · 13:20](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=800)
- "The trial includes patients aged 5 to 16 with suspected non-perforated appendicitis, excluding those under 5 because they frequently have perforation regardless of presentation." (clinical) [Ep 1 · 14:10](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=850)
- "The trial uses broad inclusion criteria without requiring specific Alvarado scores, PAS scores, or imaging findings, allowing surgeons to use their standard diagnostic approach for non-perforated appendicitis." (clinical) [Ep 1 · 15:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=900)
- "Exclusion criteria include suspicion of perforation, more than two doses of antibiotics initiated at an outside facility, previous episode of appendicitis treated non-operatively, and systemic disease." (clinical) [Ep 1 · 15:50](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=950)
- "The trial uses central randomization with minimization based on sex, center, and duration of symptoms to maintain balance across these factors." (clinical) [Ep 1 · 16:40](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1000)
- "The protocol was modified to allow patients to go home the next day if doing well, rather than requiring 24-48 hour evaluations at fixed time points, because the original schedule was impractical for overnight enrollments." (clinical) [Ep 1 · 17:30](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1050)
- "If patients are not better after initial therapy, they are given another day, but after 48 hours of IV therapy (by Wednesday morning), it is time to proceed with appendectomy because 3 days in the hospital is too much when the alternative is going home Monday." (clinical) [Ep 1 · 18:20](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1100)
- "The primary outcome is treatment failure defined as an intervention for appendicitis requiring general anesthesia within 1 year in both groups, which essentially compares negative appendectomy versus recurrent appendicitis." (clinical) [Ep 1 · 19:10](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1150)
- "The non-inferiority margin is 20% because polling showed most people consider failure rates in the twenties too high for non-operative management." (opinion) [Ep 1 · 20:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1200)
- "The actual failure rate percentage is what matters to parents when counseling, not whether the trial concludes non-inferiority—some parents will accept 26% failure to avoid surgery while others won't accept 2%." (opinion) [Ep 1 · 20:45](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1245)
- "As of the presentation, 52 patients have been enrolled: Stockholm 25, Helsinki 7, with Vancouver, Ontario, and Calgary recently receiving IRB approval." (clinical) [Ep 1 · 21:40](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1300)
- "Early results show in the operative group: 4 perforations and 2 negative appendectomies. In the non-operative group: 1 readmitted for abscess, 3 failed early (didn't leave hospital), 4 failed after discharge (within 2-5 days), and 1 recurrence at 6 months." (epidemiological) [Ep 1 · 22:25](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1345)
- "All recurrences and failures in the non-operative group have had confirmed appendicitis; no normal appendix has been removed yet." (clinical) [Ep 1 · 23:20](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1400)
- "The two negative appendectomies in the operative group had imaging showing secondary signs like fluid but not visualizing the appendix." (clinical) [Ep 1 · 20:45](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1245)
- "Of the 3 early failures in the non-operative group, 2 were due to parental impatience on the morning after enrollment, not giving the treatment a real chance." (clinical) [Ep 1 · 21:20](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1280)
- "The reason for limiting antibiotics is that Augmentin is given daily in pediatric offices to thousands of children with sniffles who don't need it, whereas the APPY trial treats an active intra-abdominal bacterial infection." (opinion) [Ep 1 · 23:00](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1380)
- "All perforated appendicitis cases are treated with antibiotics, and if complications develop, long-term antibiotics are used until resolution, so treating intra-abdominal infection is different from unnecessary antibiotic use." (clinical) [Ep 1 · 23:50](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1430)
- "The value of the study is knowing the exact failure rates and outcomes to counsel patients who might want to avoid surgery or are in circumstances where surgery isn't immediately feasible, even if non-operative management proves inferior." (opinion) [Ep 1 · 25:07](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1507)
- "No adult literature has examined long-term outcomes beyond one year for non-operative management of appendicitis." (epidemiological) [Ep 1 · 25:07](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1507)
- "The trial plans to follow the cohort in perpetuity with annual telephone follow-up to determine recurrence rates at 5 years, 10 years, and beyond." (clinical) [Ep 1 · 25:40](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1540)
- "Perforation is defined as a hole in the appendix or a fecolith in the abdomen—irrefutable proof of contamination—and is only an intraoperative diagnosis, not a preoperative one." (clinical) [Ep 1 · 27:25](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1645)
- "The presence of a fecolith is an exclusion criterion in the Midwest Pediatric Surgery Consortium preference trial but not in the APPY trial." (clinical) [Ep 1 · 28:10](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1690)
- "At Nationwide, a separate small population with appendicoliths was allowed enrollment, but that arm was stopped based on the failure rate." — Todd Ponsky (clinical) [Ep 1 · 29:02](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1742)
- "In a cohort of patients with post-appendectomy abscesses, outcomes were relatively equivalent between drain and no drain, but the biggest abscesses and worst patients received drains." — Todd Ponsky (epidemiological) [Ep 1 · 29:56](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1796)
- "After size-matching to 17.5 cm² (AP versus lateral in axial dimension), there was an advantage to not having a drain." — Todd Ponsky (epidemiological) [Ep 1 · 30:40](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1840)
- "For abscesses less than 20 cm² (less than 4 x 5 cm), drains are typically discouraged because the advantage is small and drains add an extra anesthetic, procedure, and may increase length of stay." — Todd Ponsky (clinical) [Ep 1 · 31:10](https://library.globalcastmd.com/watch/appendicitis-management-appy-trial-update-course-2016-549?t=1870)
- "In a 2010 study from Journal of Pediatric Surgery, 200 CT scans were reviewed by 6 surgeons (including 2 fellows) and 2 radiologists who were blinded to diagnosis, and reviewers correctly identified perforated versus non-perforated appendicitis in 72% of scans that had no abscesses." (host_summary) [Ep 2 · 0:01](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=1)
- "Cases with abscesses were excluded from the CT scan accuracy study." (host_summary) [Ep 2 · 2:28](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=148)
- "In Doctor Ponsky's 2009 study on inter-observer variation in assessment of appendiceal perforation, 110 surgeons (62 attendings and 48 fellows) from university, community, and children's hospitals reviewed images, and agreement among attendings in defining perforation was 27%." (host_summary) [Ep 2 · 2:38](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=158)
- "Inter-observer and intra-observer variability in identifying perforated appendicitis from images was close to chance alone; when one image was turned upside down and flipped, surgeons did not agree with their own previous assessment." (host_summary) [Ep 2 · 5:40](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=340)
- "At the speaker's hospital, perforated appendicitis is defined as a visible hole in the appendix or a fecalith in the abdomen; if neither is seen, it is not classified as perforated." (clinical) [Ep 2 · 7:00](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=420)
- "Doctor Saint Peter developed the standardized perforation definition (hole or fecalith) for a prospective trial in the early 2000s, and it is still used at the speaker's institution." (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=480)
- "When patients with stool in the abdomen or a hole in the appendix were grouped together as perforated, those without either finding had an abscess incidence of less than 5%." — Todd Ponsky (host_summary) [Ep 2 · 8:30](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=510)
- "In the two years before applying the standardized perforation definition, 292 non-perforated appendicitis cases had a 1.7% abscess rate and 131 perforated cases had a 14% abscess rate." (host_summary) [Ep 2 · 9:20](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=560)
- "After applying the standardized definition for two years, the abscess rate dropped to 0.7% for non-perforated appendicitis and rose to 18% for perforated appendicitis, indicating that some perforated cases had been misclassified as non-perforated before the definition was used." (host_summary) [Ep 2 · 9:50](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=590)
- "Doctor Saint Peter's prospective randomized study compared irrigation and suction versus suction alone during laparoscopic appendectomy for perforated appendicitis, with 110 patients in each arm and a minimum of 500cc irrigation (average 850cc) in the irrigation group." (host_summary) [Ep 2 · 10:31](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=631)
- "The irrigation study found no difference between groups in abscess rate, length of hospitalization, hospital charges, or operative time, concluding there was no advantage to irrigation during laparoscopic appendectomy for perforated appendicitis." (host_summary) [Ep 2 · 11:40](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=700)
- "The 18-19% abscess rates in both arms of the irrigation study are higher than some other studies because a standardized definition of perforation was used, ensuring only true perforated cases were included." (opinion) [Ep 2 · 10:47](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=647)
- "A 2017 University of Minnesota retrospective study (432 patients over 10 years, 105 perforated) compared standardized large-volume irrigation (3-12 liters in small focused aliquots) by one surgeon to surgeon preference for irrigation by others, finding 0% abscess rate with standardized irrigation versus 19% with surgeon preference." (host_summary) [Ep 2 · 11:27](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=687)
- "The Minnesota irrigation study had methodological problems: it was retrospective, had no definition of perforation, had no standard antibiotic usage over the 10-year period, and included only about 10 perforated cases per year." (opinion) [Ep 2 · 12:30](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=750)
- "A 2018 meta-analysis of irrigation versus suction alone for laparoscopic appendectomy included 3 randomized trials and 2 retrospective studies with 2500 patients (4/5 adults) and found no difference in abscess development, wound infection, or length of hospitalization." (host_summary) [Ep 2 · 14:20](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=860)
- "In the Minnesota study showing benefit from irrigation, the surgeon used a focused push-suck technique with small volumes (100cc at a time) rather than irrigating the whole abdomen." (host_summary) [Ep 2 · 16:34](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=994)
- "In studies using the standardized perforation definition, the presence of exudate everywhere (without a visible hole or stool) did not correlate with increased abscess risk." (host_summary) [Ep 2 · 17:03](https://library.globalcastmd.com/watch/perforated-appendicitis-2312?t=1023)
- "The RIFT study prospectively evaluated 15 different clinical prediction models in children with right iliac fossa pain by calculating area under the curve and failure rates." — Jose Campos (host_summary) [Ep 3 · 3:39](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=219)
- "The Shira score had an area under the curve of 0.84 and a failure rate of 3%, making it the best performing model for ruling out appendicitis." — Rod Gerardo (host_summary) [Ep 3 · 4:11](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=251)
- "A standardized ultrasound reporting template reduced equivocal reports from 27% to 9%." — Jose Campos (host_summary) [Ep 3 · 4:56](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=296)
- "The standardized ultrasound reporting reduced CT use from 19% to 9% without affecting negative laparotomy rates." — Jose Campos (host_summary) [Ep 3 · 4:56](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=296)
- "In a pilot RCT of non-perforated appendicitis, surgical failure rate was 0% versus 45% medical failure rate, with failure defined as requiring laparoscopic appendectomy during follow-up." — Jose Campos (host_summary) [Ep 3 · 6:37](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=397)
- "The non-operative versus appendectomy study randomized 26 patients to surgery and 24 to antibiotics." — Jose Campos (host_summary) [Ep 3 · 6:37](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=397)
- "Ceftriaxone plus metronidazole showed a 90% reduction in surgical site infection compared to cefoxitin for non-complicated appendicitis in a large NSQIP-based retrospective cohort study published in Annals of Surgery in 2020." — Jose Campos (host_summary) [Ep 3 · 7:35](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=455)
- "Dr. Sean Saint Peter and Whitt Holcomb defined perforated appendicitis in 2005 as a hole in the appendix or fecal material in the abdomen." — Jose Campos (host_summary) [Ep 3 · 8:24](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=504)
- "Four intraoperative findings correlate with complicated postoperative course for appendicitis: visible hole, abscess, fecal material, and diffuse fibrinopurulent exudate outside the right iliac fossa or pelvis." — Rod Gerardo (host_summary) [Ep 3 · 9:13](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=553)
- "These four intraoperative findings were associated with higher adverse effects, higher length of stay, higher emergency visits, and higher use of hospital and patient resources after adjusting for all variables." — Todd Ponsky (host_summary) [Ep 3 · 9:56](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=596)
- "Pus in the abdomen is a predictor of abscess in the recent study, which differs from Sean Saint Peter's study where it was not a predictor." — Rod Gerardo (host_summary) [Ep 3 · 10:07](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=607)
- "A double-blind RCT of 243 patients randomized to two doses of postoperative antibiotics versus placebo found a significant reduction in skin infection rate from 6.6% to 0.8% for simple appendicitis." — Jose Campos (host_summary) [Ep 3 · 10:33](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=633)
- "A 6% baseline infection rate for simple appendicitis seems too high." — Rod Gerardo (opinion) [Ep 3 · 11:08](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=668)
- "The postoperative antibiotic study did not examine postoperative abscess rates, which is the primary concern after uncomplicated appendectomy rather than surgical site infections." — Todd Ponsky (opinion) [Ep 3 · 11:20](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=680)
- "A pre-post intervention study completely eliminated opioid prescriptions after non-perforated appendectomy and found no increase in self-reported pain or extra medication use via phone interviews and surgical follow-up." — Jose Campos (host_summary) [Ep 3 · 12:05](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=725)
- "After converting from opiates to Tylenol and/or Motrin for post-appendectomy pain, patients are fine and do not come back asking for opiates." — Rod Gerardo (opinion) [Ep 3 · 12:45](https://library.globalcastmd.com/watch/journal-club-appendicitis-in-2021-4416?t=765)

## Changelog
- Sep 17: 4 items added automatically

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