The AQC  database represents a useful tool for quality control and scientific analysis  of acute appendicitis

Urs von Holzen; Andre Gehrz; Lukas Meier; Markus Zuber

doi:10.4414/smw.2012.13617

Original article

Vol. 142 No. 2930 (2012)

The AQC database represents a useful tool for quality control and scientific analysis of acute appendicitis

Urs von Holzen
Andre Gehrz
Lukas Meier
Markus Zuber

DOI: https://doi.org/10.4414/smw.2012.13617
Cite this as:: Swiss Med Wkly. 2012;142:w13617
Published: 15.07.2012

Summary

PRINCIPLES: To ensure a high quality of care in surgery, many surgical departments in Switzerland are members of the working group for quality assurance in surgery (AQC).

The purpose of this study was to assess the value of the AQC database as a tool for quality assurance and a source for scientific studies. We had two hypotheses. Firstly that the percentage of laparoscopic appendectomies would have increased over time without an increase in the complication rate and secondly that these procedures would primarily have been performed by residents.

METHODS: All appendectomies performed at the Kantonsspital Olten between 2001 and 2006 were prospectively recorded in the AQC database.

RESULTS: 684 appendectomies were performed. We recorded a clear increase in the use of laparoscopic interventions from 51 to 81%. Ninety three percent of these appendectomies were performed by residents or junior faculty members. The main complication were surgical site infection in 3.6% of the open procedures as compared to none in laparoscopic procedures (p <0.001). Intra-abdominal abscess formation was recorded in 2.7% of laparoscopic procedures as compared to 1.8% in open surgery (p = 0.608). The overall complication rate in the study was 5.4% with no statistical difference between open (6.5%) and laparoscopic (4.7%) surgery (p = 0.305).

CONCLUSIONS: The study clearly shows that the AQC-database offers a wide variety of possibilities for quality assurance and scientific analyses. Our data demonstrate that laparoscopic procedures clearly increased from 2001 to 2006. Appendectomies were mainly performed by residents and junior faculty members. Laparoscopic appendectomy is a safe procedure with a low complication rate and should be applied as a teaching operation during the surgical training.

References

AQC Homepage 2007, http://www.aqc.ch
Ohmann C, Franke C, Kraemer M, Yang Q. Status report on epidemiology of acute appendicitis. Chirurg. 2002;73(8):769–76.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–25.
Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530–4.
Outcome Messung T01- Appendizitis und Verdacht auf Appendizitis, Hauptmessung 2006, Verein Outcome, Josefstrasse 92, CH-8005 Zürich.
SCOAP Collaborative, Cuschieri J, Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg. 2008;248(4):557–63.
Güller U, Rosella L, McCall J, Brügger LE, Candinas D. Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis. Br J Surg. 2011;98(4):589–95. doi: 10.1002/bjs.7395. Epub 2011 Jan 24.
Ignacio RC, Burke R, Spencer D, Bissell C, Dorsainvil C, Lucha PA. Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc. 2004;18(2):334–7.
Faiz O, Clark J, Brown T, Bottle A, Antoniou A, Farrands P, et al. Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006. Ann Surg. 2008;248(5):800–6.
Brügger L, Rosella L, Candinas D, Güller U. Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients. Ann Surg. 2011;253(2):309–13.
Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2004;(4).
Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg. 2011;254(6):927–32.
Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg. 2005;242:439–48, discussion 448–50.
Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;(10):CD001546. Review.
Emmanuel A, Byrne J, Wilson I, Balfe P. Is laparoscopic appendicectomy a safe procedure for trainees in the peripheral hospital setting? Ir Med J. 2011;104(9):276–8.
Whang EE, Mello MM, Ashley SW, Zinner MJ. Implementing resident work hour limitations: lessons from the New York State experience. Ann Surg. 2003;237(4):449–55.
Kaderli R, Businger A, Oesch A, Stefenelli U, Laffer U. Morbidity in surgery: impact of the 50-hour work-week limitation in Switzerland. Swiss Med Wkly. 2012;142:0.

How to Cite

1.

von Holzen U, Gehrz A, Meier L, Zuber M. The AQC database represents a useful tool for quality control and scientific analysis of acute appendicitis. Swiss Med Wkly [Internet]. 2012 Jul. 15 [cited 2024 Apr. 23];142(2930):w13617. Available from: https://smw.ch/index.php/smw/article/view/1537

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] AQC Homepage 2007, http://www.aqc.ch

[2] Ohmann C, Franke C, Kraemer M, Yang Q. Status report on epidemiology of acute appendicitis. Chirurg. 2002;73(8):769–76.

[3] Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–25.

[4] Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530–4.

[5] Outcome Messung T01- Appendizitis und Verdacht auf Appendizitis, Hauptmessung 2006, Verein Outcome, Josefstrasse 92, CH-8005 Zürich.

[6] SCOAP Collaborative, Cuschieri J, Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg. 2008;248(4):557–63.

[7] Güller U, Rosella L, McCall J, Brügger LE, Candinas D. Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis. Br J Surg. 2011;98(4):589–95. doi: 10.1002/bjs.7395. Epub 2011 Jan 24.

[8] Ignacio RC, Burke R, Spencer D, Bissell C, Dorsainvil C, Lucha PA. Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc. 2004;18(2):334–7.

[9] Faiz O, Clark J, Brown T, Bottle A, Antoniou A, Farrands P, et al. Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006. Ann Surg. 2008;248(5):800–6.

[10] Brügger L, Rosella L, Candinas D, Güller U. Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients. Ann Surg. 2011;253(2):309–13.

[11] Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2004;(4).

[12] Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg. 2011;254(6):927–32.

[13] Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg. 2005;242:439–48, discussion 448–50.

[14] Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;(10):CD001546. Review.

[15] Emmanuel A, Byrne J, Wilson I, Balfe P. Is laparoscopic appendicectomy a safe procedure for trainees in the peripheral hospital setting? Ir Med J. 2011;104(9):276–8.

[16] Whang EE, Mello MM, Ashley SW, Zinner MJ. Implementing resident work hour limitations: lessons from the New York State experience. Ann Surg. 2003;237(4):449–55.

[17] Kaderli R, Businger A, Oesch A, Stefenelli U, Laffer U. Morbidity in surgery: impact of the 50-hour work-week limitation in Switzerland. Swiss Med Wkly. 2012;142:0.