Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Sartelli M 1 , Baiocchi GL 2 , Di Saverio S 3 , Ferrara F 4 , Labricciosa FM 5 , Ansaloni L 6 Show all authors , Coccolini F 6 , Vijayan D 7 , Abbas A 8 , Abongwa HK 9 , Agboola J 10 , Ahmed A 11 , Akhmeteli L 12 , Akkapulu N 13 , Akkucuk S 14 , Altintoprak F 15 , Andreiev AL 7 , Anyfantakis D 16 , Atanasov B 17 , Bala M 18 , Balalis D 19 , Baraket O 20 , Bellanova G 21 , Beltran M 22 , Melo RB 23 , Bini R 24 , Bouliaris K 25 , Brunelli D 26 , Castillo A 27 , Catani M 28 , Che Jusoh A 29 , Chichom-Mefire A 30 , Cocorullo G 31 , Coimbra R 32 , Colak E 33 , Costa S 34 , Das K 35 , Delibegovic S 36 , Demetrashvili Z 37 , Di Carlo I 38 , Kiseleva N 39 , El Zalabany T 40 , Faro M 41 , Ferreira M 42 , Fraga GP 43 , Gachabayov M 44 , Ghnnam WM 45 , Giménez Maurel T 46 , Gkiokas G 47 , Gomes CA 48 , Griffiths E 49 , Guner A 50 , Gupta S 51 , Hecker A 52 , Hirano ES 43 , Hodonou A 53 , Hutan M 54 , Ioannidis O 55 , Isik A 56 , Ivakhov G 57 , Jain S 58 , Jokubauskas M 59 , Karamarkovic A 60 , Kauhanen S 61 , Kaushik R 51 , Kavalakat A 62 , Kenig J 63 , Khokha V 64 , Khor D 65 , Kim D 27 , Kim JI 66 , Kong V 67 , Lasithiotakis K 68 , Leão P 69 , Leon M 70 , Litvin A 71 , Lohsiriwat V 72 , López-Tomassetti Fernandez E 73 , Lostoridis E 74 , Maciel J 27 , Major P 75 , Dimova A 76 , Manatakis D 77 , Marinis A 78 , Martinez-Perez A 79 , Marwah S 80 , McFarlane M 81 , Mesina C 82 , Pędziwiatr M 83 , Michalopoulos N 84 , Misiakos E 85 , Mohamedahmed A 86 , Moldovanu R 87 , Montori G 6 , Mysore Narayana R 88 , Negoi I 89 , Nikolopoulos I 90 , Novelli G 91 , Novikovs V 39 , Olaoye I 92 , Omari A 93 , Ordoñez CA 94 , Ouadii M 95 , Ozkan Z 96 , Pal A 97 , Palini GM 91 , Partecke LI 98 , Pata F 99 , Pędziwiatr M 100 , Pereira Júnior GA 101 , Pintar T 102 , Pisarska M 103 , Ploneda-Valencia CF 104 , Pouggouras K 74 , Prabhu V 105 , Ramakrishnapillai P 106 , Regimbeau JM 107 , Reitz M 108 , Rios-Cruz D 109 , Saar S 110 , Sakakushev B 111 , Seretis C 112 , Sazhin A 57 , Shelat V 113 , Skrovina M 114 , Smirnov D 115 , Spyropoulos C 116 , Strzałka M 117 , Talving P 110 , Teixeira Gonsaga RA 118 , Theobald G 7 , Tomadze G 119 , Torba M 120 , Tranà C 1 , Ulrych J 121 , Uzunoğlu MY 14 , Vasilescu A 122 , Occhionorelli S 123 , Venara A 124 , Vereczkei A 125 , Vettoretto N 126 , Vlad N 122 , Walędziak M 127 , Yilmaz TU 128 , Yuan KC 129 , Yunfeng C 130 , Zilinskas J 59 , Grelpois G 107 , Catena F 8

Affiliations 

  • 1 Department of Surgery, Macerata Hospital, Macerata, Italy
  • 2 2Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
  • 3 3Emergency Surgery, Maggiore Hospital, Bologna, Italy
  • 4 4General Surgery and Polytrauma, San Carlo Borromeo Hospital, Milan, Italy
  • 5 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, UNIVPM, Ancona, Italy
  • 6 6Department of Surgery, Bufalini Hospital, Cesena, Italy
  • 7 7General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  • 8 8Emergency Surgery, Mansoura University Hospital, Mansoura, Egypt
  • 9 9Emergency Surgery Unit, Maggiore University Hospital, Parma, Italy
  • 10 Surgery, Kwara State General Hospital, Ilorin, Kwara Nigeria
  • 11 11Surgery, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
  • 12 Surgery, First University Clinic, Tbilisi, Georgia
  • 13 13General Surgery, Baskent Universitesi Adana Eğitim ve Uygulama Hastanesi, Adana, Turkey
  • 14 14General Surgery, Training and Research Hospital of Mustafa Kemal University, Hatay, Turkey
  • 15 15General Surgery, Sakarya University School of Medicine, Sakarya, Turkey
  • 16 Primary Care, Primary Health Care Centre of Kissamos, Chania, Greece
  • 17 17Department of General Surgery, Medical University of Plovdiv, UMHAT Eurohospital, Plovdiv, Bulgaria
  • 18 18General Surgery, Hadassah Medical Center, Jerusalem, Israel
  • 19 Surgical Department, Agios Savvas Anticaner Hospital, Athens, Greece
  • 20 General Surgery, Hospital Habib Bouguefa de Bizerte, Bizerte, Tunisia
  • 21 General Surgery, S.S. Annunziata Hospital, Taranto, Italy
  • 22 Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
  • 23 23General Surgery, Centro Hospitalar São João, Porto, Portugal
  • 24 24General and Emergency Surgery, San Giovanni Bosco Hospital, Turin, Italy
  • 25 Surgical Department, General Hospital of Larissa, Larissa, Greece
  • 26 Chirurgia, Città di Castello Hospital, Città di Castello, Italy
  • 27 27Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
  • 28 28DEA, La Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
  • 29 General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
  • 30 Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
  • 31 31Emergency Surgery, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
  • 32 32Trauma/Acute Care Surgery, University of California San Diego, San Diego, USA
  • 33 General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
  • 34 34Surgery, CHVNG/E, EPE, Vila Nova de Gaia, Portugal
  • 35 35General Surgery, Numune Training and Research Hospital, Adana, Turkey
  • 36 36Colorectal Surgery, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
  • 37 Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
  • 38 38Surgery, Hamad General Hospital, Doha, Qatar
  • 39 39General and Emergency Surgery, Riga East University Hospital "Gailezers", Riga, Latvia
  • 40 General Surgery, Bahrain Defence Force Hospital, Manama, Bahrain
  • 41 41Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo Andreì, SP Brazil
  • 42 42General Surgery, Hospital Garcia de Orta, Lisbon, Portugal
  • 43 43Division of Trauma Surgery, Hospital de Clinicas, University of Campinas (Unicamp), Campinas, Brazil
  • 44 Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
  • 45 45General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • 46 46Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
  • 47 47Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
  • 48 Surgery, Therezinha de Jesus University Hospital, Juiz de Fora, Brazil
  • 49 49Upper GI/General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  • 50 50Department of General Surgery, Karadeniz Technical University, Farabi Hospital, Trabzon, Turkey
  • 51 51Surgery, Government Medical College and Hospital, Chandigarh, India
  • 52 52Department of General and Thoracic Surgery, University Hospital, Giessen, Germany
  • 53 Chirurgie, Chud-Borgou/Alibori, Parakou, Benin
  • 54 Surgical Department, Landesklinikum Hainburg, Hainburg An Der Donau, Austria
  • 55 554th Surgical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • 56 57General Surgery, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
  • 57 General Surgery, City Hospital #1, Moscow, Russia
  • 58 59Surgery, S M S Medical college, Jaipur, India
  • 59 60Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
  • 60 61Clinic for Emergency Surgery, Faculty of Medicine University of Belgrade, Belgrade, Serbia
  • 61 62Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
  • 62 63General Surgery, Jubilee Mission Medical College & Research Institute, Thrissur, India
  • 63 643rd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 64 Emergency surgery, City Hospital, Mozyr, Belarus
  • 65 66Acute Care Surgery, LAC+USC Medical Center, California, USA
  • 66 67Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
  • 67 68Department of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
  • 68 General Surgery, Scarborough, York Teaching Hospital, Scarborough, UK
  • 69 General Surgery, Colorectal Unit, Hospital de Braga, Braga, Portugal
  • 70 71General and Digestive Surgery, Hospital Fundación Jimenez Diaz, Madrid, Spain
  • 71 Surgical Disciplines, Regional Clinical Hospital, Kaliningrad, Russia
  • 72 73Faculty of Medicine, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 73 Department of Gastrointestinal Surgery, Insular University Hospital of Gran Canaria, Las Palmas, Spain
  • 74 1st Department of Surgery, Kavala General Hospital, Kavala, Greece
  • 75 762nd Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 76 77Clinic of surgery, Department of Gastrointestinal Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
  • 77 78Surgical Department, Konstantopouleio General Hospital, Athens, Greece
  • 78 79First Department of Surgery, Tzaneio, Piraeus, Greece
  • 79 80Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
  • 80 81Department of General Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
  • 81 82Department of Surgery, Radiology, Anaesthetics and Intensive Care, University of the West Indies, Kingston, Jamaica
  • 82 Department of Surgery Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
  • 83 85Department of General Surgery and Emergency Medicine, University Hospital, Kraków, Poland
  • 84 863rd Department of Surgery, Ahepa University Hospital, Thessaloniki, Greece
  • 85 873rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
  • 86 General Surgery, Khartoum Teaching Hospital, Khartoum, Sudan
  • 87 Department of Visceral, Digestive and Oncologic Surgery, Clinique Sainte Marie, Cambrai, France
  • 88 General Surgery, K R Hospital, Mysore, India
  • 89 General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
  • 90 92General Surgery, Lewisham and Greenwich NHS Trust, London, UK
  • 91 93General, Emergency Surgery, Infermi Hospital, Rimini, Italy
  • 92 94Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
  • 93 95General Surgery, King Abdullah University Hospital, Irbid, Jordan
  • 94 96Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad del Valle, Cali, Colombia
  • 95 Surgery Departement, Medical School of Fezm, Sidi Mohamed Benabdellah University, Fez, Morocco
  • 96 General Surgery, Elazig Training and Research Hospital, Elazig, Turkey
  • 97 99General Surgery, King George's Medical University, Lucknow, India
  • 98 Surgery, University Hospital, Greifswald, Germany
  • 99 Department of General Surgery, Sant'Antonio Abate Hospital, Gallarate, Italy
  • 100 102Department of Emergency Surgery and Trauma Centre, University Hospital, Kraków, Poland
  • 101 103Surgery and Anatomy, Clinics Hospital, Ribeirão Preto, Brazil
  • 102 104Abdominal surgery, UMC Ljubljana, Ljubljana, Slovenia
  • 103 105Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, The University Hospital in Krakow, Kraków, Poland
  • 104 106General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
  • 105 107Surgery, Bharati Vidyapeeth Deemed University Medical College & Hospital, Sangli, Maharashtra India
  • 106 Laparoscopic and Metabolic Surgery, KIMS Hospital, Cochin, India
  • 107 109Digestive Surgery, CHU Amiens-Picardie, Amiens, France
  • 108 General Surgery, Hospital Municipal Dr. Jose de Carvalho Florence, Sao Jose Dos Campos, Brazil
  • 109 General Surgery, Hospital General Regional # 1 I.M.S.S, Cuernavaca, Mexico
  • 110 Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
  • 111 General Surgery, University Hospital St George, Plovdiv, Bulgaria
  • 112 114General Surgery, Russells Hall Hospital, Birmingham, UK
  • 113 115General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
  • 114 Surgery, Hospital & Oncological Centre Novy Jicin, Novy Jicin, Czech Republic
  • 115 General Surgery, Clinical Hospital at Chelyabinsk Station OJSC "Russian Railways", Chelyabinsk, Russian Federation
  • 116 1183rd Department of Surgery, IASO General Hospital, Athens, Greece
  • 117 119General Surgery and Polytrauma, University Hospital, Medical College, Jagiellonian University, Kraków, Poland
  • 118 Cirurgia do Trauma, Hospital Escola Padre Albino, Catanduva, Brazil
  • 119 121Surgery Department #2, Tbilisi State Medical University, Tbilisi, Georgia
  • 120 General Surgery, Trauma University Hospital, Tirana, Albania
  • 121 1231st Department of Surgery-Department of Abdominal Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
  • 122 First Surgical Clinic, St. Spiridon University Hospital, Iasi, Romania
  • 123 Emergency Surgery, S. Anna Teaching Hospital, Ferrara, Italy
  • 124 126Digestive and Endocrinal Surgery, University Hospital, Angers, France
  • 125 127Department of Surgery, Medical School University of Pécs, Pécs, Hungary
  • 126 Surgery, ASTS Spedali Civili Brescia, Montichiari, Italy
  • 127 129Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine in Warsaw, Warsaw, Poland
  • 128 130Department of General Surgery, Kocaeli University, Kocaeli, Turkey
  • 129 Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  • 130 132Department of Surgery, Tianjin Nankai Hospital, Tianjin, China
World J Emerg Surg, 2018;13:19.
PMID: 29686725 DOI: 10.1186/s13017-018-0179-0

Abstract

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.

Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.

Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.

Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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