Royal College of Surgeons in Ireland
Clinical practice selectively follows acute appendicitis guidelines.pdf (821.84 kB)

Clinical practice selectively follows acute appendicitis guidelines

Download (821.84 kB)
journal contribution
posted on 2024-05-09, 14:26 authored by Gary Alan Bass, Shahin Mohseni, Éanna J Ryan, Maximilian Peter Forssten, Matti Tolonen, Yang Cao, Lewis J Kaplan, ESTES SnapAppy Group, Dara KavanaghDara Kavanagh

Introduction: Acute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps.

Methods: We undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications.

Results: Four thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1-4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p < 0.001).

Conclusions: The observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult


Open access funding provided by Örebro University.


Data Availability Statement

The ESTES SnapAppy Group welcomes the use of these de-identified pooled data for further research that benefits patients. Requests can be submitted to the ESTES Research Committee. Release is subject to their approval and the appropriate safeguarding as determined by applicable legislation (GDPR and HIPAA).


The original article is available at

Published Citation

Bass GA. et al. Clinical practice selectively follows acute appendicitis guidelines. Eur J Trauma Emerg Surg. 2023;49(1):45-56.

Publication Date

31 January 2023

PubMed ID



  • Surgical Affairs

Research Area

  • Surgical Science and Practice
  • Cancer


Springer Heidelberg


  • Published Version (Version of Record)