{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:03:32Z","timestamp":1790892212986,"version":"4.1.0"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>More than 250,000 appendectomies are performed annually in the US, with perforated appendicitis associated with increased morbidity and resource utilization. This study evaluates value across the appendicitis care episode within a health network, focusing on the impact of patient factors and disease severity on treatment strategies, outcomes, and cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients were identified from the Health Network System data warehouse, with pathology reports reviewed for confirmation. Quality metrics included postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), and textbook outcome (TB). Cost was assessed using total charges (TCs) for the index admission. Perforated appendicitis was managed with percutaneous drainage and intravenous antibiotics, followed by interval appendectomy when appropriate. Uni- and multivariable analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1637 appendectomies, 95% were performed using minimally invasive techniques (3% conversion, 2% open). Most patients were &lt;50\u00a0years (75%; mean age 30.5 \u00b1 9.1), while 25% were \u226550\u00a0years (mean age 61.0 \u00b1 8.7), with higher comorbidity burden and smoking prevalence (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Outcomes compared favorably with national benchmarks, demonstrating lower PC, LOS, and RA. In perforated appendicitis, staged management showed a trend toward higher value compared with observation alone. Patients \u226550 years had higher rates of malignancy (3.9% vs 1.7%) and perforation (20.7% vs 7.1%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Both age and perforation independently predicted malignancy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High-value appendicitis care is driven by risk stratification and appropriate treatment selection. Older age and perforation identify patients at increased risk for adverse outcomes and malignancy, supporting tailored, pathway-based management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261493526","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:04:51Z","timestamp":1790777091000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Appendicitis in the Elderly: Evaluating Value Across the Appendicitis Care Episode and Risk of Malignancy"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8253-1066","authenticated-orcid":false,"given":"Araceli","family":"Cuaranta","sequence":"first","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Abdelmasseh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arslan","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Errington","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Finley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Payne","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexei","family":"Gorka","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"},{"name":"at Marshall University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Willis","sequence":"additional","affiliation":[{"name":"at Marshall University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineela","family":"Kadiyala","sequence":"additional","affiliation":[{"name":"at Marshall University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Sanabria","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marshall University, Huntington, WV, USA"},{"name":"Marshall Institute for Interdisciplinary Research (MIIR), Marshall University, Huntington, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2018.09.086"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.535"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1011024"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0220202"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12160"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-189407000-00004"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410120089033"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000931"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1021466"},{"issue":"4","key":"e_1_3_8_11_2","first-page":"400","article-title":"Who pays? How reimbursement impacts the emergency department","volume":"36","author":"Downey L","year":"2014","unstructured":"Downey L, Zun LS, Burke T, Jefferson T. Who pays? How reimbursement impacts the emergency department. J Health Hum Serv Adm. 2014 Spring. 2014;36(4):400-416. PMID: 24772689.","journal-title":"J Health Hum Serv Adm. 2014 Spring"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/00031348241259045"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b13ca2"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000000406"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-06738-6"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","unstructured":"Hellmann ZJ Rehman S Hornick M Solomon DG. Unplanned readmission rate before interval appendectomy after nonoperative management of complicated appendicitis. J Am Coll Surg. 2024;240(6):908-915. doi:10.1097\/XCS.0000000000001255. Epub ahead of print. PMID: 39655815.","DOI":"10.1097\/XCS.0000000000001255"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-010-1124-1"},{"issue":"3","key":"e_1_3_8_18_2","first-page":"441","article-title":"Appendiceal cancer: a review of the literature","volume":"83","author":"Van de Moortele M","year":"2020","unstructured":"Van de Moortele M, De Hertogh G, Sagaert X, Van Cutsem E. Appendiceal cancer: a review of the literature. Acta Gastroenterol Belg. 2020;83(3):441-448. 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