Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years

• DOI: 10.1007/s00464-016-5175-4
• Publication Date: 2016-08-29T20:00:56Z
• Authors: Ferdinando Agresta; Fabio Cesare Camp...; Mauro Podda; Nicola Cillara; Graziano Pernazza; Valentina Giaccaglia; Luigi Ciccoritti; Giovanna Ioia; Stefano Mandalà; Camillo La Barbera; Arianna Birindelli; Massimo Sartelli; Salomone Di Saverio
• Keywords: Male; 610; Practice Patterns; Abdominal emergencies; Acute abdomen; Clinical audit; Emergency laparoscopy guidelines; Laparoscopic acute care surgery; Laparoscopic surgery; Laparoscopy; Laparoscopy acute abdomen; National survey; Nationwide survey on laparoscopy; Acute; Laparoscopic surgery; Clinical audit; Acute abdomen; 03 medical and health sciences; 0302 clinical medicine; Abdomen; 617; Humans; Practice Patterns, Physicians'; Emergencie; Laparoscopy acute abdomen; National survey; Abdomen, Acute; Physicians'; Abdominal emergencies; Acute abdomen; Clinical audit; Emergency laparoscopy guidelines; Laparoscopic acute care surgery; Laparoscopic surgery; Laparoscopy; Laparoscopy acute abdomen; National survey; Nationwide survey on laparoscopy; Surgery; Abdominal emergencies; Laparoscopic surgery, Abdominal emergencies, Acute abdomen, Laparoscopy, National survey, Nationwide survey on laparoscopy, Emergency laparoscopy guidelines, Clinical audit, Laparoscopy acute abdomen, Laparoscopic acute care surgery; 3. Good health; Italy; Emergency laparoscopy guideline; Health Care Survey; Emergency laparoscopy guidelines; Health Care Surveys; Practice Guidelines as Topic; Abdominal emergencie; Laparoscopic acute care surgery; Female; Laparoscopy; Guideline Adherence; Nationwide survey on laparoscopy; Emergencies; Human

Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity.Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher's exact test, and data were considered significant when p < 0.05.Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26-75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice.The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.