Incidental Neoplasms Found on Routine Emergency Appendectomy - Research Paper Example

Clinical Audit Report: Incidental neoplasms found on routine emergency appendectomy in a single institution Introduction Incidental neoplasm is a broad concept that refers to the secondary or subsidiary new and abnormal growth of particularly the tissue in a body part. Some of the body parts and organ that are at risk of incidental neoplasms include the kidney as well as the appendix. Incidental neoplasms are more often and especially a characteristic of cancer therefore commonly being referred to as tumour1. These incidental neoplasms are infrequent findings found during major specimen collection practices such as surgeries for instance renal biopsy for the kidney and appendectomy for the appendix. Neoplasms of the appendix can be referred to as incidental neoplasms of the appendix. Such is since; they are an infrequent finding found incidentally during the pathological evaluation of the appendectomy specimen. The appendectomy is a surgical practice that targets the removal of the appendix. It is more often conducted as an emergency operation for the treatment of appendicitis. Arguably, appendectomy will target the treatment of appendicitis, and incidentally, tumors will be diagnosed in the patient after undergoing the emergency surgical operation. Likely, some of these tumors diagnosed for appendicitis patients include carcinoid tumor, cystadenocarcinoma as well as cystadenoma with carcinoid tumor being the very common tumor2. However, it is worth noting that, cancer of the appendix is rare which makes the above mentioned three types among others of the tumor being found accidentally during appendectomy3. The prevalence rates of incidental neoplasms of the appendix is subject to vary depending on the hospital's clinical practice. As such, this clinical audit seeks to enlighten on the three earlier mentioned tumor types as incidental neoplasms of the appendix infrequently found in a routine emergency appendectomy in a single institution, the demographics variants that will increase the risk of the findings and effective recommendations that are based on the findings in relation to the preoperative imaging and surgical techniques. Through such, the clinical audit will emphasize on the need for an attempt to excise the mesoappendix in emergent appendicitis. The contextual audit took place during 2017, specifically between February and December in Bahrain Defence Force- Military Hospital. For its histopathology, the audit did target data analysis of the recorded patients with incidental neoplasms, normal or hypertrophic appendix as well as acute appendicitis. Worth noting that, for the above-mentioned patients, 73 in total, the audit data-analyzed recorded patients of both gender as well as different ages with the youngest being four years and the oldest 76 years. The audit aimed at evaluating whether or not the contextual hospital clinical practice has been following the National Comprehensive Cancer Network guidelines during a routine emergency appendectomy. The audit is based on the central objective of determining the level/ rate of the contextual hospital clinical practice compliance during a routine emergency appendectomy and aims at obtaining better compliance in future in order to decrease the likelihood of incidental neoplasms of appendix during a routine emergency appendectomy. Owing to the fact that emergency surgical operations in the contextual hospital are conducted by qualified healthcare personnel, such account for the presence of the hospital to have a high rate of compliance on their clinical practice to the National Comprehensive Cancer Network guidelines in relation to the routine emergency appendectomy. Such is based on the fact that, the hospital is well informed of the consequences arising from the non-compliance to the guidelines. With the above, this audit hence takes the lane to reveal whether or not, the contextual hospital clinical practice complies as well as the factors that are related and contributes to the hospital noncompliance. Guidelines The contextual audit embraces being measured against the National Comprehensive Cancer Network clinical practice guidelines in oncology, specifically targeting at the aims and objectives suggested by the National Comprehensive Cancer Network regarding routine emergency appendectomy. The guidelines state that the National Comprehensive Cancer Network has the aim to 1. Give and provide clinicians the access to both the knowledge and tools which can guide the decision-making for the management of cancer. 2. Develop an integrated suite of tools that will improve the quality of specifically cancer care. 3. Provide recommendations for the various effective key cancer screening and preventive topics and training to clinicians. 4. Providing recommendations for supportive care considerations 5. Assist in the decision-making process of individuals that are involved in cancer care such as nurses, physicians, and patients based on the ultimate goal of improving the patients care as well as outcomes. The contextual practice is of great importance since it aims at addressing incidental neoplasms of appendix found on routine emergency appendectomy as well as limits the rate of hospital clinical practice non-compliance to the above-mentioned guidelines. Method and Sample This particular audit embraces a prospective approach with its target population as the patients. The audit strictly concentrated only on patients with three major health conditions- incidental neoplasms, hypertrophic or normal appendix as well as acute appendicitis. However, it excluded any patient who had been misdiagnosed with an ovarian cyst. The audit specifically majored on only the patient in Bahrain Defence Force- Military Hospital during between the month of February and December 2017.Worth noting is, the patient were selected randomly, although they had to have one of the three health conditions without the exclusion health condition. Data collection was conducted through the use of a query which was run in the patient information and database center of the contextual hospital. The query was run on the search bar. After retrieving the information, the audit embrace sampling as its data input method. Here, data was sampled in a manual entry sheet which included the various crucial information such as the hospital number of the patient, patient gender as well as patient age. During the sampling of the retrieved data, the audit embraced the use of keys, for instance, histopathology lab key as well gender key. Results Table1: The variation of conditions among patients for histopathology PATIENT HEALTH CONDITION GENDER TOTAL MALE FEMALE Appendicitis 39 20 59 Carcinoid 1 0 1 Cystadenocarcinoma 0 1 1 Cystadenoma 2 0 2 Normal/hyperplasia appendix 5 4 9 Lymphoma 0 0 0 Appendix Endometriosis 0 1 1 Total Patients 47 26 73 Chart1: Comparison of the appendicitis with the three incidental neoplasms of the appendix. Chart 2: Comparison in percentage of the three incidental neoplasms of the appendix Discussion Incidental neoplasms are infrequent finding found incidentally during the pathological evaluation of appendectomy specimen. They are auxiliary and either new or abnormal growth of the tissue in a body part1. Incidental neoplasms will more often be a characteristic of cancer which accounts to them being referred to a tumor. More often, they are known as a result of specimen collection methods and techniques such as surgeries and biopsy. Appendectomy relates to incidental neoplasms of the appendix. Appendectomy is an emergency surgical operation that targets removal of the appendix. While the primary role of appendectomy is the treatment of appendicitis, during the emergency operation, incidentally, there will be the diagnosis of tumor- the incidental neoplasms of the appendix. Such is referred as incidental neoplasms since cancer is rare condition and case for the appendix, but most will be found accidentally on the appendectomy performed for appendicitis- its treatment. In a bid to clarify the presence of incidental neoplasms of the appendix on the routing emergency appendectomy in the identified hospital, this particular prospective study took the lane to analysis data of the recorded patients in the hospital information and data center specifically during 2017 from February to December. With the study deriving data for 73 patients of both gender and different ages, 5% of the total patients were diagnosed with incidental neoplasms of the appendix. Further to mention, 83% of the patients were suffering from appendicitis and hence required appendectomy while 12% of the patients were diagnosed with other tumor conditions. The contextual study discovered three major incidental neoplasms of routing emergency appendectomy. These include the carcinoid, cystadenocarcinoma as well as cystadenoma taking 25%, 25%, and 50% respectively. Based on the above information in relation to the incidental neoplasms, arguably, the hospital can be termed to have a high compliance level with the pre-mentioned National Comprehensive Cancer Network guidelines. Such is since, first, the hospital clinical practice are able to diagnose carcinoid- a tumor of the appendix which is asymptomatic3. Arguably, with the carcinoid tumor being asymptomatic, such hence poses a challenge infrequently finding it, but through the hospital clinical practice offering effective key cancer screening and preventive topic, the clinician are hence able to screen for a such a tumor. Besides, the hospital clinical practice through its health personnel, were able to screen for a higher rate of cystadenoma recording 50%, since it’s the most common neoplasm of the appendix3. The audit has both strengths and weakness. To start with the audit has strengths such as its capability in being able to retrieve valid information particularly from the hospital information and data center. Such offers authenticity to the audit. On the other hand, it has weakness such challenges in searching for data of the patients incompatibility with the hospital data center set regulations. Such has the possibility of limiting effective retrieving of the required data which will hence pose a challenge to the audit. Conclusion To sum up, incidental neoplasms of the appendix are found on the routine emergency appendectomy. Histopathology indicates that the three most common incidental neoplasm of the appendix includes cystadenoma, carcinoid, and cystadenocarcinoma. This particular clinical audit has enlightened on the prevalence of the above mentioned incidental neoplasms of the appendix in a single institution- the Bahrain Defence Force- Military Hospital. The audit has brought to light that the hospital clinical practice holds a remarkable compliance level, but it’s not limited to more improvement, to the National Comprehensive Cancer Network pre-mentioned guidelines. Recommendations and Quality Improvement Plan Even with the remarkable compliance level, there is still room for and need of quality improvement. During quality improvement, there is the need to consider two major aspects. These include the hospital educating more clinicians on effective, updated and technological screening and preventive training and topics for the clinicians. Besides, the allocation for an adequate time frame for the development of an integrated suite of tools that can be used in improving the quality of cancer care. Acknowledgements I appreciate the great help and guidance that I occasionally received from my lecturer. Besides, I can’t forget the warm welcome that I received from the hospital as well as its administration permission for me to access its information and data center in order to acquire and retrieve the data. The above two greatly helped and made it possible for my successful completion of this clinical audit. References 1. Muir CS, Percy C. Classification and coding for neoplasms. Cancer registration: principles and methods. Lyon: IARC. 1991;81. 2. Gu Y, Wang N, Xu H. Carcinoid tumor of the appendix: a case report. Oncology letters. 2015 May 1;9(5):2401-3. 3. Ruoff C, Hanna L, Zhi W, Shahzad G, Gotlieb V, Saif MW. Cancers of the appendix: a review of the literature. ISRN Oncology. 2011 Aug 11;2011. Read More