Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective. Methods: This economic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multicentre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires administered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors. Results: The CUA produced an incremental cost-effectiveness ratio (ICER) of −GBP 23,278.51 (−EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios. Conclusion: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than appendicectomy and led to improved QOL outcomes for patients. The ICER value of −GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric operation globally. Same-day discharge (SDD) LSG is now becoming increasingly common, with many studies reporting this to be safe when compared to a postoperative inpatient (IP) stay. This systematic review and meta-analysis aims to compare outcomes between patients undergoing LSG as SDD and IP. Materials and methods: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. A search strategy was developed and used to search the MEDLINE/Pubmed, Cochrane library, EMBASE, and Scopus databases. The primary outcome measures were mortality, emergency room (ER) visits, readmission, and reoperation. Secondary outcomes were morbidity, postoperative leak, length of stay of rehospitalization, cancellation of planned day-case, reasons for cancellations, postoperative pulmonary embolism (PE), and postoperative deep vein thrombosis (DVT). Pooled odds ratios with 95% confidence intervals were calculated for outcomes using fixed- or random-effects models. Results: 11 studies were identified and included in the qualitative analysis, with a total of 138 001 patients in the SDD (25 069) or IP (112 932) groups. Seven studies with a total of 3737 patients were included in the meta-analysis. The number of ER visits was significantly higher in the IP group compared to the SDD group (OR = 1.52, 95% CI: 1.09–2.13, P = 0.01). There was no significant difference in the readmission rate (OR = 1.48, 95% CI: 0.80–2.76, P = 0.21) or the reoperation rate (OR = 0.62, 95% CI: 0.12–3.25, P = 0.58). Mortality and morbidity were low in all studies where they were reported and were largely similar across the groups. Conclusion: Overall, SDD LSG when compared to IP LSG is safe and not associated with higher mortality, morbidity, readmission, reoperation rates, or ER visits.

Novel diagnostic tools have been developed to aid diagnosis and reduce misdiagnosis. However, the accuracy of these tools depends on estimates of disease prevalence. This study aimed to determine the prevalence of rheumatological diseases in a real-world cohort of patients and assess the rate of misdiagnosis at first presentation and follow-up. Patients with symptoms of inflammatory arthritis were referred by primary care. Rheumatologists made initial diagnoses, initiated treatment and revised diagnoses during follow-up. Clinical data including diagnoses were extracted from electronic patient records. Over 2 years, 260 patients were seen. Most patients presented with peripheral joint symptoms (95%), and 23% had axial involvement. Psoriasis was present in 15%, inflammatory bowel disease in 4% and uveitis in 4%. Autoantibodies were positive for cyclic citrullinated peptide in 11% and rheumatoid factor in 12%. Seventeen per cent (n = 45) of patients were misdiagnosed, with 8% (n = 20) initially diagnosed with 1 of the 5 most common rheumatological conditions but later found to have a noninflammatory disorder. Conversely, 7% (n = 17) initially received a diagnosis of an ‘other rheumatological disease’ but later had their diagnoses revised to 1 of the 5 most common rheumatological conditions. Disease prevalence is context-specific, and prevalence estimates in the intended setting should be determined prior to implementation of novel diagnostic tools. In real-world cohorts, noninflammatory diseases like chronic pain syndromes were more prevalent than in observational studies and registries. Misdiagnosis occurs in about one-fifth of patients, highlighting the benefits of novel diagnostic tools for earlier, more accurate diagnosis.