Towards an evidence-based management of right iliac fossa pain in the over 50-year-old patient

Does CT Reduce the Rate of Negative Laparoscopies for Acute Appendicitis? A Single-Center Retrospective Study

In surgical practice, surgeons request CT scans to rule out acute appendicitis, even in young patients. We aimed to assess the feasibility of using a CT scan to reduce the rate of negative laparoscopies in patients younger than 40 with equivocal signs of acute appendicitis. Therefore, we conducted a retrospective observational study on the patients admitted with a provisional diagnosis of acute appendicitis. Patients younger than 40 and with the Alvarado score between 3 and 6 were included. These were divided into two groups: those who had or did not have a CT scan. Each group was further subdivided into patients that had a laparoscopy and those that did not. Out of 204 patients included in the study, 16% were included in the CT group, and 84% in the non-CT group. 71.9% of the patients that underwent a CT scan had appendicitis and underwent an appendectomy. Five patients with a normal CT scan had appendectomy due to persistent signs of acute appendicitis. The histopathology of the 23 patients with positive CT was positive, and 3 of the 5 patients with negative CT that underwent appendectomy had positive histology results. The negative appendectomy rate for patients that had preoperative CT is 7.14% compared to 32.4% in patients without preoperative CT. The rate of negative laparoscopy in patients younger than 40 years old that undergo preoperative CT is significantly lower with a p-value of .00667.

Review of appendicectomies over a decade in a tertiary hospital in New Zealand

BACKGROUND

Acute appendicectomy is the most common emergency operation for patients with abdominal pain. In the last decade, computed tomography (CT) scans have increasingly been used to aid in the diagnosis in order to reduce the negative appendicectomy rate. The aim of this study was to evaluate our institution's negative appendicectomy rate and the use of pre-operative imaging.

METHODS

A retrospective review was undertaken for all adult patients (>16 years), who underwent an appendicectomy on emergency basis in the years 2004, 2009 and 2014. Cases were identified from the hospital electronic theatre record system. Data were also obtained from the patients records and laboratory reports.

RESULTS

A total of 874 patients were included, 227 in 2004, 308 in 2009 and 339 in 2014. The negative appendicectomy rate was 29.1% in 2004, 20.1% in 2009 and 19.5% in 2014 (P = 0.014). Negative appendicectomies were more common in women (P = <0.001), patients between the ages of 16-30 years (P = <0.001) and were associated with low inflammatory markers (median white cell count of 10.2, C-reactive protein of 8, P = <0.001). The use of CT scan prior to operation increased between 2009 and 2014 (34 (11.0%) versus 64 (18.9%), P = <0.001).

CONCLUSION

Though the number of appendicectomies being performed in our institution has increased over the last decade, the negative appendicectomy rate remains fairly static and the increased use of CT scans did not further decrease the proportion of negative appendicectomies between 2009 and 2014.