Langenbeck's Archives of Surgery

, Volume 399, Issue 4, pp 493–501

Appendicitis—the balance between cost effectiveness and safety remains challenging

  • Juliane Liese
  • Thomas M. Halbinger
  • Frank Ulrich
  • Wolf O. Bechstein
  • Christoph W. Strey
Original Article

DOI: 10.1007/s00423-014-1179-5

Cite this article as:
Liese, J., Halbinger, T.M., Ulrich, F. et al. Langenbecks Arch Surg (2014) 399: 493. doi:10.1007/s00423-014-1179-5

Abstract

Purpose

The diagnosis of acute appendicitis remains a challenge in daily clinical practice. The aim of the present study was to determine clinical criteria for a careful and cost-effective integration of computed tomography (CT) scans in the clinical pathway for the diagnosis of acute appendicitis.

Methods

In this retrospective study, we analyzed all patients who were admitted to our hospital with suspected appendicitis (2008–2011). We included all patients who had an appendectomy with or without preoperative CT. Furthermore, we analyzed all patients who received a CT because of suspected appendicitis but did not have an appendectomy.

Results

A total of 367 patients were included in this study. A CT was performed in 35 % of the patients with suspected appendicitis. Women had a significantly higher rate of negative appendectomy (NA) (16.5 %) than men (5.3 %). The frequency of NA was 5.7 % in the group of patients who were imaged, whereas it was 11.8 % (p = 0.075) among those who were not imaged. Thereby, CT scans helped to reduce total hospital expenses (€1,317.44 (no CT scan) to €675.85 (CT scan and no operation). Furthermore, CT scans can be avoided in men with normal white blood cell counts who should be observed if not operated immediately.

Conclusion

CT can be effectively applied for the diagnosis of acute appendicitis. We propose a diagnostic algorithm which helps to simultaneously avoid unnecessary operations and radiation exposure.

Keywords

Appendicitis Computed tomography Negative appendectomy Appendiceal perforation 

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Juliane Liese
    • 1
  • Thomas M. Halbinger
    • 1
  • Frank Ulrich
    • 1
  • Wolf O. Bechstein
    • 1
  • Christoph W. Strey
    • 2
  1. 1.Department of General and Visceral SurgeryUniversity Hospital Frankfurt, Goethe-UniversityFrankfurtGermany
  2. 2.Department of General, Visceral and Vascular SurgeryDiakoniekrankenhaus FriederikenstiftHannoverGermany