Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis
- First Online:
- 783 Downloads
To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs.
In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008–2009 (756 patients/group I) and 2011–2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation.
After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 € from 2,482 to 1,888 € (CL:−1081; −143).
Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs.
• The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis.
• This led to a considerable increase in the use of preoperative imaging.
• Mandatory imaging led to reduction in unnecessary surgeries and surgical complications.
• Use of mandatory imaging seems to reduce health care costs.
KeywordsImaging Diagnosis Appendicitis Health-care costs Operative surgical procedures
Institutional Review Board
Magnetic Resonance Imaging
Negative Predictive Value
Positive Predictive Value
- 6.Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA, Werkgroep richtlijn Diagnostiek en behandeling van acute a (2010) [Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended]. Ned Tijdschr Geneeskd 154:A303Google Scholar
- 10.Hakkart-van Roijen L TS, Bouwmans CA. (2010) Dutch manual for cost research. Handleiding voor kostenonderzoek, methoden en standard kostprijzen voor economische evaluaties in de gezondheidszorg. College voor zorgverzekeringenGoogle Scholar