Abstract
Background
The optimal diagnostics and treatment of acute appendicitis continues to be a challenge. We evaluated the implementation of the guideline “diagnostics and treatment in acute appendicitis” in 2010. This guideline states that, in every patient with clinically suspected acute appendicitis, an ultrasonography or CT scan is advised to confirm the diagnosis before surgery.
Patients and methods
We selected all consecutive patients with acute appendicitis in our hospital in the years 2008 and 2011. We compared the use of imaging and the operation results in both years.
Results
In 2008, 228 patients were treated for acute appendicitis. In 43 %, imaging was performed. In 2011, 238 patients were treated; in 99 % of the cases, imaging was performed. A decrease in patients with negative appendectomy was seen from 19 % in 2008 to 5 % in 2011. Financial analysis showed a reduction in costs favoring 2011.
Conclusions
The increased use of pre-operative imaging in patients with suspected acute appendicitis resulted in a cost-effective way to decrease the number of patients with negative appendectomies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buckius MT, McGrath B, Monk J et al (2012) Changing epidemiology of acute appendicitis in the united states: study period 1993–2008. J Surg Res 175:185–190
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults. Radiology 241(1):83–94
Addiss DG, Shaffer N, Fowler BS et al (1990) Epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925
Bakker OJ, Go PMNYH, Puylaert JBCM et al (2010) Richtlijn voor diagnostiek en behandeling van acute appendicitis. Nederlands Tijdschrift voor de Geneeskunde 154:A303
Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36(1):39–51
Yu CW, Juan LI, Wu MH et al (2013) Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 100:322–329
Körner H, Söndenaa K, Söreide JA et al (1997) Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21:313–317
Berry J, Malt RA (1984) Appendicitis near its centenary. Ann Surg 200(5):567–575
Parks NA, Schroeppel TJ (2011) Update on imaging for acute appendicitis. Surg Clin N Am 91:141–154
Brown MA (2008) Imaging acute appendicitis. Semin Ultrasound CT MR 29:293–307
Morino M, Pellegrino L, Castagna E et al (2006) Acute nonspecific abdominal pain—a randomized, controlled trial comparing early laparoscopy versus clinical observation. Ann Surg 244(6):881–886
Yu SH, Kim CN, Park JW et al (2005) Ultrasonography in the diagnosis of appendicitis: evaluation by meta-analysis. Korean J Radiol 6(4):267–277
Flum DR (2005) Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 201:933–939
Flum DR, Morris A, Koepsell T et al (2001) Has misdiagnosis of appendicitis decreased over time? A population based analysis. JAMA 286(14):1748–1753
Bendeck SE, Nino Murcia M, Berry GJ et al (2002) Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 225:131–136
Applegate KE, Sivit CJ, Salvador AE et al (2001) Effect of cross-sectional imaging on negative appendectomy and perforation rates in children. Radiology 220:103–107
Karakas SP, Guelfguat M, Leonidas JC et al (2000) Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol 30:94–98
Pittman-Waller VA, Myers JG, Stewart RM et al (2000) Analysis of 5755 consecutive appendectomies. Am Surg 66:548–554
Anderson R, Hugander A, Thulin A et al (1994) Indications for operation in suspected appendicitis and incidence of perforation. BMJ 308:107
Luckmann R (1989) Incidence and case fatality rates for acute appendicitis in California; a population-based study of the effects of age. Am J Epidemiol 129:905
Kathouda N, Mason RJ, Towfigh S (2005) Laparoscopic versus open appendectomy, a prospective randomized double-blind study. Ann Surg 242(3):439–448
Rybkin AV, Ruedi F, Thoeni F (2007) Current concepts in imaging of appencitis. Radiol Clin N Am 45:411–422
Randen A, Bipat S, Zwinderman A et al (2008) Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence disease. Radiology 249(1):97–106
Terawasa T, Blackomre C, Bent S et al (2004) Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 114:537–546
Pickhardt PJ, Lawrence EM, Dustin Pooler B et al (2011) Diagnostic performance of multidetector computed tomography for suspected appendicitis. Ann Intern Med 154:789–796
Poortman P, Lohle P, Schoemaker C et al (2003) Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study. Am J Radiol 181:1355–1359
Wan MJ, Krahn M, Ungar WJ (2009) Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis—a Markov decision analytical model. Radiology 250(2):378–386
Disclosures
P. A. Boonstra, R. N. van Veen, H. B. A. C. Stockmann have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boonstra, P.A., van Veen, R.N. & Stockmann, H.B.A.C. Less negative appendectomies due to imaging in patients with suspected appendicitis. Surg Endosc 29, 2365–2370 (2015). https://doi.org/10.1007/s00464-014-3963-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3963-2