A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq

Abstract

The most common surgical emergency is suspected acute appendicitis, the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women, with a male to female ratio of 1.4:1; correct diagnosis can be made in 70-80% of patients after the operations about 32% of appendectomies revealed normal appendices and meanwhile appendectomy has a considerable morbidity and mortality. The aim is to explore potential morbidity and mortality associated with negative appendectomy. Prospective case series study, including 5847 patients, who were suspected to have acute appendicitis over a period of five years from 1st December 2013 to 30th November 2018, in emergency department of Sulaimani Teaching Hospital. All the collected data were collected, organized then analyzed by Statistical Package for the Social Sciences version 21. Morbidity in the patients with negative appendectomies occurred in patients in the form of 90 (01.91%) wound infection, 48 (01.02%) intestinal obstruction and last 15 (00.32%) patients developed septicemia. While mortality in negative appendectomy patients was 21, (00.45%). Negative appendectomies have high rates of morbidity and mortality, knowing real rates may help in considering various policies and may be helpful to elude avoidable complications and potential mortality. Non traumatic acute abdomen is 4-8% of adults admitted to the emergency department 1,2. The most common surgical emergency is suspected acute appendicitis, "the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women" 3. Males are affected one and half more times than females 4 while definite diagnosis could be done in 70-80% of patients 1 , after the operations about 32% of appendectomies revealed normal appendices 5 , In females of child bearing age, gynecological pathologies are simulating acute appendicitis 1 , which may increase the prevalence of negative appendectomies. Clinical suspicion of acute appendicitis is mostly done on patient's symptoms and physical findings, including Alvarado score "which has adding accuracy (98.60%) versus computerized tomography (CT) scan (99.03%) 6. Although laboratory blood and urine investigations and simple imaging like plain erect abdominal radiogram and ultrasonography of abdomen and pelvis may aid in accuracy of the diagnosis. "But are not as helpful as magnetic resonance imaging (MRI) and CT scan, which have accuracy of 98% in diagnosing acute appendicitis and lastly diagnostic laparoscopy" 1,3,7-10 .

To err is human; acute appendicitis a mistaken clinical identity for metastatic follicular thyroid carcinoma, a case report

“…Right iliac fossa pain immediately raises suspicion for appendicitis especially when coupled with features for infection and gastrointestinal symptoms. It creates diagnostic uncertainty with tendency towards a thought block for other differentials and to rule out appendicitis first due to the severity of complications for a delayed appendicitis diagnosis and treatment [10] , [11] . A CT abdomen is the gold standard for diagnosing as it aids in conforming the diagnosis, a quick investigation as well as helps to look for other probable causes for RIF tenderness [12] .…”

Low-Value Surgical Procedures in Low- and Middle-Income Countries

“…The 133 included studies collectively reported on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and more than 11.4 million participants (median per study, 989 [IQR, 257-6857]) from 63 LMICs . Of all 133 LMICs, we found studies from 15 of all 29 low-income countries (51.7%), 25 of all 50 lower-middle–income countries (50.0%), and 23 of all 55 upper-middle–income countries (41.8%) . Fourteen studies (10.5%) were multinational …”

“…Fourteen studies (10.5%) were multinational . Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle–income countries and 30 (25.2%) were from East Asia and the Pacific (Table 1 and Figure 2).…”

Endoscopic retrograde appendicitis therapy versus laparoscopic appendectomy versus open appendectomy for acute appendicitis: a pilot study

“…Appendectomy has long been standard treatment for acute appendicitis. However, there are a series of potential postoperative complications, such as postoperative bleeding, wound infection and intestinal obstruction [ 2 , 3 ], and the overall complication rate has been reported to be 8.2–31.4% [ 1 ]. Moreover, negative appendectomy is also a nonnegligible problem [ 4 ].…”