Diagnosing acute appendicitis: surgery or imaging?

Rossem, Charles C. van; Bolmers, Matthijs D M; Schreinemacher, M. H. F.; Bemelman, Willem A.; Geloven, A. A. W. van; Pinkney, Thomas; Bhangu, Aneel

doi:10.1111/codi.13470

Cited by 40 publications

(36 citation statements)

References 24 publications

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“…The finding in this cohort that incidence peaks among persons aged 10-19 years, and is greater among men compared to women, is consistent with previous epidemiological literature [1,32,36,37]. In 2010, a new Dutch guideline on treatment of appendicitis was published, which incorporates ultrasound or CT imaging in the standard diagnostic process [38,39]. It is plausible that fewer patients were operated as a result due to better diagnosis and a fall in the proportion of appendectomy for appendix sana.…”

Section: Discussionsupporting

confidence: 86%

“…It is plausible that fewer patients were operated as a result due to better diagnosis and a fall in the proportion of appendectomy for appendix sana. A large Dutch cohort study (n = 1943) performed in 2014 demonstrated a low negative appendectomy rate of 3% [38,39]. Another factor that might play a role is the growing popularity of non-operative treatment and fading dogma 'when in doubt, take it out'.…”

Section: Discussionmentioning

confidence: 99%

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Disease burden of appendectomy for appendicitis: a population-based cohort study

2019

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Background Few large-scale epidemiologic studies evaluate the clinical and economic burden of appendicitis. These data may impact future research and treatment strategies. In this study, the objective was to determine the burden of appendectomy for appendicitis in terms of incidence rates, length of hospital stay (LOS) and hospital costs on a national level. In addition, outcomes were compared for subgroups based on surgical treatment, age and hospital setting. Methods Observational retrospective population-based cohort study using the national Dutch healthcare reimbursement registry, which covers hospital registration and reimbursement for 17 million inhabitants. Patients with a diagnosis of appendicitis who underwent appendectomy between 2006 and 2016 were included. Primary outcomes were incidence rates, LOS and hospital costs. Results A total of 135,025 patients were included. Some 53% of patients was male, and 64% was treated in a general hospital. The overall incidence rate of appendectomy was 81 per 100,000 inhabitants and showed a significant decreasing trend across time and age. Mean ± SD LOS per patient was 3.66 ± 3.5 days. LOS showed a significant increase with age and was significantly longer for open versus minimally invasive appendectomy. Mean ± SD hospital costs per patient were €3700 ± 1284. Costs were initially lower for open compared to minimally invasive appendectomy, but were similar from 2012 onward. Compared to non-university hospitals, patients treated in university hospitals had a significantly longer LOS and higher costs. Conclusions Appendectomy for appendicitis represents a substantial clinical and economic burden in the Netherlands. A preference for minimally invasive technique seems justified. Keywords Appendicitis • Appendectomy • Length of stay • Hospital costs Although acute appendicitis is highly prevalent among adults and children worldwide, literature on the clinical and economic burden of the disease is scarce. Emergent appendectomy remains the cornerstone of treatment and is nowadays mostly performed via the minimally invasive approach in Western countries [1-3]. It is known as a low-risk surgical procedure, with reported mortality rates between 0.03 and 0.24% [4-6]. Depending on the intraoperative classification, patients may be discharged within 24-48 h, or after a few days of prolonged antibiotic prophylaxis [7, 8]. Infectious complications occur in some 9-20% of patients, accompanied by a hospital readmission rate of 6% [5, 9]. Whereas morbidity and mortality are estimators of the burden of

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Disease burden of appendectomy for appendicitis: a population-based cohort study

2019

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“…The overall NAR in UK adults aged 16–45 years was 20·0 per cent, significantly higher than the rate recorded in other countries that participated in the RIFT Study. This represents one of the world's highest NARs. Although simple and complex appendicitis may represent distinct pathologies, some surgeons believe that delaying surgery may increase the risk of appendiceal perforation.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, concerns over the radiation exposure associated with CT have limited its routine use. Although modern low‐dose protocols have reduced radiation exposure whilst maintaining diagnostic performance, CT rates are lower in the UK than in many other high‐income countries, and this is associated with higher normal appendicectomy rates (NARs).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Bhangu

2019

Br J Surg

Self Cite

118

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Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67⋅6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28⋅2 per cent) than men (120 of 993, 12⋅1 per cent) (relative risk 2⋅33, 95 per cent c.i. 1⋅92 to 2⋅84; P < 0⋅001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63⋅1 per cent, failure rate 3⋅7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24⋅7 per cent, failure rate 2⋅4 per cent).Conclusion: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified. * Co-authors of this study are listed in Appendix S1 (supporting information).

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“…A small number of cases showed clinical features of acute and clinical chronic appendicitis, especially in ileocecal valve cancer. Acute appendicitis is the most commonly encountered condition in general surgery and it may affect anyone, regardless of their age [4] . Unfortunately, the misdiagnosis of right colon cancer as appendicitis or appendiceal abscess does occur occasionally in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Analysis on misdiagnosed cases of right colon cancer as appendicitis

Liu¹

2016

Adv Mod Oncol Res

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Abstract:The aim of this case report is to investigate the causes of misdiagnosing right colon cancer as appendicitis, in order to reduce the misdiagnosis rate. The process of diagnosing and treating 44 misdiagnosed right colon cancer cases was analyzed. It was found that the right colonic lumen in these patients was thick, and their cancer consisted mostly of the ulcerative type or of a cauliflower-like tumor that protruded into the intestinal cavity. Moreover, ring-shaped and structured cancer was rarely observed, which suggested a decreased likelihood of obstruction. The patients showed limited peritoneal irritation signs in their right lower abdomen, which was also a potential cause for misdiagnosis. Right colon cancer associated with appendicitis is easily misdiagnosed as simple appendicitis, chronic appendicitis, or appendiceal abscess. Therefore, it is necessary to raise general awareness on the manifestations of the disease in order to exclude other common complications during diagnosis and to reduce the misdiagnosis rate. An accurate early diagnosis and treatment will improve patient prognosis.

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Diagnosing acute appendicitis: surgery or imaging?

Abstract: This article discusses the role of imaging in the diagnostic work-up of patients who are suspected of acute appendicitis, comparing national snapshot studies as a model to do so.

Cited by 40 publications

References 24 publications

Disease burden of appendectomy for appendicitis: a population-based cohort study

Disease burden of appendectomy for appendicitis: a population-based cohort study

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Analysis on misdiagnosed cases of right colon cancer as appendicitis

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