Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Abstract

Negative appendectomy remains a concern in current surgical practice. Data from the developing world is scarce. Data of appendectomies during the last 5 years were analyzed. Interval and incidental appendectomies were excluded. The demographic details, presenting complaints, clinical signs, and investigations performed were recorded in a predesigned proforma. The data were critically analyzed. Six hundred eighty-five appendectomies were performed during the period. One hundred eighty-five patients with a normal appendix were identified on histopathology. Sixty-seven patients with incidental or interval appendectomies were excluded. Thus, 118 patients had appendectomies performed erroneously. All these patients with presumed diagnosis of acute appendicitis were operated on by resident surgeons. Records of 17 patients could not be retrieved. The most common symptom was abdominal pain (100 %), and the commonest sign was right iliac fossa tenderness (93 %). Most of the patients underwent USG to supplement the diagnosis. CT scan and diagnostic laparoscopy were not performed. The negative appendectomy rate was 17.2 % (12.4 % in males; 33.3 % in females). The highest incidence of negative appendectomy was in females aged 11-20 years (66.7 %). The rate of negative appendectomy at our institute is comparable with the world statistics. More diligence is required in making the clinical diagnosis of acute appendicitis, especially in young females. The use of C-reactive protein and CT scan may decrease the negative appendectomy rate.

A New And Early Marker In Diagnosis Of Acute Complicated Appendicitis: Immature Granulocyte

“…Despite all of the developments in diagnosis and treatment methods, high NA and perforation rates have still been reported (13-36%, 12-21%, respectively). [4,10,12,[19][20][21][22] Perforation rates can reach 50%, particularly among the elderly. [3,5,6,22] As perforation rates increase, the rates of morbidity and mortality, the duration of hospital stay, and medical costs increase as well.…”

The role of inflammatory markers in decreasing negative appendectomy rate: a study based on computed tomography findings

“…However, high NARs were also reported in previous studies conducted in our country and in others worldwide. [3,10,11] Therefore, to analyze the effect of the proposed cut-off values in the present study, the actual and recalculated NARs were compared and the difference was found to be almost significant. We believe the cut-off values proposed in our study, particularly in equivocal cases, may have a value in the diagnosis of AA and thus may help decrease NAR.…”

“…High NARs have been reported in our country as well as in some other countries. [3,10,11] Recently, diagnostic values of MPV, RDW, and NLR are increasingly being evaluated in patients with suspected AA, although largely varied results have been reported. [12,13] To our knowledge, there are no published studies that have investigated the role of these inflammatory markers in decreasing NAR based on CT findings of AA.…”

Comparison of Clinical Features Between Patients with Positive and Negative Appendectomy

“…As in our country, high rates of appendicitis cases have been reported in some other countries (15). Therefore, more effort should be made in order to reduce the incidence of NAR and its complications on patients and hospitals (16). Negative appendectomies lead to both postoperative complications, increased morbidity and mortality rates and costs.…”