Negative Appendectomy: Clinical and Economic Implications

Abstract

Historically, performing a negative appendectomy (NA) was justified to reduce the incidence of perforation. Furthermore, it is also believed that NA is associated with minimal morbidity and cost. The purpose of this study was to evaluate the frequency, clinical characteristics, and economic implications of NA. We reviewed the inpatient admissions on 274,405 patients who underwent nonincidental appendectomy as their primary procedure from the California State Inpatient Databases (2005–2011). Overall, 96.9 per cent had appendicitis (nonperforated = 73.1%, perforated = 23.8% and 3.1%) had NA. NA rates decreased steadily from 4.2 per cent in 2005 to 2.5 per cent in 2011 ( P < 0.01). The rates of appendectomy for perforated appendicitis rates also decreased slightly from 25.3 to 23.3 per cent during this time ( P = <0.01). Multivariate regression showed that female gender, African American race, and public insurance were all associated with increased NA rates. Compared with patients with appendectomy for nonperforated appendicitis, NA was associated with longer length of stay (NA = 3.2 days vs nonperforated = 1.7 days), higher median cost per admission (NA = $8626 vs nonperforated = $7605), and higher morbidity (4.7 vs 1.9%), all P < 0.01. Contrary to classic justification for NA, we did not find an inverse association of appendectomy for perforated appendicitis and NA at the hospital level. In conclusion, NA is associated with substantial clinical and financial burden, while having no apparent impact on lowering the rate of appendectomy for perforated appendicitis.

Review of appendicectomies over a decade in a tertiary hospital in New Zealand

“…Operative removal of the appendix remains the standard treatment for acute appendicitis in most hospitals, however, errors in diagnosing acute appendicitis results in unnecessary appendicectomies being performed . Negative appendicectomies have obvious patient risks, both surgical and anaesthetic, but also carry an economic burden on the health‐care system …”

Cohort study of 1241 patients to identify predictors of negative appendicectomy

“…The NAR is low in the USA, ranging from 3.1% to 4.5% in recent large cohort studies. 18,32 The difference in NAR between geographical regions relates to a few factors. Firstly, differences in the way individual centres define and report NA rates can account for the variation.…”

Histopathological audit of appendectomy specimen in a Tertiary Care Center.

“…17 It is justified historically that NAR serves to reduce the chances of perforation, as there is minimal morbidity and cost but extra and apparent clinical and financial load. 18 Surgical excision of a normal appendix is not rare that bewray the patients to inevitable hazards of anesthesia and surgery, may be due to inaccurate clinical evaluation, availability of diagnostic facilities, which impedes the accuracy in the diagnosis. There are so many diseases clinically resembling the acute appendicitis.…”

“…Different studies throughout the world detected various benign and malignant unusual pathology in resected appendix with varying frequency consistent with our study, supporting the value of routine histopathological examination of resected appendix. 18,23,24,25…”