Negative appendectomy rate in patients diagnosed with acute appendicitis

Chaochankit, Wongsakorn; Boocha, Aeraungkoon; Samphao, Srila

doi:10.1186/s12893-022-01852-0

Cited by 18 publications

(12 citation statements)

References 25 publications

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“…Though this is in contrast to some of the existing literature. 8, 19,24,25 , other studies have suggested WBC is not a predictor of AA. 26 Furthermore it has been suggested that WBC is a poor predictor of AA due to an unreliable speci city and sensitivity and there is no consensus for a reliable cut off value.…”

Section: Discussionmentioning

confidence: 93%

“…8,22-25 Also in keeping with other literature we found advancing age to be negatively associated with a negative appendicectomy. 8,17,19,[22][23] This may be due to older patients being more likely to undergo cross-sectional radiological imaging to exclude other diagnosis that can mimic AA or identify any underlying pathology that may cause AA in older patients. 4 The ndings in this study cohort have suggested USS is of no discernible bene t in paediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…16 There has been a trend of declining negative appendicectomy rates potentially due to better diagnostics and rates of negative appendicectomies are widely reported to be under 10% with the use of diagnostic imaging and biochemical markers. [17][18][19][20] Mandatory imaging has led to reported rates of 2-3%. 21,22 The aim of our study was to evaluate diagnostic methods that are widely accessible and utilised in clinical practice within a District General Hospital to determine their effectiveness individually and in combination to enhance the diagnosis of AA.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with negative appendicectomy rates: A retrospective cohort study

Donald,

Halliday,

Smith

et al. 2024

Preprint

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Background Acute appendicitis (AA) is the most common emergency general surgical condition worldwide. Diagnosis is challenging and incorporates clinical, biochemical and radiological investigations. Our aim was to provide data from routine practice investigating widely utilised diagnostic methods from a single centre within the United Kingdom. Methods We conducted a retrospective observational cohort study of patients who underwent a laparoscopic appendicectomy for AA between April 2022–March 2023. AA was defined as the presence of transmural polymorphonuclear leukocytes on histology. Subgroup analysis was performed on paediatric patients. Factors associated with AA were investigated and the diagnostic utility of biochemical and radiological investigations was examined. Results 330 appendicectomies were analysed. We found an overall negative appendicectomy rate (NAR) of 38% and 48% in paediatric patients. Independent factors associated with AA on multivariate analysis included elevated neutrophil counts (> 7 × 109/L) (OR 4.04), elevated CRP (> 5mg/L) (OR 3.04) and a radiological diagnosis (OR 8.0). Computerised tomography (CT) and ultrasound had sensitivity/specificity of 98%/47% and 35%/86% respectively. The positive-predictive values were 85% for CT and 50% for ultrasound and negative-predictive values were 86% for CT and 77% for ultrasound. Conclusion Our study has highlighted the importance of utilising a combination of factors to improve the diagnostic certainty of AA. However, our routine practice data has shown different sensitivities and specificities of imaging in comparison to existing literature, resulting in a high NAR. Further real world data is needed to understand whether these differences from the existing data are seen in other clinical settings.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with negative appendicectomy rates: A retrospective cohort study

Donald,

Halliday,

Smith

et al. 2024

Preprint

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“…Acute appendicitis is still often misdiagnosed, and the negative appendectomy rate remains high [ 19 ]. In most studies, the negative appendectomy rate is less than 10% [ 20 , 21 ], but in some reported studies, it is higher—about 10–15% [ 9 ] and can exceed 20% [ 19 ]. A negative appendectomy rate is not reported in our study because in our database [ 18 ], only patients with a confirmed diagnosis of acute appendicitis who underwent laparoscopic appendectomy were included.…”

Section: Discussionmentioning

confidence: 99%

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

et al. 2023

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Background: Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. Methods: A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson’s chi-squared test, Wilcoxon rank sum (Mann–Whitney U) test, and Fisher’s exact test in R statistical software package version 4.2.1. Results: 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (p-value in comparison of groups’ sex > 0.99, age p-value 0.16), postoperative complications (p-value > 0.99), histological findings (p-value 0.27), or length of hospital stays (p-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops—91.35 €, with PDS loops—96.51 €, and with a stapler—514.50 €. Conclusions: Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.

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“…Negative appendicectomy refers to surgical removal of the normal appendix on nal pathological report [4]. The Second Australian Atlas of Healthcare Variation in 2017 revealed that negative appendicectomy rates in Australia were 21-24% [5 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide

Scaddan,

Asedy,

Lee

et al. 2024

Preprint

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Purpose: Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient’s treatment. The proposed study will be a quantitative multicentre retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia and the effect of this on operative outcomes. Selected outcome measures will be examined by time from initial presentation at an Emergency Department to the patient being diagnosed and then time of diagnosis to surgery being performed. The secondary aim is to compare rates of negative appendicectomies between hospitals. Methods: Appendicectomy patients will be identified from Operating Room register by medical student data collectors, then each respective hospital’s Emergency Room data collection will subsequently be accessed to complete case report forms based on demographics and Clinical Findings, Pre-operative investigations and Management and follow up. Case report forms with >95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This includes the four two-week data collection periods and the subsequent one month follow up per collection period for possible postoperative complications. This study RGS6483 has received HREC approval by the Royal Perth Hospital HREC Ethics Committee, with a waiver of consent obtained. Dissemination of results: Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. No patient-identifiable data will be entered into the system. Results will subsequently be shared via scientific journal publication and presentation at relevant meetings.

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Negative appendectomy rate in patients diagnosed with acute appendicitis

Cited by 18 publications

References 25 publications

Risk factors associated with negative appendicectomy rates: A retrospective cohort study

Risk factors associated with negative appendicectomy rates: A retrospective cohort study

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide

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