Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

Abstract

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania.
 Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power.
 Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males.
 Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis.
 Keywords: Negative appendectomy rate, SubSaharan Africa, Alvarado score, Appendectomy, Suspected acute appendicitis

Diagnostic accuracy of computed tomography in adults with suspected acute appendicitis at the emergency department in a private tertiary hospital in Tanzania

“…Whether this resulted from attitudes and practices towards AS use for suspected AA could not be determined. However, it has been previously shown that AS is used in only 6% of suspected AA in this setting [ 27 ]. Reasons for its uncommon use need to be determined and addressed to decrease CT overuse and negative appendectomy rates.…”

Diagnosis of Acute Appendicitis: A Cross-sectional Study on Alvarado’s Score from a Low Income Country

“…The reported negative appendectomy rates vary between 11-40% in literature. [12][13][14][15][16][17][18] A rate of 15-20% has been accepted as appropriate to reduce the incidence of perforation in the past but this figure is being challenged these days due to the high post-operative morbidity in patients who have undergone a negative appendectomy. [19][20][21][22][23][24] This diagnostic difficulty has led to the need for developing objective ways of evaluating patients with suspected acute appendicitis by using scoring systems.…”