Negative Appendicectomy Rate: Incidence and Predictors

Noureldin, Khaled; Ali, Ali Asgar Hatim; Issa, Mazen; Shah, Heer; Ayantunde, Bolu; Ayantunde, Abraham

doi:10.7759/cureus.21489

Cited by 17 publications

(14 citation statements)

References 27 publications

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“…Across our sample, AA was found more in males (75.8%) than in females in Qatar's population, which is similar to many reports in the literature [23,24]. On the other hand, other studies showed equal distribution between males and females [25,26]. In the view that AA affects the young population between the second and fourth decades, we found that our study cohort matches this with a mean age of 33.3 years, while a recently published article showed a relatively younger age group than this study that showed a mean age less than 30 years [17,27].…”

Section: Discussionsupporting

confidence: 90%

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

Al‐Tarakji¹,

Zarour²,

Singh³

et al. 2022

Cureus

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Background/objectiveAcute appendicitis (AA) is one of the most common surgical emergencies that require a proper diagnosis to avoid a negative outcome in the case of missed or delayed diagnosis. Our study aims to assess the diagnostic power of the Alvarado score and the prediction of the severity of acute appendicitis in correlation to intraoperative findings and the final histopathology (HP) result. MethodsThis retrospective study was applied to 1,303 patients with clinically proven acute appendicitis (AA) and available HP results. We correlated Alvarado score to the gold standard HP and intraoperative findings. We selected the cutoff point of Alvarado at 5 and 7 as they were the most frequent cutoff value mentioned in the literature and based on the ROC curve in this study to assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsThe mean age of the study cohort is 33.3 ± 9.5 years, with a male predominance (75.8%). The negative appendectomy (NA) rate was 4%. The operative complication rate was 1.2%, and we recorded one mortality case (0.1%). The diagnostic evidence of AA was in 95.9% of cases. Alvarado score ≥ 7 presented sensitivity and specificity of 66.4% and 69.8%, respectively, with PPV of 98.1% and NPV of 8.1%, with an accuracy of 66.5%. For Alvarado score ≥ 5, the sensitivity was 91.2%, specificity was 22.6%, PPV was 96.5%, NPV was 9.8%, and accuracy was 88.4%. In addition, we demonstrated statistical significance between Alvarado risk stratification with HP and intraoperative grades (p = 0.001 each). ConclusionThe Alvarado scoring system alone is not enough to diagnose AA with unsatisfactory sensitivity and specificity. However, it is a good indicator of the severity of AA that we can depend on to prioritize those patients waiting for surgery.

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Section: Discussionsupporting

confidence: 90%

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

Al‐Tarakji¹,

Zarour²,

Singh³

et al. 2022

Cureus

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“…Of the included studies, 16 were retrospective, ten were prospective, and one study had both a pro- and a retrospective cohort. Most studies ( n = 16) originated from Europe [17, 18, 20–22, 24, 25, 28, 30, 31, 34–37, 40, 42]. Summary of characteristics of the included studies is given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The rate of other intra-abdominal findings than appendicitis or a normal appendix ranged from 0.6% [21, 31] to 18.5% [17] (Fig. 2) with an IQR of 1.5–5.3%.…”

Section: Resultsmentioning

confidence: 99%

Other Pathologies Were Rarely Reported after Laparoscopic Surgery for Suspected Appendicitis: A Systematic Review and Meta-Analysis

Henriksen¹,

Rosenberg²,

Fonnes³

2023

Dig Surg

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Background: Diagnostic laparoscopy is often used when a patient is suspected of having acute appendicitis. The aim of this study was to assess the rate of other pathologies found during diagnostic laparoscopy for suspected acute appendicitis. Methods: This systematic search included studies with ≥100 patients who received laparoscopy for suspected acute appendicitis and reported on the histopathologic and other intra-abdominal findings. We performed a meta-analysis estimating the rate of other pathologies, and a sensitivity analysis excluding smaller cohorts (≤500 patients). Age groups, sex, specific findings, and geographic regions were investigated. Certainty of evidence was assessed with GRADE. Results: A total of 27 studies were included covering 25,547 patients and of these 793 had an unexpected pathology. The findings were benign pathology in the appendix (34%), malignancy (30%), gynecologic pathology (5%), gastrointestinal pathology (4%), or unspecified (27%). Meta-analysis showed an overall rate of unexpected findings of 3.5% (95% CI 2.7–4.3; moderate certainty), and the sensitivity analysis showed similar results. Malignancy found in the appendix when treating suspected acute appendicitis was 1.0% (95% CI 0.8–1.3%; high certainty). Conclusion: The rate of other histopathological findings in patients with suspected acute appendicitis was low and a malignancy in appendix was found in 1% of patients.

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“…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%

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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Negative Appendicectomy Rate: Incidence and Predictors

Cited by 17 publications

References 27 publications

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

Other Pathologies Were Rarely Reported after Laparoscopic Surgery for Suspected Appendicitis: A Systematic Review and Meta-Analysis

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

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