What is negative about negative appendicectomy rates? An experience from a district general hospital

Aravindan Narayanan, Shalini Sundararaman, Lakshminarayanan Varadhan, Ranbir Rajput, Vivek Gupta, Nick Reay-Jones

Abstract


Background:Negative appendicectomy rate is an important outcome measure following appendicectomy and there is a huge disparity on the quoted rates amongst various institutions globally. Our aim is to explore the outcomes following appendicectomy especially in relation to the histologically normal appendix and establish the clinical implications.

Methods:Data was collected from the OPCS database from 2010-2012 of all emergency appendicectomies (open and laparoscopic) and retrospective review of all consecutive negative appendicectomies were carried out in that period with particular emphasis on per-operative findings, pathology reports and the clinical outcome.

Results:550 open and 118 laparoscopic appendicectomy operations were performed in the study period with age ranging from 4 to 92 years. There were 319 male and 349 female patients in the study group. The length of stay varied from 2 days to 10 days with an average of 3.0 days. Of the patients who had negative histology for appendicitis, 66 had alternate findings at pathology. There was no 30- day readmission recorded for these patients from the negative appendicectomy group and their post-operative pain score was significantly lower (P <0.001).

Conclusions:Although the negative appendicectomy rates are declining globally with the use of imaging modalities, arguments for removing a macroscopically normal appendix still exists. With varied pathology noted in a macroscopically normal appendix it is reasonable to remove it especially with resultant better clinical outcome and perhaps probe the need for achieving lower negative appendicectomy rates.


Keywords


Acute appendicitis, Laparoscopy, Negative appendicectomy, Alternative pathology, Clinical outcome

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References


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