The Impact of Helical Computed Tomography on the Negative Appendectomy Rate: A Multi-Center Comparison

Kim, Kyuseok; Lee, Christopher C.; Song, Ki–Whan; Kim, Woojeong; Suh, Giljoon; Singer, Adam J.

doi:10.1016/j.jemermed.2007.05.042

Cited by 52 publications

(32 citation statements)

References 37 publications

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“…An increased proportion of uncomplicated cases could have indicated the overuse of surgery when additional radiology was used but this outcome was not found in our study. Other studies have also demonstrated 151 a decrease in the number of negative appendectomies with increased use of preoperative imaging [18,28,29]. An important benefit of reducing the number of negative appendectomies is avoiding complications from unnecessary surgery, which according to our data are comparable in number to that of OA.…”

Section: Discussionsupporting

confidence: 70%

Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients

Dahlberg

Boström²

2017

Dig Surg

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Acute appendicitis is one of the most common reasons for emergency surgery. At Stockholm South General Hospital, information on all patients - 15 years or older - undergoing surgery for acute appendicitis is included in a quality register. Data on surgical method, preoperative imaging, hospital stay, intraoperative findings, and 30-day complications were recorded for each patient. From January 2004 to December 2014, 5,614 consecutive patients were registered. The percentage of patients examined with preoperative imaging increased from 30% in 2004 to 93% in 2014. The use of laparoscopic appendectomy increased from 6 to 79%. Negative appendectomies decreased from 7.5-10 to 1.7%. The mean perforation rate was 28.6%. Some form of postoperative complication occurred in 6.6% of those on whom laparoscopy was performed and 10.5% of those who underwent an open surgery, with a significant difference (p < 0.001) in the rate of surgical site infections (surgical site infections, higher in open cases) but with no difference in the number of deep postoperative abscesses. The overall hospital stay decreased from 2004 to 2014 for perforated and non-perforated appendicitis. The overall 30-day mortality rate was 0.12%. Changes in preoperative imaging and treatment strategy for appendicitis during this period resulted in a lower rate of negative appendectomies with acceptable complication rates and shortened hospital stay.

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Section: Discussionsupporting

confidence: 70%

Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients

Dahlberg

Boström²

2017

Dig Surg

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“…Studie Zeitraum Patientenzahl Negative Appendektomie Alvarado [8] 1975-1976 254 10,6% Colson et al [9] 1995-1996 659 9,1% Korner et al [10] 1989-1993 1486 24,0% Zielke et al [11] 1989-1996 2.359 14.3% Flum et al [12] 1987-1998 63.707 15,5% Bijnen et al [13] 1991-1999 1.821 15,5% Jones et al [14] 2000-2002 385 7,8% Kim et al [15] 2005 339 10,6% Cuschieri et al [16] 2006-2007 3.540 5,5% Simpson et al [1] 2004-2005 199 17,6% Wagner et al [17] 2000 [14]. Die Kombination aus CT-Diagnostik und klinischem Untersuchungsbefund lieferte bessere Ergebnisse als der alleinige klinische Untersuchungsbefund bzw.…”

Section: Tab 1 Rate Negativer Appendektomien In Der Literaturunclassified

Strategien zur Vermeidung negativer Appendektomien

Wente

Waleczek²

2009

Chirurg

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Appendectomy is the most commonly performed emergency surgical procedure. Even in the era of laparoscopic surgery and modern computed tomography, the rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (10-15%). The general problem and incidence, as well as the influence of modern diagnostic modalities on the rate of negative appendectomies are of particular clinical relevance. Several clinical scoring systems have been developed, but they did not find their way into the daily clinical routine. A proposed diagnostic algorithm could support further efforts to reduce the rate of negative appendectomies. The risk of overtreatment in the reduction of the negative appendectomy rate might potentially lead to acceptance of a higher perforation rate.

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“…Many researchers have affirmed that routine use of CT scan have led to proportionate decrease in the NAR. 9,49 However, it was also noted by many that liberal use of CT scan for AA may not help as much as claimed by previous studies 50 and also there are known pitfalls of CT scan. 51 The biggest problem faced today is the lack of clear guidelines or consensus as to the indications of using CT scanning in AA, leaving the discretion with institutions/regions to follow what possibly suit them the most.…”

Section: Ct Scanmentioning

confidence: 95%

Imaging in acute appendicitis: What, when, and why?

Debnath

George

Ravikumar

2017

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 7 4 -7 9 a r tLaboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article. #

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The Impact of Helical Computed Tomography on the Negative Appendectomy Rate: A Multi-Center Comparison

Cited by 52 publications

References 37 publications

Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients

Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients

Strategien zur Vermeidung negativer Appendektomien

Imaging in acute appendicitis: What, when, and why?

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