Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications.

Details

Serval ID
serval:BIB_4C41416A986F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications.
Journal
Langenbeck's archives of surgery
Author(s)
Sauvain M.O., Slankamenac K., Muller M.K., Wildi S., Metzger U., Schmid W., Wydler J., Clavien P.A., Hahnloser D.
ISSN
1435-2451 (Electronic)
ISSN-L
1435-2443
Publication state
Published
Issued date
08/2016
Peer-reviewed
Oui
Volume
401
Number
5
Pages
643-649
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Negative appendectomies are costly and are embedded with unnecessary risks for the patients. A careful indication for surgery seems mandatory even more so, since conservative therapy emerges as a potential alternative to surgery. The aims of this population-based study were to analyze whether radiological examinations for suspected appendicitis decreased the rate of negative appendectomies without increasing the rate of perforation or worsening postoperative outcomes.
This study is a retrospective analysis of a prospective population-based database. The data collection included preoperative investigations and intraoperative and postoperative outcomes.
Based on 2559 patients, the rate of negative appendectomies decreased significantly with the use of CT scan as compared to clinical evaluation only (9.3 vs 5 %, p = 0.019), whereas ultrasonography alone was not able to decrease this rate (9.3 vs 6.2 %, p = 0.074). Delaying surgery for radiological investigation did not increase the rate of perforation (18.1 vs 19.2 %; adjusted odds ratio (OR) 1.01; 0.8-1.3; p = 0.899). Postoperative complications (surgical reintervention, postoperative wound infection, postoperative hematoma, postoperative intra-abdominal abscess, postoperative ileus) were all comparable.
In this population-based study, CT scan was the only radiological modality that significantly reduced the rate of negative appendectomy. The delay induced by such additional imaging did not increase perforation nor complication rates. Abdominal CT scans for suspected appendicitis should therefore be more frequently used if clinical findings are unconclusive.

Keywords
Adult, Appendectomy/adverse effects, Appendicitis/diagnostic imaging, Appendicitis/surgery, False Positive Reactions, Female, Humans, Intestinal Perforation/etiology, Intestinal Perforation/prevention & control, Intraoperative Complications/etiology, Intraoperative Complications/prevention & control, Male, Middle Aged, Postoperative Complications/etiology, Postoperative Complications/prevention & control, Retrospective Studies, Time-to-Treatment, Tomography, X-Ray Computed, Unnecessary Procedures, Young Adult, Appendectomy, Appendicitis, CT, Negative appendectomy, Perforated appendicitis, Ultrasound
Pubmed
Web of science
Create date
29/05/2016 15:35
Last modification date
20/08/2019 15:00
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