Current management of appendicitis at a community center—how can we improve?

Abstract 

Background

Controversies regarding the diagnosis and treatment of appendicitis remain. Practices and outcomes at a community center including imaging, timing of surgery, and surgical technique are reported.

Methods

From January to July 2006, 134 patients undergoing appendectomy in Victoria, British Columbia, were reviewed. Accuracy of preoperative imaging, time from the emergency room to the operating room, length of stay, and early complications were analyzed. Patients with and without perforation were compared using sample t tests.

Results

Preoperative computed tomography was obtained for 101 patients (75%) with a negative appendectomy rate of 3% versus 10% for patients without imaging. Imaging did not prolong the time to surgery (11.8 vs 10.9 h, P = .48). Patients with perforation stayed in the hospital significantly longer and had more complications.

Conclusions

The liberal use of computed tomography resulted in fewer negative appendectomies without a significant delay to surgery. Patients with perforation had increased complications and longer hospitalizations. Efforts should be made to identify and treat early appendicitis.

Keywords: Appendectomy, Perforated appendicitis, Laparoscopy