Advertisement

Negative appendectomy: a 10-year review of a nationally representative sample

      Abstract

      Background

      Appendectomy remains one of the most common emergency surgical procedures encountered throughout the United States. With improvements in diagnostic techniques, the efficiency of diagnosis has increased over the years. However, the entity of negative appendectomies still poses a dilemma because these are associated with unnecessary risks and costs to both patients and institutions. This study was conducted to show current statistics and trends in negative appendectomy rates in the United States.

      Methods

      A retrospective analysis was conducted using data from the National Inpatient Sample from 1998 to 2007. Adult patients (>18 y) having undergone appendectomies were identified by the appropriate International Classification of Diseases 9th revision codes. Patients with incidental appendectomy and those with appendiceal pathologies, also identified by relevant International Classification of Diseases 9th revision codes, were excluded. The remaining patients represent those who underwent an appendectomy without appendiceal disease. The patients then were stratified according to sex, women were classified further into younger (18–45 y) and older (>45 y) based on child-bearing age. The primary diagnoses subsequently were categorized by sex to identify the most common conditions mistaken for appendiceal disease in the 2 groups.

      Results

      Between 1998 and 2007, there were 475,651 cases of appendectomy that were isolated. Of these, 56,252 were negative appendectomies (11.83%). There was a consistent decrease in the negative appendectomy rates from 14.7% in 1998 to 8.47% in 2007. Women accounted for 71.6% of cases of negative appendectomy, and men accounted for 28.4%. The mortality rate was 1.07%, men were associated with a higher rate of mortality (1.93% vs .74%; P < .001). Ovarian cyst was the most common diagnosis mistaken for appendicitis in younger women, whereas malignant disease of the ovary was the most common condition mistaken for appendiceal disease in women ages 45 and older. The most common misdiagnosis in men was diverticulitis of the colon.

      Conclusions

      There has been a consistent decline in the rates of negative appendectomy. This trend may be attributed to better diagnostics. Gynecologic conditions involving the ovary are the most common to be misdiagnosed as appendiceal disease in women.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Verbrugghe P.
        • Kujala P.
        • Waelput W.
        • et al.
        Clusterin in human gut-associated lymphoid tissue, tonsils, and adenoids: localization to M cells and follicular dendritic cells.
        Histochem Cell Biol. 2008; 129: 311-320
        • Matsushita M.
        • Uchida K.
        • Okazaki K.
        Role of the appendix in the pathogenesis of ulcerative colitis.
        Inflammopharmacology. 2007; 15: 154-157
        • Ma K.W.
        • Chia N.H.
        • Yeung H.W.
        • et al.
        If not appendicitis, then what else can it be?.
        Hong Kong Med J. 2010; 16: 12-17
        • Addiss D.G.
        • Shaffer N.
        • Fowler B.S.
        • et al.
        The epidemiology of appendicitis and appendectomy in the united States.
        Am J Epidemiol. 1990; 132: 910-925
        • Flum D.R.
        • Koepsell T.
        • Flum D.R.
        • et al.
        The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis.
        Arch Surg. 2002; 137: 799-804
        • Velanovich V.
        • Satava R.
        Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance.
        Am Surg. 1992; 58: 264-269
        • Harswick C.
        • Uyenishi A.A.
        • Kordick M.F.
        • et al.
        Clinical guidelines, computed tomography scan, and negative appendectomies: a case series.
        Am J Emerg Med. 2006; 24: 68-72
        • van Randen A.
        • Laméris W.
        • van Es H.W.
        • et al.
        Profiles of US and CT imaging features with a high probability of appendicitis.
        Eur Radiol. 2010; 20: 1657-1666
        • Wagner P.L.
        • Eachempati S.R.
        • Soe K.
        • et al.
        Defining the current negative appendectomy rate: for whom is preoperative computed tomography making an impact?.
        Surgery. 2008; 144: 276-282
        • Coursey C.A.
        • Nelson R.C.
        • Patel M.B.
        • et al.
        Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies?.
        Radiology. 2010; 254: 460-468
        • Wente M.N.
        • Waleczek H.
        Strategy for avoidance of negative appendectomies.
        Chirurg. 2009; 80: 588-593
        • Mirza M.R.
        • Habib L.
        • Jaleel F.
        Factors identified for negative appendicectomies.
        Mymensingh Med J. 2009; 18: 198-202
        • Dearing D.D.
        • Recabaren J.A.
        • Alexander M.
        Can computed tomography scan be performed effectively in the diagnosis of acute appendicitis without the added morbidity of rectal contrast?.
        Am Surg. 2008; 74: 917-920
        • Harswick C.
        • Uyenishi A.A.
        • Kordick M.F.
        • et al.
        Clinical guidelines, computed tomography scan, and negative appendectomies: a case series.
        Am J Emerg Med. 2006; 24: 68-72
        • Piper H.G.
        • Rusnak C.
        • Orrom W.
        • et al.
        Current management of appendicitis at a community center—how can we improve?.
        Am J Surg. 2008; 195: 585-588
        • Brandt M.M.
        • Wahl W.L.
        Liberal use of CT scanning helps to diagnose appendicitis in adults.
        Am Surg. 2003; 69: 727-731