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M A Gok, M Bughio, S Yim, S Khan, K Riaz, U A Khan, EP198 - Negative appendicectomy: A cohort study, British Journal of Surgery, Volume 111, Issue Supplement_8, September 2024, znae197.456, https://doi.org/10.1093/bjs/znae197.456
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Abstract
Negative appendectomy is charaterized as removal of normal appendix histopatholigically. Diagnosis of appendicitis remains a challenge, despites improved diagnostic algorithms (including scoring systems, serological & radiological tests), negative appendectomy rate remains < 20%. The aim of the study is to assess negative appendicectomy at a single centre.
Cohort study was carried out on all appendicectomies from Mar’2020 to Jan’2024. Descriptive demography & post-operative outcomes were evaluated for negative appendicectomies (Histopathological HPA confirmed normal appendix), all other appendicectomies (HPA confirmed appendicitis) were recruited as controls.
| . | Normal HPA (n = 41) . | Appendicitis HPA (n = 477) . | Mann-Whitney U (p value) . |
|---|---|---|---|
| Age(yrs) | 26.4 | 36.7 | < 0.005 |
| Sex(M : F) | 16 : 25 | 235 : 242 | NS |
| BMI(kg/m2) | 24.7 | 25.5 | NS |
| GP | 8 | 135 | NS |
| A & E | 33 | 342 | NS |
| WCC(x109/L) | 10.7 | 13.5 | < 0.0001 |
| CRP(mg/L) | 43.4 ± 10.5 | 68.3 ± 3.9 | < 0.005 |
| Open(n) | 0 | 8 | NS |
| Lap(n) | 41 | 469 | NS |
| ASA(median) | 1 | 1 | NS |
| Diagnostic(n) | |||
| Clinical | 0 | 33 | |
| USS scan | 23 | 117 | < 0.001 |
| CT scan | 18 | 327 | < 0.01 |
| AB (days) | |||
| Inpatient | 2 ± 0.5 | 2 ± 1 | NS |
| Discharge | 0 ± | 2 ± 2.5 | < 0.005 |
| Operation time (mins) | 66.2 | 75.7 | < 0.01 |
| LOS (days) (med) | 2 | 2 | NS |
| Appendix HPA (mm) | |||
| Length | 62.4 | 67.0 | NS |
| Diameter | 8.6 | 11.5 | < 0.0001 |
| Cost (£) | 3376 | 4341 | < 0.05 |
| . | Normal HPA (n = 41) . | Appendicitis HPA (n = 477) . | Mann-Whitney U (p value) . |
|---|---|---|---|
| Age(yrs) | 26.4 | 36.7 | < 0.005 |
| Sex(M : F) | 16 : 25 | 235 : 242 | NS |
| BMI(kg/m2) | 24.7 | 25.5 | NS |
| GP | 8 | 135 | NS |
| A & E | 33 | 342 | NS |
| WCC(x109/L) | 10.7 | 13.5 | < 0.0001 |
| CRP(mg/L) | 43.4 ± 10.5 | 68.3 ± 3.9 | < 0.005 |
| Open(n) | 0 | 8 | NS |
| Lap(n) | 41 | 469 | NS |
| ASA(median) | 1 | 1 | NS |
| Diagnostic(n) | |||
| Clinical | 0 | 33 | |
| USS scan | 23 | 117 | < 0.001 |
| CT scan | 18 | 327 | < 0.01 |
| AB (days) | |||
| Inpatient | 2 ± 0.5 | 2 ± 1 | NS |
| Discharge | 0 ± | 2 ± 2.5 | < 0.005 |
| Operation time (mins) | 66.2 | 75.7 | < 0.01 |
| LOS (days) (med) | 2 | 2 | NS |
| Appendix HPA (mm) | |||
| Length | 62.4 | 67.0 | NS |
| Diameter | 8.6 | 11.5 | < 0.0001 |
| Cost (£) | 3376 | 4341 | < 0.05 |
| . | Normal HPA (n = 41) . | Appendicitis HPA (n = 477) . | Mann-Whitney U (p value) . |
|---|---|---|---|
| Age(yrs) | 26.4 | 36.7 | < 0.005 |
| Sex(M : F) | 16 : 25 | 235 : 242 | NS |
| BMI(kg/m2) | 24.7 | 25.5 | NS |
| GP | 8 | 135 | NS |
| A & E | 33 | 342 | NS |
| WCC(x109/L) | 10.7 | 13.5 | < 0.0001 |
| CRP(mg/L) | 43.4 ± 10.5 | 68.3 ± 3.9 | < 0.005 |
| Open(n) | 0 | 8 | NS |
| Lap(n) | 41 | 469 | NS |
| ASA(median) | 1 | 1 | NS |
| Diagnostic(n) | |||
| Clinical | 0 | 33 | |
| USS scan | 23 | 117 | < 0.001 |
| CT scan | 18 | 327 | < 0.01 |
| AB (days) | |||
| Inpatient | 2 ± 0.5 | 2 ± 1 | NS |
| Discharge | 0 ± | 2 ± 2.5 | < 0.005 |
| Operation time (mins) | 66.2 | 75.7 | < 0.01 |
| LOS (days) (med) | 2 | 2 | NS |
| Appendix HPA (mm) | |||
| Length | 62.4 | 67.0 | NS |
| Diameter | 8.6 | 11.5 | < 0.0001 |
| Cost (£) | 3376 | 4341 | < 0.05 |
| . | Normal HPA (n = 41) . | Appendicitis HPA (n = 477) . | Mann-Whitney U (p value) . |
|---|---|---|---|
| Age(yrs) | 26.4 | 36.7 | < 0.005 |
| Sex(M : F) | 16 : 25 | 235 : 242 | NS |
| BMI(kg/m2) | 24.7 | 25.5 | NS |
| GP | 8 | 135 | NS |
| A & E | 33 | 342 | NS |
| WCC(x109/L) | 10.7 | 13.5 | < 0.0001 |
| CRP(mg/L) | 43.4 ± 10.5 | 68.3 ± 3.9 | < 0.005 |
| Open(n) | 0 | 8 | NS |
| Lap(n) | 41 | 469 | NS |
| ASA(median) | 1 | 1 | NS |
| Diagnostic(n) | |||
| Clinical | 0 | 33 | |
| USS scan | 23 | 117 | < 0.001 |
| CT scan | 18 | 327 | < 0.01 |
| AB (days) | |||
| Inpatient | 2 ± 0.5 | 2 ± 1 | NS |
| Discharge | 0 ± | 2 ± 2.5 | < 0.005 |
| Operation time (mins) | 66.2 | 75.7 | < 0.01 |
| LOS (days) (med) | 2 | 2 | NS |
| Appendix HPA (mm) | |||
| Length | 62.4 | 67.0 | NS |
| Diameter | 8.6 | 11.5 | < 0.0001 |
| Cost (£) | 3376 | 4341 | < 0.05 |
Despite radiological diagnostics, the negative appendicectomy rate was 7.9 %. Laparoscopy offers an additional diagnostic modality especially in women & post op recovery is quicker. The negative appendicectomy rate has been declining in recent years, but cannot be abolished. A negative appendicectomy rate of < 10 % must be deemed acceptable, to achieve a 90 % therapeutic appendectomy (HPA confirmed appendicitis) rate.
