TY - JOUR
T1 - Negative appendectomy rate in the pediatric population
T2 - can we reach near-zero rates? An observational study
AU - Dreznik, Yael
AU - Paran, Maya
AU - Sher, Carmel
AU - Konen, Osnat
AU - Baazov, Artur
AU - Nica, Adrianna
AU - Kravarusic, Dragan
N1 - Publisher Copyright:
© 2023 Royal Australasian College of Surgeons.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - Introduction: Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors. Methods: A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected. Results: Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre-operative imaging (from 40% to nearly 100%). Conclusion: Low NAR under 2% is an achievable benchmark in the era of accessible pre-operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near-zero rates of NAR.
AB - Introduction: Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors. Methods: A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected. Results: Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre-operative imaging (from 40% to nearly 100%). Conclusion: Low NAR under 2% is an achievable benchmark in the era of accessible pre-operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near-zero rates of NAR.
KW - acute appendicitis
KW - negative appendectomy rate
KW - normal appendix
UR - http://www.scopus.com/inward/record.url?scp=85179300757&partnerID=8YFLogxK
U2 - 10.1111/ans.18825
DO - 10.1111/ans.18825
M3 - Article
C2 - 38082452
AN - SCOPUS:85179300757
SN - 1445-1433
VL - 94
SP - 204
EP - 207
JO - ANZ Journal of Surgery
JF - ANZ Journal of Surgery
IS - 1-2
ER -