Defining the current negative appendectomy rate: For whom is preoperative computed tomography making an impact?

  • Wagner P
  • Eachempati S
  • Soe K
 et al. 
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Abstract

Background: Historically, the negative appendectomy rate (NAR) for patients operated on for acute appendicitis (AA) has exceeded 20%. We sought to define the current NAR with increased use of computed tomography (CT) and laparoscopy. Methods: Records of 1425 consecutive patients undergoing appendectomy for suspicion of AA during the past 7 years at a single institution were reviewed. The NAR was calculated and compared with earlier data from this institution (1995-1999). Statistical methods included the Fisher exact test and the Student t test; differences of P < .05 were considered statistically significant. Results: The overall NAR was 7.65% compared to 16.3% over the period 1995-1999 (P = .0001), without a change in the perforation rate. Concurrently, the rate of preoperative CT increased from 32% to 95%. CT was associated with a lesser NAR only among adult females (7.6% vs 20.8%, P = .005) but not among adult males or children. No difference in NAR was noted in comparing laparoscopic and open appendectomy. Patients without AA had a greater mean duration of symptoms and lower white blood cell count at presentation than those with AA. Most patients undergoing negative appendectomy had a CT, and more than 50% had CT interpretations that were positive for, or could not exclude, AA. Conclusions: The NAR in our hospital has decreased progressively to ∼5%. Although preoperative CT is used in almost all patients, it is only associated with a lesser NAR among adult females. False-positive CTs may contribute to the residual NAR, and further data are needed to determine whether subgroups of male or pediatric patients benefit from preoperative CT. © 2008 Mosby, Inc. All rights reserved.

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Authors

  • Patrick L. Wagner

  • Soumitra R. Eachempati

  • Kevin Soe

  • Frederic M. Pieracci

  • Jian Shou

  • Philip S. Barie

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