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[Quality assurance in appendicitis--what has changed? Analysis of 2 prospective multicenter quality assurance
A Koch1, L D Schreiber, W Mokros
1Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg. Andreas.Koch@medizin.uni-magdeburg.de
Aims Of The Study:
The present study aims to determine the influence of introduction of laparoscopic techniques and of DRG (diagnosis related gains) on the quality of appendicitis therapy.
Patients And Methods:
All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1.7.1988 to 31.12.1989, 6,266 patients from 18 hospitals were included, and from 1.6.1996 to 31.5.1997, 7,398 patients from 34 institutions.
Results:
In the first period (1988/89), 1,869 patients were treated conservatively (29.8%), 4,397 (70.2%) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8%, the perforation rate was 8.3% and the wound infection rate 9.6%. In the second period (1996/97), 2,430 patients were treated conservatively (32.8%), in 24.9% of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9% and the rate of wound infections 2.5%. During this second period, 33.2% of all appendectomies were performed using the laparoscope, the conversion rate was 7.2%.
Conclusions:
The introduction of laparoscopic techniques and of DRG did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.