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Acute appendicitis---a recent audit of an old problem
1Department of Surgery, Queen Elizabeth Hospital, Wylie Road, Kowloon, Hong Kong.
Insights
Diagnostic accuracy for appendicitis was 74% overall. Female patients, especially those aged 15-40, had lower diagnostic accuracy compared to males, highlighting a need for improved appendicitis diagnosis in this demographic.
Area of Science:
- Surgery
- Gastroenterology
- Public Health
Background:
- Appendicitis remains a common surgical emergency requiring accurate diagnosis.
- Diagnostic challenges in appendicitis can lead to delayed treatment or unnecessary surgery.
- Assessing diagnostic accuracy and patient outcomes is crucial for improving surgical care.
Purpose of the Study:
- To evaluate the diagnostic accuracy of appendicectomy.
- To identify factors influencing diagnostic accuracy, particularly in female patients.
- To compare outcomes based on timing of surgery and appendicitis complication status.
Main Methods:
- Retrospective review of appendicectomy cases at Queen Elizabeth Hospital, Hong Kong (1993-1994).
- Analysis of diagnostic accuracy for true appendicitis.
- Comparison of diagnostic accuracy and morbidity rates between genders, age groups, and surgical timing.
Main Results:
- Overall diagnostic accuracy for appendicitis was 74%.
- Diagnostic accuracy was significantly lower in female patients (66%) compared to males (82%), particularly in those aged 15-40 years (62%).
- Complicated appendicitis (21% morbidity) had higher morbidity than uncomplicated cases (9%). No significant difference in outcomes was found based on surgical timing (same day vs. next day admission).
Conclusions:
- Appendicectomy diagnostic accuracy requires improvement, especially for female patients aged 15-40.
- While overall morbidity and mortality rates were acceptable, complicated appendicitis poses a higher risk.
- The timing of surgery (same day vs. next day) did not significantly impact diagnostic accuracy or morbidity.
Abstract:
We conducted a retrospective review of all patients who had an appendicectomy performed at the Queen Elizabeth Hospital, Hong Kong, from January 1993 through December 1994. The diagnostic accuracy for true appendicitis was 74%. Nine per cent of patients had other pathologies, which also needed exploration. The diagnostic accuracy in female patients was 66%, compared with 82% for male patients (P<0.0001). Female patients aged between 15 to 40 years were diagnosed accurately 62% of the time, which has significantly lower than the rate for other female patients (P=0.016). the overall morbidity and mortality rates were 9.2% and 3%, respectively. Complicated appendicitis had a higher morbidity rate of 21%, compared with 9% for uncomplicated appendicitis (P<0.0001). Results for patients who were operated on the day of admission were compared with those who were operated on the day after admission. No significant difference in diagnostic accuracy (P=0.46), percentage of complicated appendicitis (P=0.7), and morbidity rate (P=0.8) was found.