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Institutioning a clinical practice guideline to decrease the rate of normal appendectomies.

Deanna Blisard1, Joel C Rosenfeld, Fernando Estrada

  • 1Department of Surgery, St. Lukes Hospital and Health Network, Bethlehem, Pennsylvania 18015, USA.

The American Surgeon
|September 26, 2003
PubMed
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Implementing a clinical guideline for acute appendicitis diagnosis reduced normal appendectomy rates. This initiative improved patient care by decreasing unnecessary surgeries, particularly in female patients.

Area of Science:

  • Surgery
  • Clinical Practice Guidelines

Background:

  • Laparoscopic appendectomy's rise correlated with increased normal appendectomy rates.
  • Acute appendicitis diagnosis presents challenges, leading to unnecessary procedures.

Purpose of the Study:

  • To evaluate the impact of a clinical practice guideline on normal appendectomy rates.
  • To assess the guideline's effectiveness in improving preoperative evaluation for acute appendicitis.

Main Methods:

  • Retrospective review of 464 patients undergoing appendectomy for suspected acute appendicitis (1997-2000).
  • Comparison of normal appendectomy rates before (1997-1998) and after (1999-2000) guideline implementation.
  • Analysis of rates stratified by surgical approach (open vs. laparoscopic) and sex.

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Main Results:

  • Overall normal appendectomy rate decreased from 21.7% to 16.7% post-guideline.
  • In females, the rate decreased from 31.0% to 23.1%, showing a trend towards improvement.
  • In males, the rate slightly increased from 10.4% to 11.1%.

Conclusions:

  • A clinical practice guideline effectively reduced the rate of normal appendectomies.
  • The guideline showed a positive trend in decreasing unnecessary surgeries for suspected appendicitis, especially in females.