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Surgical audit: A prospective study of the morbidity and mortality of acute appendicitis
T S Malatani1, A A Latif, A Al-Saigh
1Department of Surgery, King Saud University-Abha Branch, College of Medicine, Abha, Saudi Arabia.
Abstract:
Between March and September 1989, acute apendicitis was clinically diagnosed in 317 patients who were studied as part of a prospective surgical audit. The study was designed to determine the accuracy of diagnosis, comparison of the macroscopic appearance of the appendix at operation, and subsequent histopathology and complications associated with the morbidity and mortality of emergency appendectomy. The clinical diagnosis was correct in 278 patients (88%). Thirty-nine (12%) of the patients had a negative laparotomy. There was no mortality, and wound infection was the source of increased morbidity in 37 (12%) patients. The highest incidence of wound infection was among those who had pus in the peritoneum (20%) or had a perforated or gangrenous appendix (25%). When the macroscopic appearance of the appendix was compared with the subsequent histopathological findings, a false positive error of 7% and a false negative error of 42% was found. During appendectomy the gross appearance of the appendix must be carefully noted so that a meticulous surgical technique can be complemented by appropriate antibiotic prophylaxis against wound infection, started at the time of surgery.
Insights
This prospective audit of 317 acute appendicitis cases found clinical diagnosis accuracy at 88%. While no deaths occurred, wound infections impacted 12% of patients, particularly those with pus or perforated appendices.
Area of Science:
- Surgical Audit
- Gastrointestinal Surgery
- Clinical Diagnosis
Background:
- Acute appendicitis diagnosis relies on clinical assessment, but accuracy can vary.
- Surgical audits are crucial for evaluating diagnostic accuracy and patient outcomes.
- Understanding complications like wound infection is vital for improving appendectomy procedures.
Purpose of the Study:
- To assess the accuracy of clinical diagnosis in acute appendicitis.
- To compare macroscopic appendix appearance with histopathology.
- To identify factors contributing to morbidity and mortality in emergency appendectomy.
Main Methods:
- Prospective surgical audit of 317 patients with clinically diagnosed acute appendicitis.
- Comparison of intraoperative macroscopic findings with postoperative histopathological results.
- Analysis of patient data for complications, focusing on wound infections.
Main Results:
- Clinical diagnosis was correct in 88% of patients; 12% underwent negative laparotomy.
- No mortality was recorded; 12% of patients experienced wound infections.
- Highest wound infection rates were observed in cases with peritoneal pus (20%) or perforated/gangrenous appendices (25%).
- Histopathological comparison revealed a 7% false positive and 42% false negative rate for macroscopic assessment.
Conclusions:
- Clinical diagnosis of acute appendicitis is reasonably accurate but not infallible.
- Careful macroscopic assessment of the appendix during surgery is essential.
- Appropriate antibiotic prophylaxis should complement meticulous surgical technique to reduce wound infections.
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