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Emergency appendicectomy in Australia: findings from a multicentre, prospective study
Thomas Arthur1,2, Richard Gartrell3, Bavahuna Manoharan4
1Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
ANZ Journal of Surgery
|July 8, 2017
Summary
This study found a 19% negative appendicectomy rate (NAR) in Australia, with most emergency appendicectomies performed laparoscopically. While within traditional limits, this NAR is high compared to international standards, indicating room for improvement in acute appendicitis diagnosis.
Area of Science:
- Surgical outcomes research
- Gastrointestinal surgery epidemiology
Background:
- Emergency appendicectomy is Australia's most frequent emergency surgical procedure.
- Limited contemporary data exist on current Australian emergency appendicectomy practices and outcomes.
Purpose of the Study:
- To assess current practices and outcomes of emergency appendicectomy in Australia.
- To determine the negative appendicectomy rate (NAR) and complication rates.
Main Methods:
- A multicentre, prospective, observational study.
- Recruited 1189 patients undergoing emergency appendicectomy across 27 Australian centres over 2 months.
- Primary outcome: negative appendicectomy rate (NAR); secondary outcomes: 30-day complications, operative method, and conversion rates.
Main Results:
- The overall NAR was 19.0%.
- Laparoscopic-first approach used in 98.2% of cases, with a 2.4% conversion rate to open surgery.
- 30-day complication rate was 9.4%, including readmission (6.6%) and surgical site infection (1.9%). Open surgery correlated with higher readmission and infection rates.
Conclusions:
- The study's NAR is acceptable by traditional Australian standards but high internationally.
- Findings suggest a need to refine diagnostic accuracy for acute appendicitis to lower the NAR.
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