[Acute appendicitis]

Area of Science:

• Medicine
• Surgery
• Public Health

Background:

• Appendectomy rates have seen a notable decline over the past two decades in Germany.
• This trend is particularly pronounced in Hannover, with a 50% reduction in appendectomies.
• Concurrently, the proportion of patients hospitalized for appendicitis but not operated on has risen substantially from 20% to 65%.

Purpose of the Study:

• To analyze trends in appendectomy rates and outcomes in Germany.
• To investigate the implications of decreased surgical intervention for appendicitis.
• To identify factors contributing to mortality and patient complaints related to appendicitis.

Main Methods:

• Retrospective analysis of appendectomy rates and patient data over 20 years.
• Examination of hospitalization and surgical intervention statistics.
• Review of patient complaints and mortality data related to appendicitis.

Main Results:

• A significant decrease in appendectomy rates observed nationwide and in Hannover.
• A substantial increase in non-operative management post-hospitalization.
• An 80% reduction in mortality associated with appendicitis, now at 0.7 per 100,000 population.
• Advanced appendicitis with perforation identified as the primary cause of death, predominantly in patients over 65.
• Delayed diagnosis cited as a major issue in 10% of general surgery complaints concerning appendicitis.

Conclusions:

• While appendectomy rates have declined, overall mortality has improved.
• Delayed diagnosis and advanced appendicitis in the elderly remain critical challenges.
• The rise in non-operative management warrants further investigation into its efficacy and safety.