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Morbidity after negative appendectomy: a single-centre experience on 627 cases.

Nicolò Tamini1,2, Letizia Santurro3, Maria Francesca Chiappetta3

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European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|May 2, 2019
PubMed
Summary

Negative appendectomy (NA) occurs in 14.9% of suspected appendicitis cases, with young women at higher risk. Increasing preoperative CT scans can reduce NA rates without increasing perforation, balancing surgical risks.

Keywords:
Acute appendicitsDiagnostic laparoscopyNegative appendectomy

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Area of Science:

  • Abdominal Surgery
  • Diagnostic Imaging
  • Surgical Outcomes

Background:

  • Acute appendicitis is a common cause of emergency department abdominal pain.
  • Negative appendectomy (NA) rates and optimal management strategies for nonpathological appendices remain debated.
  • This study analyzes clinical outcomes of NA to assess the burden of potentially avoidable procedures.

Purpose of the Study:

  • To analyze clinical outcomes of histologically negative appendectomy (NA).
  • To elucidate the burden associated with potentially avoidable appendectomy procedures.
  • To identify risk factors and optimal diagnostic strategies for reducing NA.

Main Methods:

  • Retrospective analysis of a prospectively collected database of patients undergoing appendectomy for suspected appendicitis.
  • Exclusion of elective appendectomies, appendectomies for other causes, or those during other procedures.
  • Analysis of patient demographics, preoperative imaging (CT, ultrasound), operative details, and clinical outcomes.

Main Results:

  • A negative appendectomy (NA) rate of 14.9% was observed in 627 patients.
  • Preoperative CT scan sensitivity was 0.949, specificity 0.625; ultrasound sensitivity was 0.648, specificity 0.438.
  • Length of stay and complication rates in NA patients were comparable to uncomplicated appendicitis, but lower than severe appendicitis.

Conclusions:

  • Young women are at higher risk for negative appendectomy (NA).
  • Increasing preoperative CT use and integrating imaging assessments can reduce NA incidence without increasing perforation rates.
  • Surgeons must carefully weigh risks and benefits before performing appendectomy on a macroscopically noninflamed appendix during diagnostic laparoscopy.