Diagnosis of acute appendicitis and clinical outcomes following laparoscopic surgery: a cohort study

The clinical assessment of appendicitis remains challenging, especially between genders and across age groups. Negative appendicectomy rates (NARs) can be as high as 43% and are significantly higher in the female population. Evidence suggests blood markers such as white blood cell count (WBC) and C-reactive protein have poor predictive value. There is a lack of regional data assessing workup and outcomes following laparoscopic appendicectomy.

A multi-centre, retrospective study was performed. A database of adult patients undergoing laparoscopic appendicectomy at Manly and Mona Vale Hospitals (Sydney, Australia) was analysed with regard to clinical assessment and outcomes. The primary endpoint was histological confirmation of acute appendicitis (AA). Secondary endpoints were length of hospital stay, NAR, correlation between preoperative WBC and AA, and sensitivity of preoperative imaging.

A total of 501 patients were included in the study. AA was confirmed in 91.2% of patients. The NAR was 8.8% across all subgroups. The NAR was 12.1% in women. 95.6% of patients had preoperative imaging. There was a statistically significant relationship between WBC and length of stay (P < 0.005), with elevated WBC correlating with increasing length of stay.

We concluded that preoperative WBC when elevated can be used as a marker for AA and also as a predictor for length of stay in hospital. We would also advocate the use of preoperative imaging in young women and children.