Preoperative imaging lowers the negative appendectomy rate in acute appendicitis

Area of Science:

• Emergency Medicine
• Surgical Diagnostics
• Health Services Research

Background:

• Acute appendicitis diagnosis is challenging, often relying on clinical assessment in Denmark.
• Current practice prioritizes rapid assessment, with imaging used selectively.
• This approach may lead to a high rate of negative appendectomies, especially in young adults.

Purpose of the Study:

• To evaluate the impact of preoperative imaging on negative appendectomy rates.
• To assess the diagnostic accuracy of clinical assessment versus imaging-guided strategies.
• To inform the adoption of guideline-based diagnostic pathways for appendicitis.

Main Methods:

• Retrospective cohort study of 613 adult patients undergoing surgery for suspected appendicitis.
• Data collected from electronic medical records at a tertiary university hospital (2021-2023).
• Comparison of negative appendectomy rates between patients with and without preoperative imaging.

Main Results:

• Overall negative appendectomy rate (NAR) was 14.9%.
• Patients without preoperative imaging had a NAR of 24.4%.
• Patients with preoperative imaging had a significantly lower NAR of 6.9% (p < 0.001).

Conclusions:

• Clinical assessment alone results in a substantial number of unnecessary appendectomies.
• Preoperative imaging is crucial for reducing negative appendectomy rates.
• Wider adoption of guideline-based imaging strategies can improve diagnostic accuracy and resource utilization.