Operations for Suspected Appendicitis

How good are we?

Kim Bailey CT2

• Background• Methods• Results• Discussion• Conclusions

Background

• Appendicetomy commonest acute general surgical procedure

• Diagnosis and surgery within 24 hours of hospital admission reduces complication rates

• Role of imaging increasing• 15-20% acceptable rate of negative

appendicetomy

Methods

• Retrospective Collection over a 3 month period

• 100 cases• Data on age, sex, consultant in charge, length

of time to surgery, scan, time to scan, length of stay and histology

• T-test used to determine significance

Results

• Average Age: 32 yrs (16 – 79 yrs)• 38 Males : 62 Females• 61 CR : 39 UGI• Scans (56% of suspected cases)– 39 USS– 14 CT – 3 CT KUB

• 9 (24%) Males received scans (4 USS, 3 CT, 2 CT KUB )

The Surgery

• 100 cases– 79 Laparoscopic Appendicetomies – 14 Diagnostic Laparoscopies– 5 Laparoscopic converted to open procedures– 1 Acute Right hemicolectomy (histology – crohns)– 1 Laparotomy

14% negative rate – macroscopically normal appendix

• So are we doing our surgery within 24 hours of hospital admission??

…………………………………………. No

Time From Admission to Surgery

• 50% of cases went within 24hrs

• Average: 28.46 (5.08 – 82.02)– CR 26.01– UGI 32.30

• T-test p value = 0.01

The Other Times

• Average time from admission to scan:• CR: 16.04 (-2.49 – 70.31)• UGI: 14.21 (-2.03 – 55.21)

• Average time from scan to surgery:• CR: 19.00 (2.22 -78.19)• UGI: 28.46 (7.23 – 60.57)

• Average time post surgery to discharge:• CR: 50.21 (15.23 - 496.31) • UGI: 43.23 (3.21 – 196.51)

• Average length of stay in hospital:• CR: 77.30 (26.51 – 506.44) • UGI: 75.43 (26 -231.54)

Consultant DataConsultant: No of Cases Average time to

SurgeryLongest Waiter

JA 17 15.42 28.39

DM/Locum 3 17.37 27.14

IH 6 19.35 31.22

JG 12 23.00 36.33

PS 8 25.57 46.09

KW 7 31.34 67.57

HOG 9 33.14 91.29

PJ 6 35.24 58.00

ZK 11 37.14 82.02

JH 13 37.40 96.11

GD 4 39.13 66.51

DD 4 43.30 70.56

Histology• 86 Appendixes– 44 Acute Appendicitis – 9 necrosing/gangernous/perforated– 11 Normal – 7 None– 6 Faecolith present, no signs of appendicitis– 3 Lymphoid Hyperplasia– 2 Periappendicitis– 4 Variety

• Old healed appendicitis, foreign body at tip, hemicolectomy (crohns), distal fibrous obliteration,

25 % NEGATIVE APPENDICECTOMY RATE

If you include diagnostic laparoscopies…Excluding 7 Cases…..

DISCUSSION OF RESULTS….

Conclusion

• We take too long to get suspected appendicitis to theatre

• Currently have a higher than average negative appendicetomy rate

• Clinic signs v’s radiological evidence• More data needed • Re-audit of practice to see improvement

Questions?