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Surgery. 2008 Aug;144(2):276-82. doi: 10.1016/j.surg.2008.03.040.

Defining the current negative appendectomy rate: for whom is preoperative computed tomography making an impact?

Author information

1
Department of Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY 10065, USA. plw9001@nyp.org

Abstract

BACKGROUND:

Historically, the negative appendectomy rate (NAR) for patients operated on for acute appendicitis (AA) has exceeded 20%. We sought to define the current NAR with increased use of computed tomography (CT) and laparoscopy.

METHODS:

Records of 1425 consecutive patients undergoing appendectomy for suspicion of AA during the past 7 years at a single institution were reviewed. The NAR was calculated and compared with earlier data from this institution (1995-1999). Statistical methods included the Fisher exact test and the Student t test; differences of P < .05 were considered statistically significant.

RESULTS:

The overall NAR was 7.65% compared to 16.3% over the period 1995-1999 (P = .0001), without a change in the perforation rate. Concurrently, the rate of preoperative CT increased from 32% to 95%. CT was associated with a lesser NAR only among adult females (7.6% vs 20.8%, P = .005) but not among adult males or children. No difference in NAR was noted in comparing laparoscopic and open appendectomy. Patients without AA had a greater mean duration of symptoms and lower white blood cell count at presentation than those with AA. Most patients undergoing negative appendectomy had a CT, and more than 50% had CT interpretations that were positive for, or could not exclude, AA.

CONCLUSIONS:

The NAR in our hospital has decreased progressively to approximately 5%. Although preoperative CT is used in almost all patients, it is only associated with a lesser NAR among adult females. False-positive CTs may contribute to the residual NAR, and further data are needed to determine whether subgroups of male or pediatric patients benefit from preoperative CT.

PMID:
18656636
DOI:
10.1016/j.surg.2008.03.040
[Indexed for MEDLINE]
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