High rates of appendicectomy in a developing country: an attempt to contribute to a more rational use of surgical resources.

OBJECTIVE

In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiology of appendicitis.

DESIGN

Prospective clinical and pathological study.

SETTING

Teaching hospital, Madagascar.

SUBJECTS

165 patients who underwent appendicectomy during a two month period.

INTERVENTIONS

Clinical investigation and histopathological examination of removed appendixes.

MAIN OUTCOME MEASURES

Appendicitis score, local incidence of appendicectomy, appendicitis, perforation, and negative appendicectomy.

RESULTS

There was a high incidence of primary appendicectomy (51.1/10,000 population/year) in relation to the incidence of histologically confirmed appendicitis (7.7/10,000), resulting in a negative appendicectomy rate of 85% (43/10,000). There were considerable sex related differences in the incidence of primary appendicectomy (81/10,000 women/year; 22/10,000 men), appendicectomy for appendicitis (12/10,000 women/year; 4/10,000 men) and non-perforating appendicitis (8/10,000 women/year; 2/10,000 men), but much less in that of perforating appendicitis (4/10,000 women/year; 2/10,000 men).

CONCLUSION

There is potential for more economic use of medical resources by reducing the rate of negative appendicectomy. The incidence of non-perforating appendicitis depends on the number of appendicectomies done, which may explain the differences observed in the incidence of appendicitis between industrialised and developing countries.