Hatem Fady, Baig Hassan, Khaldas Foad, Lucocq James
General Surgery, Cairo University, Cairo, EGY.
Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, GBR.
Cureus. 2022 Jul 28;14(7):e27412. doi: 10.7759/cureus.27412. eCollection 2022 Jul.
Introduction A negative appendicectomy rate (NAR) is defined as the portion of pathologically normal appendices removed surgically in patients suspected of having acute appendicitis. The lifetime risk of acute appendicitis is 8.6% for males and 6.7% for females; contrarily, the lifetime risk of appendicectomy is 12% for males and 23.1% for females. This study aims primarily to evaluate the true NAR in females of childbearing age to offer insight into potential strategies to reduce the number of unnecessary operative procedures carried out, along with their associated morbidity and mortality. Methods All emergency appendicectomies over a one-year period were retrospectively identified and collected from a single tertiary care centre. Preoperative clinical, laboratory and postoperative histopathological data were collected. The negative appendicectomy rate in subgroups divided by biomarkers and radiological imaging findings were analysed. The diagnostic value of these modalities in the context of acute appendicitis was found by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. Results A total of 417 patients were included (median age 26; M:F, 0.7:1.0). The overall negative appendicectomy rate was 35.0% (146/417). Two-hundred sixty-one patients underwent an appendicectomy in the child-bearing age group. The NAR was significantly higher in those females with raised WBC and C-reactive protein (CRP) compared to their male counterparts (p-value -<0.001). Conclusion Women of childbearing age have a higher NAR of 43% when compared to the general population of 35%. Preoperative tests, including ultrasound scans, computed tomography and inflammatory markers in blood tests, help direct those who would benefit from surgery to the operating theatre, however, no test alone is suitably sensitive or specific. To reduce the NAR, management options include a return to observation and serial examination, increased use of low-dose CT or a commitment to improving the performance of ultrasonography.
引言 阴性阑尾切除率（NAR）的定义是，在疑似患有急性阑尾炎的患者中，手术切除的阑尾经病理检查为正常的比例。男性一生中患急性阑尾炎的风险为8.6%，女性为6.7%；相反，男性一生中接受阑尾切除术的风险为12%，女性为23.1%。本研究主要旨在评估育龄期女性的真实NAR，以便深入了解减少不必要手术操作数量及其相关发病率和死亡率的潜在策略。方法 回顾性确定并收集了一家三级医疗中心在一年期间进行的所有急诊阑尾切除术。收集术前临床、实验室和术后组织病理学数据。分析了按生物标志物和影像学检查结果划分的亚组中的阴性阑尾切除率。通过计算敏感性、特异性、阳性预测值和阴性预测值，发现了这些检查方法在急性阑尾炎诊断中的价值。结果 共纳入417例患者（中位年龄26岁；男:女，0.7:1.0）。总体阴性阑尾切除率为35.0%（146/417）。261例患者在育龄期组接受了阑尾切除术。白细胞（WBC）和C反应蛋白（CRP）升高的女性患者的NAR显著高于男性患者（p值<0.001）。结论 与总体人群的35%相比，育龄期女性的NAR更高，为43%。术前检查，包括超声扫描、计算机断层扫描和血液检查中的炎症标志物，有助于将那些将从手术中获益的患者送往手术室，然而，没有一种检查单独具有足够的敏感性或特异性。为降低NAR，管理选项包括恢复观察和系列检查、增加低剂量CT的使用或致力于提高超声检查的性能。
