Dirie Jamal, Suleman Humza, Karimjee Hussain
General Surgery, Royal Surrey NHS Foundation Trust, Guildford, GBR.
Cureus. 2023 Jul 13;15(7):e41809. doi: 10.7759/cureus.41809. eCollection 2023 Jul.
Background Appendicitis is one of the most common causes of acute abdominal pain and appendicectomy is one of the most frequently performed surgical procedures. The proliferation of radiological imaging has reduced the number of patients who have a normal appendix removed, i.e., a negative appendicectomy. We aimed to assess the effect of preoperative imaging on the negative appendicectomy rate (NAR). Methodology All emergency appendicectomies performed at a district general hospital in the United Kingdom over two separate one-year periods were retrospectively analysed using emergency theatre log books. The timeframes were chosen based on the introduction of a diagnostic pathway to reduce the number of appendicectomies performed on patients later found not to have appendicitis or alternative abnormality, i.e., a negative appendicectomy. This pathway involved a greater emphasis placed on preoperative imaging (CT or ultrasound) for patients with suspected appendicitis. The study excluded any patients who were found to have an alternative pathology during surgery. Information technology databases were used to collect data on patient demographics, date of surgery, histology, and any preoperative imaging that was performed. All histological findings showing acutely inflamed appendices and those positive for malignancy were categorised as positive, whereas all other findings were categorised as negative. Results During our initial data collection period (April 2018 to April 2019), we collected data on 207 patients who underwent an appendicectomy. The NAR was 17%. During our subsequent data collection period (August 2020 to August 2021), we collected data on 184 patients. The NAR was 16%. In our adult population, the NAR decreased from 13% to 9%. Discussion At first glance, the NAR does not seem to have improved. On closer look, all patients over the age of 21 years in our re-audit underwent pr-operative CT, and there was a reduction in the NAR in these patients. The issue arises with younger patients, in whom justifying the radiation associated with a CT scan may be difficult. Although ultrasound does not carry the same radiation risk, previous audits at our trust have that shown its sensitivity and specificity for appendicitis is approximately 60%. We may have to explore alternative imaging modalities such as MRI in the paediatric population or accept the higher NAR.
阑尾炎是急性腹痛最常见的病因之一，阑尾切除术是最常施行的外科手术之一。放射影像学的发展减少了切除正常阑尾的患者数量，即阴性阑尾切除术的数量。我们旨在评估术前影像学检查对阴性阑尾切除术率（NAR）的影响。
使用急诊手术室日志，对英国一家地区综合医院在两个独立的一年期间内进行的所有急诊阑尾切除术进行回顾性分析。选择这些时间段是基于引入了一种诊断途径，以减少对后来发现没有阑尾炎或其他异常情况的患者进行阑尾切除术的数量，即阴性阑尾切除术。该途径更加强调对疑似阑尾炎患者进行术前影像学检查（CT或超声）。该研究排除了在手术期间发现有其他病理情况的任何患者。使用信息技术数据库收集患者人口统计学、手术日期、组织学以及所进行的任何术前影像学检查的数据。所有显示阑尾急性炎症和恶性阳性结果的组织学发现都归类为阳性，而所有其他发现都归类为阴性。
在我们最初的数据收集期（2018年4月至2019年4月），我们收集了207例行阑尾切除术患者的数据。阴性阑尾切除术率为17%。在随后的数据收集期（2020年8月至2021年8月），我们收集了184例患者的数据。阴性阑尾切除术率为16%。在我们的成年人群中，阴性阑尾切除术率从13%降至9%。
乍一看，阴性阑尾切除术率似乎没有改善。仔细观察发现，我们重新审核的所有21岁以上患者都接受了术前CT检查，这些患者的阴性阑尾切除术率有所降低。年轻患者出现了问题，因为对他们来说，证明CT扫描相关的辐射风险是困难的。尽管超声没有同样的辐射风险，但我们医院之前的审核表明，其对阑尾炎的敏感性和特异性约为60%。我们可能不得不探索儿科人群中的替代成像方式，如MRI，或者接受较高的阴性阑尾切除术率。
