Diagnostic ultrasound for suspected appendicitis: does the added cost produce a better outcome?

Acute appendicitis is one of the most common abdominal surgical emergencies in North America. Although the treatment of appendicitis has remained the same for over 250 years, diagnostic techniques have changed immensely. Most recently, graded compression ultrasonography has received much support. In an attempt to determine whether ultrasonography has improved the outcome in acute appendicitis, we retrospectively reviewed the records of all patients undergoing appendectomy and/or ultrasound for suspected appendicitis during two separate 12-month periods. We began using ultrasound in the diagnosis of appendicitis in 1987; therefore, 1986 was used as our pre-ultrasound year; 1989 was used as our comparison year because ultrasound had become widely applied in the diagnosis of acute appendicitis by this time. Data was tabulated on all patients undergoing appendectomy in both study years, as well as those also undergoing ultrasonography in 1989. The populations in 1986 and 1989 were similar for all data tabulated. The diagnostic accuracy rate actually decreased after the implementation of ultrasonography (85.6% vs 77.0%, P < 0.05). This trend was seen in both male and female patients, reaching statistical significance in the male population (P < 0.05). The incidence of perforation and complications were not statistically decreased after the implementation of ultrasound. Ultrasound did not decrease the length of hospital stay, and in addition added approximately $48,000 to the treatment cost of appendicitis in 1989. Thus, despite adding cost, ultrasonography for appendicitis did not improve our ability to diagnose or accurately treat appendicitis.