[Is appendectomy really performed too frequently? Results of the prospective multicenter study of the Swiss Society of General Surgery].
Scientific publications and provoking criticism from the lay press have recently pointed out, that appendices may be surgically removed too frequent and without indisputable necessity. In an attempt to verify these questionable statements, the Swiss Society for General Surgery (SGAC) initiated a prospective controlled multi center trial. From September 1997 to December 1998, hundred and twenty-five institutions documented 4603 appendectomies performed due to a suspected appendicitis. Histological investigation of all specimens revealed a 7% rate of normal appendices, 7.2% for patients with national health service (NHS) and 5.9% for patients with private insurances respectively. Compared to the results of the literature, where a frequency of normal appendices around 15% is judged as standard, these results are excellent. In 17.2% of the patients (15.9% NHS and 23.6% privately insured patients) an "appendicitis perforata" was observed. This percentage remains in the range reported by other authors. The analysis of time of admission (i.e. day or night) and the delay from admission to surgery shows a distribution independent to the insurance of the patients. Therefore, the planned appendectomy for patients with private insurances does not exist. A different choice of the surgical technique could be observed depending on the insurance status. In 30.4% of the private insured patients a laparoscopic appendectomy was performed as compared to 22.6% of patients with NHS. Surprisingly, an identical median hospitalization time can be observed for both groups (laparoscopic 5.5 days, open surgery 5.5 days).
Richter
M
M
Laffer
U
U
Ayer
G
G
Blessing
H
H
Biaggi
J
J
Bruttin
J M
JM
Brugger
J J
JJ
Liechti
J
J
König
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D011446:Prospective Studies; D013557:Switzerland; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*