title: Implications of removing a normal appendix.
abstract: BACKGROUND
  The diagnosis of acute appendicitis remains difficult, and therefore 15-30% of the removed appendices appear to be normal. The aim of this study is to investigate the morbidity, mortality and costs of removing a normal appendix in patients with suspected appendicitis.
  
  
  METHODS
  A retrospective study was performed on patients who underwent a negative appendectomy for suspected appendicitis in the period 1991-1999 with a median follow-up of 4.4 years. Patients who underwent an elective appendectomy or appendectomy for other reasons were excluded.
  
  
  RESULTS
  In 285 patients (70% women, 30% men) a normal appendix was removed. In 192 (67%) patients a muscle-splitting incision was performed, in 6 (2%) a median laparotomy, and in 51 (18%) the normal appendix was removed by laparoscopy. In 36 patients (13%) a diagnostic laparoscopy was converted to a muscle-splitting incision. Complications occurred in 16 (6%) patients, in 5 (2%) a reoperation was needed. The mean hospital stay was 4.4 (SE 2.8) days, in case of complication 7.4 (SE 4.2) days. The mean extra hospital costs of a negative appendectomy were EUR 2,712.
  
  
  CONCLUSIONS
  The removal of a normal appendix has considerable complications and costs. In an attempt to prevent these costs, extra diagnostic tools should be considered. Expensive diagnostic tools as diagnostic laparoscopy should be used selectively in order to not further exceed costs.
authors.affiliation: Department of Surgery, Medical Center Alkmaar, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Bijnen
authors.forename: W T
authors.initials: WT
authors.lastname: Van Den Broek
authors.forename: A B
authors.initials: AB
authors.lastname: Bijnen
authors.forename: P
authors.initials: P
authors.lastname: De Ruiter
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007902:Length of Stay; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome