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 was to investigate morbidity, mortality and costs of removing a normal appendix in patients with suspected appendicitis.
  
  
  METHODS
  Retrospective study of 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 re-operation was needed. The mean hospital stay was 4.4 (SE 2.8) days, in case of complications 7.4 (SE 4.2) days. The mean extra hospital costs of a negative appendectomy were EUR 2712.
  
  
  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 such as diagnostic laparoscopy should be used selectively in order not to further increase costs.
authors.affiliation: Department of Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands. wtbroek@xs4all.nl
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000191:economics / Q000401:mortality; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D001065:Appendix / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies