[Diagnosis of acute appendicitis over two decades - effects of increasing number of imaging procedures on costs, preoperative reliability and patient outcome].
BACKGROUND
An increasing number of modern imaging procedures are being applied for the diagnosis of appendicitis. We compared one hundred consecutive appendectomies of the years 1988, 1998 and 2008 concerning reliability of preoperative diagnosis and resulting costs.


METHODS
We analysed the first one hundred consecutive patients undergoing appendectomy during the years 1988, 1998 and 2008, 59 % were female and 41 % male. The average age was 26 years, the average BMI 21.09. The costs and results of radiological investigations (US, CT, MRI, X-ray) have been compared in all patients. The sensitivity of ultrasound and CT scan in preoperative diagnosis has been analysed.


RESULTS
The number of preoperative imaging procedures for the diagnosis of appendicitis has increased over the last two decades. Simultaneously increased the costs (total costs and costs per partient) for imaging procedures. 2008 the costs were 10 times higher than 1988. CT had a higher sensitivity (77 %) in the diagnosis of appendicitis than ultrasound (33 %). The number of operations because of subacute and chronic appendicitis was lower in 2008 (34 of 100) compared with 1988 (80 of 100) and 1998 (60 of 100). In 2008 (14) we found a higher number of gangrenous and perforated appendicitis compared to 1988 (2) and 1998 (5). The majority (50 of 100) of patients in the group with acute and phlegmonous appendicitis was found in 2008.


CONCLUSIONS
There has been an increase in the use of preoperative imaging procedures in the diagnosis of appendicitis during the last 20 years. This causes more costs in the public health system. Ultrasound as the standard imaging method for diagnosing appendicitis showed poor sensitivity. CT scans had good results concerning sensitivity, but are expensive and involve exposure to radiation for the patient.
Schreiner
M
M
Ludwig Boltzmann Institut für operative Laparoskopie, Chirurgie 2 AKh Linz, Linz, Osterreich. markus.schreiner@akh.linz.at
Spazier
M
M
Wayand
W
W
D000328:Adult; D001062:Appendectomy / Q000191:economics; D001064:Appendicitis / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D001317:Austria; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000191:economics* / Q000639:trends*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D010535:Laparoscopy / Q000191:economics; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000639:trends; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics; D014463:Ultrasonography / Q000191:economics; D055815:Young Adult