title: Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy.
abstract: BACKGROUND
  The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London.
  
  
  METHODS
  This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy  over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate  and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications.
  
  
  RESULTS
  All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009  (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445),  perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029)  or perforation (p=0.014).
  
  
  CONCLUSIONS
  This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's  age was the only predictor of negative appendicectomy and perforation.
authors: University College London Hospitals NHS Foundation Trust, London, UK.
authors: S R
authors: SR
authors: Markar
authors: A
authors: A
authors: Karthikesalingam
authors: J
authors: J
authors: Cunningham
authors: C
authors: C
authors: Burd
authors: G
authors: G
authors: Bond-Smith
authors: T R
authors: TR
authors: Kurzawinski
mesh_terms: D000328:Adult; D000367:Age Factors; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008131:London; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014463:Ultrasonography; D019564:Unnecessary Procedures / Q000706:statistics & numerical data