title: Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis.
abstract: OBJECTIVE
  To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs.
  
  
  METHODS
  In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation.
  
  
  RESULTS
  After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 <euro> from 2,482 to 1,888 <euro> (CL:-1081; -143).
  
  
  CONCLUSIONS
  Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs.
  
  
  CONCLUSIONS
  • The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. • This led to a considerable increase in the use of preoperative imaging. • Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. • Use of mandatory imaging seems to reduce health care costs.
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lahaye
authors.forename: D M J
authors.initials: DM
authors.lastname: Lambregts
authors.forename: E
authors.initials: E
authors.lastname: Mutsaers
authors.forename: B A B
authors.initials: BA
authors.lastname: Essers
authors.forename: S
authors.initials: S
authors.lastname: Breukink
authors.forename: V C
authors.initials: VC
authors.lastname: Cappendijk
authors.forename: G L
authors.initials: GL
authors.lastname: Beets
authors.forename: R G H
authors.initials: RG
authors.lastname: Beets-Tan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery; D001065:Appendix / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009426:Netherlands; D011300:Preoperative Care / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*; D014463:Ultrasonography; D019564:Unnecessary Procedures / Q000191:economics*; D055815:Young Adult