title: Impact of the Increased Use of Preoperative Imaging and Laparoscopy on Appendicectomy Outcomes.
abstract: The diagnosis of appendicitis is based on clinical picture. The aim of this retrospective study was to analyse variation of outcomes and impact of increasing use of radiological investigations and laparoscopy over a 5-year period. A retrospective audit of appendicectomies over the last 5 years (01 January 2007-31 December 2011) was conducted. The negative appendicectomy rate (NAR), perforation rate and complication rate were used as outcome endpoints. A statistical analysis was performed to evaluate the difference in outcomes with surgical approach and use of radiology. One thousand fifty-five appendicectomies were performed in this period. The NAR was 22.65 % (21 % for open and 28 % for laparoscopic) and perforation rate was 14 %. There was no statistically significant difference in NAR with the use of ultrasound (P 0.3814) but there was a significant reduction in NAR with the use of computed tomography (CT) (P <0.0001). Intra-abdominal abscess (2.3 %) and wound infection (1.4 %) were the common complications with the former being higher with laparoscopy and the latter with open appendicectomy. Over 5 years, there were no significant changes in appendicectomy outcomes. The impact of diagnostic imaging on NAR varies with age, gender and the use of CT. CT can significantly reduce the negative appendicectomy rate in equivocal presentations. Complication rates vary with surgical approach.
authors.affiliation: Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria road, Macclesfield, SK10 3BL Cheshire UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Sridhar
authors.affiliation: Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria road, Macclesfield, SK10 3BL Cheshire UK.
authors.forename: M
authors.initials: M
authors.lastname: Andrikopoulou
authors.affiliation: Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria road, Macclesfield, SK10 3BL Cheshire UK.
authors.forename: L
authors.initials: L
authors.lastname: Clarke
authors.affiliation: Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria road, Macclesfield, SK10 3BL Cheshire UK.
authors.forename: C
authors.initials: C
authors.lastname: Ashley
authors.affiliation: Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria road, Macclesfield, SK10 3BL Cheshire UK.
authors.forename: P
authors.initials: P
authors.lastname: Mekhail
authors.affiliation: Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria road, Macclesfield, SK10 3BL Cheshire UK.
authors.forename: U A
authors.initials: UA
authors.lastname: Khan
keywords: Appendicectomy; Computed tomography; Laparoscopy; Treatment outcome; Ultrasound