title: Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?
abstract: Negative appendectomy remains a concern in current surgical practice. Data from the developing world is scarce. Data of appendectomies during the last 5 years were analyzed. Interval and incidental appendectomies were excluded. The demographic details, presenting complaints, clinical signs, and investigations performed were recorded in a predesigned proforma. The data were critically analyzed. Six hundred eighty-five appendectomies were performed during the period. One hundred eighty-five patients with a normal appendix were identified on histopathology. Sixty-seven patients with incidental or interval appendectomies were excluded. Thus, 118 patients had appendectomies performed erroneously. All these patients with presumed diagnosis of acute appendicitis were operated on by resident surgeons. Records of 17 patients could not be retrieved. The most common symptom was abdominal pain (100 %), and the commonest sign was right iliac fossa tenderness (93 %). Most of the patients underwent USG to supplement the diagnosis. CT scan and diagnostic laparoscopy were not performed. The negative appendectomy rate was 17.2 % (12.4 % in males; 33.3 % in females). The highest incidence of negative appendectomy was in females aged 11-20 years (66.7 %). The rate of negative appendectomy at our institute is comparable with the world statistics. More diligence is required in making the clinical diagnosis of acute appendicitis, especially in young females. The use of C-reactive protein and CT scan may decrease the negative appendectomy rate.
authors.affiliation: Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, 110095 India ; C-1/1201, Olive County, Sector-5, Vasundhara, Ghaziabad, UP India.
authors.forename: Mohit Kumar
authors.initials: MK
authors.lastname: Joshi
authors.affiliation: Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, 110095 India.
authors.forename: Richa
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, 110095 India.
authors.forename: Shaan E
authors.initials: SE
authors.lastname: Alam
authors.affiliation: Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, 110095 India.
authors.forename: Sarla
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, 110095 India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
keywords: Acute appendicitis; Appendicitis; Diagnostic error; Negative appendectomy