title: Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications.
abstract: OBJECTIVE
  Negative appendectomies are costly and are embedded with unnecessary risks for the patients. A careful indication for surgery seems mandatory even more so, since conservative therapy emerges as a potential alternative to surgery. The aims of this population-based study were to analyze whether radiological examinations for suspected appendicitis decreased the rate of negative appendectomies without increasing the rate of perforation or worsening postoperative outcomes.
  
  
  METHODS
  This study is a retrospective analysis of a prospective population-based database. The data collection included preoperative investigations and intraoperative and postoperative outcomes.
  
  
  RESULTS
  Based on 2559 patients, the rate of negative appendectomies decreased significantly with the use of CT scan as compared to clinical evaluation only (9.3 vs 5 %, p = 0.019), whereas ultrasonography alone was not able to decrease this rate (9.3 vs 6.2 %, p = 0.074). Delaying surgery for radiological investigation did not increase the rate of perforation (18.1 vs 19.2 %; adjusted odds ratio (OR) 1.01; 0.8-1.3; p = 0.899). Postoperative complications (surgical reintervention, postoperative wound infection, postoperative hematoma, postoperative intra-abdominal abscess, postoperative ileus) were all comparable.
  
  
  CONCLUSIONS
  In this population-based study, CT scan was the only radiological modality that significantly reduced the rate of negative appendectomy. The delay induced by such additional imaging did not increase perforation nor complication rates. Abdominal CT scans for suspected appendicitis should therefore be more frequently used if clinical findings are unconclusive.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.|Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
authors.forename: M-O
authors.initials: MO
authors.lastname: Sauvain
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Slankamenac
authors.affiliation: Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: M K
authors.initials: MK
authors.lastname: Muller
authors.affiliation: Department of Surgery, Waid Hospital, Zürich, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Wildi
authors.affiliation: Department of Surgery Triemli Hospital, Zürich, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Metzger
authors.affiliation: Hospital Zollikerberg, Zürich, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Schmid
authors.affiliation: Hospital Männedorf, Zürich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Wydler
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
authors.forename: P-A
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland. dieter.hahnloser@chuv.ch.|Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, Lausanne, 1011, Switzerland. dieter.hahnloser@chuv.ch.
authors.forename: D
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Appendectomy; Appendicitis; CT; Negative appendectomy; Perforated appendicitis; Ultrasound