Appendicitis—the balance between cost effectiveness and safety remains challenging

• Published in: Langenbeck's archives of surgery 2014-04, Vol.399 (4), p.493-501
• Main Authors: Liese, Juliane, Halbinger, Thomas M., Ulrich, Frank, Bechstein, Wolf O., Strey, Christoph W.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy - economics; Appendicitis - diagnostic imaging; Appendicitis - surgery; Cardiac Surgery; Cost-Benefit Analysis; Female; General Surgery; Hospital Costs - statistics & numerical data; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Safety; Retrospective Studies; Thoracic Surgery; Tomography, X-Ray Computed - economics; Traumatic Surgery; Unnecessary Procedures - economics; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-014-1179-5

Purpose The diagnosis of acute appendicitis remains a challenge in daily clinical practice. The aim of the present study was to determine clinical criteria for a careful and cost-effective integration of computed tomography (CT) scans in the clinical pathway for the diagnosis of acute appendicitis. Methods In this retrospective study, we analyzed all patients who were admitted to our hospital with suspected appendicitis (2008–2011). We included all patients who had an appendectomy with or without preoperative CT. Furthermore, we analyzed all patients who received a CT because of suspected appendicitis but did not have an appendectomy. Results A total of 367 patients were included in this study. A CT was performed in 35 % of the patients with suspected appendicitis. Women had a significantly higher rate of negative appendectomy (NA) (16.5 %) than men (5.3 %). The frequency of NA was 5.7 % in the group of patients who were imaged, whereas it was 11.8 % ( p  = 0.075) among those who were not imaged. Thereby, CT scans helped to reduce total hospital expenses (€1,317.44 (no CT scan) to €675.85 (CT scan and no operation). Furthermore, CT scans can be avoided in men with normal white blood cell counts who should be observed if not operated immediately. Conclusion CT can be effectively applied for the diagnosis of acute appendicitis. We propose a diagnostic algorithm which helps to simultaneously avoid unnecessary operations and radiation exposure.