Morbidity after negative appendectomy: a single-centre experience on 627 cases

• Published in: European journal of trauma and emergency surgery (Munich : 2007) 2020-08, Vol.46 (4), p.859-864
• Main Authors: Tamini, Nicolò, Santurro, Letizia, Chiappetta, Maria Francesca, Gattuso, Ilaria, Barbieri, Consuelo, Fattori, Luca, Gianotti, Luca
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Appendicitis - diagnostic imaging; Appendicitis - surgery; Child; Child, Preschool; Critical Care Medicine; Emergency medical care; Emergency Medicine; False Negative Reactions; Female; Humans; Infant; Intensive; Male; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patients; Prognosis; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Ultrasonic imaging
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-019-01138-w

Introduction Acute appendicitis is one of the most common causes of abdominal pain in emergency departments worldwide. Despite the improvement in radiological and clinical investigations, negative appendectomy remains a debated topic as well as the optimal strategy for use in cases demonstrating a nonpathological appendix during a procedure for suspected appendicitis. The aim of the present study was thus to analyse clinical outcomes of histologically NA to better elucidate the burden associated with a potentially avoidable procedure. Materials and methods We retrospectively analysed a prospectively collected database of all patients undergoing appendectomy for suspected appendicitis. Patients who underwent an elective appendectomy or an appendectomy for other causes than suspected appendicitis or even an appendectomy during the course of another procedure were excluded from the analysis. Results Data of 627 patients undergoing an emergency procedure for suspected appendectomy were registered. Of the 627 patients, 533 (85%) were found to have acute appendicitis (378 uncomplicated, 155 severe), while the NA rate was 14.9%. A preoperative CT scan was performed in 148 patients (23.6%), an ultrasound evaluation was conducted in 427 patients (68.1%), and 127 patients (20.3%) underwent no imaging prior to surgical intervention. The large majority of procedures was performed laparoscopically (77.7%) and the median procedure duration was 70 min (range 17–270 min). The cumulative conversion rate (both AA and NA) was 5.7%. Leucocytes were significantly lower in cases of NA, while C-reactive protein (CRP) level was found to be increased fourfold in cases of severe versus uncomplicated appendicitis and NA. An increased use of endoloop in appendiceal stump closure was noted in the NA group (88.3% loop vs. 11.7% stapler), while endostapler usage increased in the severe appendicitis group up to 38.1%. Most patients with NA underwent only preoperative ultrasound (71.3%), with just 8.5% of patients in this group having a CT scan before surgery. Ultrasound sensivity was 0.648 and specificity was 0.438. For CT scan, sensivity was 0.949 and specificity was 0.625. LOS in the NA patient group was comparable to that of patients affected by uncomplicated appendicitis, while patients with severe appendicitis experienced a 2-day-longer median recovery. Complications were significantly higher in the severe appendicitis group but comparable in the other two groups. Surgical site infe