High rates of appendicectomy in a developing country: an attempt to contribute to a more rational use of surgical resources

• Published in: The European journal of surgery 1999-03, Vol.165 (3), p.248-252
• Main Authors: Langenscheidt, Philipp, Lang, Christoph, Püschel, Werner, Feifel, Gernot
• Format: Article
• Language: English
• Subjects: Appendectomy - statistics & numerical data; Appendectomy - utilization; Appendicitis - complications; Appendicitis - diagnosis; Appendicitis - epidemiology; Appendicitis - surgery; Biological and medical sciences; Developing Countries - statistics & numerical data; Female; Health Resources - statistics & numerical data; Health Resources - utilization; Humans; Incidence; Madagascar - epidemiology; Male; Medical sciences; Prospective Studies; Sex Distribution; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surveys and Questionnaires; Tropical medicine
• ISSN: 1102-4151; 1741-9271
• DOI: 10.1080/110241599750007126

Objective: In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiology of appendicitis. Design: Prospective clinical and pathological study. Setting: Teaching hospital, Madagascar. Subjects: 165 patients who underwent appendicectomy during a two month period. Interventions: Clinical investigation and histopathological examination of removed appendixes. Main outcome measures: Appendicitis score, local incidence of appendicectomy, appendicitis, perforation, and negative appendicectomy. Results: There was a high incidence of primary appendicectomy (51.1/10000 population/year) in relation to the incidence of histologically confirmed appendicitis (7.7/10000), resulting in a negative appendicectomy rate of 85% (43/10000). There were considerable sex related differences in the incidence of primary appendicectomy (81/10000 women/year; 22/10000 men), appendicectomy for appendicitis (12/10000 women/year; 4/10000 men) and non‐perforating appendicitis (8/10000 women/year; 2/10000 men), but much less in that of perforating appendicitis (4/10000 women/year; 2/10000 men). Conclusion: There is potential for more economic use of medical resources by reducing the rate of negative appendicectomy. The incidence of non‐perforating appendicitis depends on the number of appendicectomies done, which may explain the differences observed in the incidence of appendicitis between industrialised and developing countries. Copyright © 1999 Taylor and Francis Ltd.