Our Summary

This research paper looks at the frequency of unnecessary appendix removal surgeries, which happen when doctors suspect a patient has appendicitis, but the appendix turns out to be healthy. These unnecessary surgeries, known as negative appendectomies, reportedly happen 15-25% of the time. The study aimed to see if using pre-operative imaging (like a CT scan) could lower the number of these unnecessary surgeries.

The research team looked at all emergency appendix removals in a single hospital from 2017-2018. They excluded patients under 18 years old. The findings showed that almost 30% of the patients had a pre-operative CT scan. When they compared the patients who had a CT scan to those who didn’t, they found fewer unnecessary surgeries in the group who had the scan.

The cost of these surgeries was also examined. Without a CT scan, the total cost for the surgeries was £322,320. However, if all patients had a pre-operative CT scan, and it reduced the negative appendectomy rate by 15%, the total cost would drop significantly to £36,212.

In simpler terms, the research suggests that using a CT scan before surgery can reduce the number of unnecessary appendix removals and save a significant amount of money.

FAQs

  1. What percentage of appendix removal surgeries are reportedly unnecessary or “negative appendectomies”?
  2. What role does pre-operative imaging, like a CT scan, play in reducing the number of unnecessary appendix removal surgeries?
  3. How does the use of pre-operative CT scans impact the overall cost of appendix removal surgeries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about appendectomy is to ask about the possibility of getting a CT scan before the surgery. This imaging test can help confirm whether the appendix is truly inflamed and needs to be removed, potentially avoiding unnecessary surgery and its associated risks and costs. It’s important to discuss this option with your healthcare provider to ensure the best course of action for your specific situation.

Suitable For

Patients who are typically recommended for an appendectomy are those who are experiencing symptoms of appendicitis, such as abdominal pain, nausea, vomiting, and fever. In some cases, a physical examination may not be enough to confirm a diagnosis, and additional imaging tests like a CT scan may be recommended. This research suggests that using pre-operative imaging, such as a CT scan, can help lower the rate of unnecessary surgeries and reduce healthcare costs.

Timeline

Before appendectomy:

  1. Patient experiences abdominal pain, usually starting around the belly button and moving to the lower right side of the abdomen.
  2. Patient may also experience nausea, vomiting, loss of appetite, and low-grade fever.
  3. Patient visits a doctor or emergency room to seek medical attention for their symptoms.
  4. Doctor performs a physical examination, including checking for tenderness in the abdomen and signs of inflammation.
  5. Doctor may order blood tests and imaging tests, such as a CT scan, to confirm the diagnosis of appendicitis.
  6. If appendicitis is suspected, patient undergoes surgery for appendectomy.

After appendectomy:

  1. Patient undergoes surgery to remove the appendix, either through open surgery or laparoscopic surgery.
  2. Recovery time varies, but most patients can leave the hospital within 1-2 days after surgery.
  3. Patient may experience pain, discomfort, and fatigue in the days following the surgery.
  4. Patient is advised to rest, drink plenty of fluids, and avoid strenuous activities for a few weeks.
  5. Patient may need to follow up with their doctor for post-operative care and monitoring.
  6. Patient’s symptoms should improve over time, with complete recovery expected within a few weeks.

What to Ask Your Doctor

  1. What are the signs and symptoms of appendicitis that I should be aware of?
  2. What diagnostic tests will be used to determine if I have appendicitis?
  3. Will I need a CT scan before the surgery?
  4. What are the risks and benefits of having a CT scan before the surgery?
  5. How will the results of the CT scan affect my treatment plan?
  6. What is the likelihood that the surgery will turn out to be unnecessary?
  7. What are the potential complications of an appendectomy?
  8. How long is the recovery process after an appendectomy?
  9. Are there any alternative treatment options for appendicitis?
  10. How can I prevent appendicitis in the future?

Reference

Authors: Chan J, Fan KS, Mak TLA, Loh SY, Ng SWY, Adapala R. Journal: Ulster Med J. 2020 Jan;89(1):25-28. Epub 2020 Feb 18. PMID: 32218624