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Imaging utilization affects negative appendectomy rates in appendicitis: An ACS-NSQIP study

2019; Elsevier BV; Volume: 217; Issue: 6 Linguagem: Inglês

10.1016/j.amjsurg.2018.12.072

1879-1883

Joshua Tseng, Tara Cohen, Nicolas Melo, Rodrigo F. Alban,

Intraperitoneal and Appendiceal Malignancies

Negative appendectomy rates (NAR) historically ranged from 15 to 25%, but have decreased recently.Using the 2016 ACS-NSQIP database, we identified patients who underwent appendectomies for appendicitis. Patients with and without appendicitis on pathology were compared. Multivariate analysis was used to identify predictors of negative appendectomies.11,841 patients underwent appendectomies, with a NAR of 4.5%. Utilization rates of US, CT and MRI were 14.9%, 86.1%, and 1.1%. NAR's of US, CT, and MRI were 9.7%, 2.5%, and 7.1%, and 19.2% for patients without imaging. An ultrasound consistent with appendicitis has a NAR of 4.8%; adding a CT decreases it to 0.6%. Predictors of NA include females, smoking, no imaging, and ultrasounds. Factors with lower odds of NA include leukocytosis, sepsis, and CTs.The NAR in the 2016 ACS-NSQIP population is 4.5%. CTs are the most frequently used imaging modality and have the lowest NAR. Obtaining a CT in addition to an ultrasound is associated with lower NAR. This should be further explored with a cost-benefit analysis between multiple imaging studies versus negative appendectomies.