A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq

Hiwa Omer Ahmed, Rizgar Muhedin, Amir Boujan, Aso Hama Saeed Aziz, Ara Muhamad Abdulla, Rezan Ahmed Hardi, Aso Ahmed Abdulla, Taban Aziz Sidiq, Hiwa Omer Ahmed, Rizgar Muhedin, Amir Boujan, Aso Hama Saeed Aziz, Ara Muhamad Abdulla, Rezan Ahmed Hardi, Aso Ahmed Abdulla, Taban Aziz Sidiq

Abstract

The most common surgical emergency is suspected acute appendicitis, the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women, with a male to female ratio of 1.4:1; correct diagnosis can be made in 70-80% of patients after the operations about 32% of appendectomies revealed normal appendices and meanwhile appendectomy has a considerable morbidity and mortality. The aim is to explore potential morbidity and mortality associated with negative appendectomy. Prospective case series study, including 5847 patients, who were suspected to have acute appendicitis over a period of five years from 1st December 2013 to 30th November 2018, in emergency department of Sulaimani Teaching Hospital. All the collected data were collected, organized then analyzed by Statistical Package for the Social Sciences version 21. Morbidity in the patients with negative appendectomies occurred in patients in the form of 90 (01.91%) wound infection, 48 (01.02%) intestinal obstruction and last 15 (00.32%) patients developed septicemia. While mortality in negative appendectomy patients was 21, (00.45%). Negative appendectomies have high rates of morbidity and mortality, knowing real rates may help in considering various policies and may be helpful to elude avoidable complications and potential mortality.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The total number of the patients who were admitted on suspension of acute appendicitis and their flow in the emergency department.

References

    1. Hatipoglu S, Hatipoglu F, Abdullayev R. Acute right lower abdominal pain in women of reproductive age: Clinical clues. World J. Gastroenterol. 2014;14:4043–4049. doi: 10.3748/wjg.v20.i14.4043.
    1. Gray J, Wardrope J, Fothergill DJ. Abdominal pain, abdominal pain in women, complications of pregnancy and labour. Emerg. Med. J. 2004;21:606–613. doi: 10.1136/emj.2004.017830.
    1. Tai, H.H., Ying, C. H., Chi, W. Acute appendicitis or not: Facts and suggestions to reduce valueless surgery, J. Acute Med., Volume 3, Issue 4, Pages 142-147. (2013).
    1. Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530–534. doi: 10.1136/.
    1. Ahmed, H.O. Alternative diagnosis for pain in patents who underwent appendectomies for normal appendices and the incidence of negative appendectomies, Ann. Coll. Med. Mosul, vol. 37, number 1&2 (2011)
    1. Mariadason JG, Wang WN, Wallack MK, Belmonte A, Matar IH. Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy. Ann. R. Coll. Surg. Engl. 2012;94(6):395–401. doi: 10.1308/003588412X13171221592131.
    1. Petroianu, A., Diagnosis of acute appendicitis, Int. J. Surg., Volume 10, Issue 3, Pages 115-119. (2012)
    1. Jearwattanakanok, K., Yamada, S., Suntornlimsiri, W., Smuthtai, W. & Patumanond, J. Clinical Scoring for Diagnosis of Acute Lower Abdominal Pain in Female of Reproductive Age, Emergency Medicine International, Article ID 730167, 6 pages (2013).
    1. Thompson, J. P., Selvaraj, D., Nicola, R., Thompson, J. P., Selvaraj, D., Mimickers of Acute AppendicitisJ Am Osteopath Coll Radiol; Vol. 3, Issue 4. (2014)
    1. Kamwendo, F., Foslin, L., Bodin, L. Programs to reduce pelvic inflammatory disease—the Swedish experience, The Lancet, VOLUME 351, SPECIAL ISSUE, S25–S28 (1998).
    1. Kruszka PS, Kruszka SJ. Evaluation of Acute Pelvic Pain in Women. Am. Fam. Physician. 2010;15(82(2)):141–147.
    1. Cherpes, T. L., Rice, P. A. Pelvic Inflammatory Disease, Infectious Diseases in Obstetrics and Gynecology, Article ID 714289, (2011).
    1. Das BB, Ronda J, Trent M. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infect. Drug. Resist. 2016;9:191–197. doi: 10.2147/IDR.S91260.
    1. Gomes CA, et al. Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J. Emerg. Surg. 2015;10:60. doi: 10.1186/s13017-015-0053-2.
    1. Sellars, H., Boorman, P. Acute appendicitis, Surgery (Oxford), Volume 35, Issue 8, August, Pages 432–438) (2017).
    1. Ahmed, H. O. Role of ultrasound in diagnosis of acute appendicitis, Journal of Zankoy Sulaimani9(1) part A, 107–114, (2006).
    1. Drake FT, Flum DR. Improvement in the diagnosis of appendicitis. Adv. Surg. 2013;47:299–328. doi: 10.1016/j.yasu.2013.03.003.
    1. Handler A, Davis F, Ferre C, Yeko T. The relationship of smoking and ectopic pregnancy. Am. J. Public. Health. 1989;79(9):1239–1242. doi: 10.2105/AJPH.79.9.1239.
    1. Resende, F., Almeida, A. B., Maia, J. C. Challenges in uncomplicated acute appendicitis, Journal of Acute Disease, Volume 5, Issue 2, 1, Pages 109–113, (2016).
    1. Becker P, Fichtner SF, Schilling D. Clinical Management of Appendicitis. Visc. Med. 2018;34:453–458. doi: 10.1159/000494883.
    1. Osime O, Ajayi P. Incidence of negative appendectomy: experience from a company hospital in Nigeria. Cal. J. Emerg. Med. 2005;6(4):69–73.
    1. Paavana L, Mazari MF, Wilson TR. The morbidity of negative appendicectomy. Ann. R. Coll. Surg. Engl. 2014;96(7):517–20. doi: 10.1308/003588414X13946184903801.
    1. Ferris, M. et al. The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies, Ann. Surg., Volume 266 - Issue 2 - p 237–241, (2017).
    1. Margenthaler JA, et al. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann. Surg. 2003;238(1):59–66.
    1. Sekaran T.V.C., Johnson. N., Acute appendicitis, Surg. Volume 32, Issue 8, Pages 413-417 (2014)
    1. Colson, M., Skinner, K.A., Dunnington, G., High negative appendectomy rates are no longer acceptable, Am. J. Surg., Volume 174, Issue 6, Pages 723–727, (1997).
    1. GeonJeon, B., Predictive factors and outcomes of negative appendectomy, Am. J. Surg., Volume 213, Issue 4, Pages 731-738, (2017).
    1. Davoodabadi A, Davoodabadi H, Akbari H, Janzamini M. Appendicitis in Pregnancy: Presentation, Management and Complications. Zahedan J. Res. Med. Sci. 2016;18(7):e7557. doi: 10.17795/zjrms-7557.
    1. Wray CJ, Kao LS, Millas SG. Acute Appendicitis: Controversies in Diagnosis and Management. Curr. Probl. Surg. 2013;50:54–86. doi: 10.1067/j.cpsurg.2012.10.001.
    1. Findlay, J.M. et al. Non-operative Management of Appendicitis in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, J. Am. Coll. Surg., Volume 223, Issue 6, Pages 814-824.e2 (2016).
    1. Narayanan A, et al. What is negative about negative appendicectomy rates? An experience from a district general hospital. Int. Surg. J. 2015;2:161–4. doi: 10.5455/2349-2902.isj20150507.

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