Progress in the diagnosis of appendicitis

A report from washington state's surgical care and outcomes assessment program

Frederick Thurston Drake, Michael G. Florence, Morris G. Johnson, Gregory Jurkovich, Steve Kwon, Zeila Schmidt, Richard C. Thirlby, David R. Flum

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Studies suggest that computed tomography and ultrasonography can effectively diagnose and rule out appendicitis, safely reducing negative appendectomies (NAs); however, some within the surgical community remain reluctant to add imaging to clinical evaluation of patients with suspected appendicitis. The Surgical Care and Outcomes Assessment Program (SCOAP) is a physician-led quality initiative that monitors performance by benchmarking processes of care and outcomes. Since 2006, accurate diagnosis of appendicitis has been a priority for SCOAP. The objective of this study was to evaluate the association between imaging and NA in the general community. METHODS: Data were collected prospectively for consecutive appendectomy patients (age > 15 years) at nearly 60 hospitals. SCOAP data are obtained directly from clinical records, including radiological, operative, and pathological reports. Multivariate logistic regression models were used to examine the association between imaging and NA. Tests for trends over time were also conducted. RESULTS: Among 19,327 patients (47.9% female) who underwent appendectomy, 5.4% had NA. Among patients who were imaged, frequency of NA was 4.5%, whereas among those who were not imaged, it was 15.4% (P < 0.001). This association was consistent for men (3% vs 10%, P < 0.001) and for women of reproductive age (6.9% vs 24.7%, P < 0.001). In a multivariate model adjusted for age, sex, and white blood cell count, odds of NA for patients not imaged were 3.7 times the odds for those who received imaging (95% CI: 3.0-4.4). Among SCOAP hospitals, use of imaging increased and NA decreased significantly over time; frequency of perforation was unchanged. CONCLUSIONS: Patients who were not imaged during workup for suspected appendicitis had more than 3 times the odds of NA as those who were imaged. Routine imaging in the evaluation of patients suspected to have appendicitis can safely reduce unnecessary operations. Programs such as SCOAP improve care through peer-led, benchmarked practice change.

Original languageEnglish (US)
Pages (from-to)586-594
Number of pages9
JournalAnnals of Surgery
Volume256
Issue number4
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

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Appendectomy
Appendicitis
Outcome Assessment (Health Care)
Logistic Models
Benchmarking
Leukocyte Count
Ultrasonography
Tomography
Physicians

Keywords

  • appendicitis
  • computed tomography
  • negative appendectomy
  • quality improvement
  • surgery
  • ultrasonography

ASJC Scopus subject areas

  • Surgery

Cite this

Progress in the diagnosis of appendicitis : A report from washington state's surgical care and outcomes assessment program. / Drake, Frederick Thurston; Florence, Michael G.; Johnson, Morris G.; Jurkovich, Gregory; Kwon, Steve; Schmidt, Zeila; Thirlby, Richard C.; Flum, David R.

In: Annals of Surgery, Vol. 256, No. 4, 01.10.2012, p. 586-594.

Research output: Contribution to journalArticle

Drake, Frederick Thurston ; Florence, Michael G. ; Johnson, Morris G. ; Jurkovich, Gregory ; Kwon, Steve ; Schmidt, Zeila ; Thirlby, Richard C. ; Flum, David R. / Progress in the diagnosis of appendicitis : A report from washington state's surgical care and outcomes assessment program. In: Annals of Surgery. 2012 ; Vol. 256, No. 4. pp. 586-594.
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