An Analytical study about trends in the Management of Acute Appendicitis Cases in Tertiary Medical Centres

Abstract

Introduction : Acute appendicitis (AA) is one of  the most common surgical disease with a lifetime risk of 7–8%. Improving the diagnostic & Management pathway is the cornerstone for decreasing the negative appendectomy rate and the risk of wrong diagnosis. The primary aim of the this study is to describe the clinical, diagnostic, treatment, and pathological profile of patients with AA in surgical departments of randomly selected  hospitals Methods:  This Retrospective study involved Prior Consent from  Hospital Authorities   Subjects included both the genders , all age groups including pediatric and geriatric age group and all classes of socio economic strata. A total of 100  patients case sheet were selected which were  proven cases of acute appendicitis during a period of 6 months. This retrospective Analytical Study was planned to see the current trends of Management of Acute Appendicitis in Randomly selected  Tertiary Care Hospitals of Raipur district. Results: Case sheets of total 100 diagnosed patients were chosen . They included 35% women and  65% men, with a median age of 31 years . 18% patients had previous episodes of AA. 23% patients underwent abdominal CT scan, 66% patients had an USG, Rest 11%  patients had both CT scan and USG. 90 % patients had their Alvarado Score recorded, with a median value of 7 (IQR, 6–8). The Alvarado score was ??4 in  9% patients, between 5 and 6 in 1067 29% patients, between 7 and 8 in 41% patients, and between 9 and 10 in rest of the patients. 94 % patients had their Andersson’s Score recorded, with a median value of 6 (IQR, 5–8). In 21%  patients, the Andersson’s score was ??4, between 5 and 8  in 68% patients, and between 9 and 12 in rest of the  patients. Conclusion: The results of the present study gives a snapshot of current worldwide trend in the diagnostic work-up and therapeutic management of AA. Ultrasound and CT are used in Sufficient cases . Alvarado, Andersson’s, and WSES grading scores are useful methods to classify the patients, and they predict and correlate with the surgical or pathological diagnosis. 97 % of patients are treated with surgery, which, in more than 50% cases, is performed using a laparoscopic approach, with a low conversion rate. The hospital stay is usually short, with few complications at 7 and 30 days postoperatively. Further analysis based on the present data are needed to study in detail the role of preoperative diagnostic work-up, the usefulness of prognostic scores, the potential value of appropriate antibiotic therapy, and the real advantages of a laparoscopic approach.