Pre-operative Imaging Avoids Unnecessary Surgery for Suspected Acute Appendicitis

Background: The decision to perform an appendicectomy is traditionally based on clinical findings. This approach, however, results in high rates of negative (non-inflamed) appendicectomies with procedure morbidity associated. Therefore, some consider a negative appendicectomy to be a complication since surgical morbidity could have been avoided. The aim of this study was to evaluate the effect of preoperative imaging on the negative appendicectomy rate in case of suspected appendicitis. Methods: The prospectively collected database for all patients who had undergone acute surgery for a suspected appendicectomy, with or without preoperative imaging, was analysed over a 5-year period. Patient and treatment characteristics, histopathology and postoperative outcomes were recorded and analyzed. Results: A total of 2,070 patients were included, 848 (41%) with preoperative imaging (CT, ultrasound or MRI) and 1,222 (59%) without. Imaged patients were older and suffered from more comorbities. The negative appendicectomy rate was 19.2% (n=235) for the non-imaged patients, and 12.4% (n=105) for imaged patients (p<0.0001). When preoperative imaging was performed, a CT-scan was most accurate to diagnose appendicitis correctly compared to ultrasound (93.6 vs. 30.2%, p<0.0001). Median hospital stay was 3.2 days in the imaged group compared to 2.1 days in the non-imaged group (p=0.171). Conclusion: Preoperative imaging significantly reduces the negative appendicectomy rate. In this time of modern imaging modalities readily available, it is recommended to perform preoperative imaging in case of suspected acute appendicitis to avoid unnecessary surgery and associated morbidity.