Operations for Suspected Appendicitis How good are we? Kim Bailey CT2.
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Transcript of Operations for Suspected Appendicitis How good are we? Kim Bailey CT2.
Operations for Suspected Appendicitis
How good are we?
Kim Bailey CT2
• Background• Methods• Results• Discussion• Conclusions
Background
• Appendicetomy commonest acute general surgical procedure
• Diagnosis and surgery within 24 hours of hospital admission reduces complication rates
• Role of imaging increasing• 15-20% acceptable rate of negative
appendicetomy
Methods
• Retrospective Collection over a 3 month period
• 100 cases• Data on age, sex, consultant in charge, length
of time to surgery, scan, time to scan, length of stay and histology
• T-test used to determine significance
Results
• Average Age: 32 yrs (16 – 79 yrs)• 38 Males : 62 Females• 61 CR : 39 UGI• Scans (56% of suspected cases)– 39 USS– 14 CT – 3 CT KUB
• 9 (24%) Males received scans (4 USS, 3 CT, 2 CT KUB )
The Surgery
• 100 cases– 79 Laparoscopic Appendicetomies – 14 Diagnostic Laparoscopies– 5 Laparoscopic converted to open procedures– 1 Acute Right hemicolectomy (histology – crohns)– 1 Laparotomy
14% negative rate – macroscopically normal appendix
• So are we doing our surgery within 24 hours of hospital admission??
…………………………………………. No
Time From Admission to Surgery
• 50% of cases went within 24hrs
• Average: 28.46 (5.08 – 82.02)– CR 26.01– UGI 32.30
• T-test p value = 0.01
The Other Times
• Average time from admission to scan:• CR: 16.04 (-2.49 – 70.31)• UGI: 14.21 (-2.03 – 55.21)
• Average time from scan to surgery:• CR: 19.00 (2.22 -78.19)• UGI: 28.46 (7.23 – 60.57)
• Average time post surgery to discharge:• CR: 50.21 (15.23 - 496.31) • UGI: 43.23 (3.21 – 196.51)
• Average length of stay in hospital:• CR: 77.30 (26.51 – 506.44) • UGI: 75.43 (26 -231.54)
Consultant DataConsultant: No of Cases Average time to
SurgeryLongest Waiter
JA 17 15.42 28.39
DM/Locum 3 17.37 27.14
IH 6 19.35 31.22
JG 12 23.00 36.33
PS 8 25.57 46.09
KW 7 31.34 67.57
HOG 9 33.14 91.29
PJ 6 35.24 58.00
ZK 11 37.14 82.02
JH 13 37.40 96.11
GD 4 39.13 66.51
DD 4 43.30 70.56
Histology• 86 Appendixes– 44 Acute Appendicitis – 9 necrosing/gangernous/perforated– 11 Normal – 7 None– 6 Faecolith present, no signs of appendicitis– 3 Lymphoid Hyperplasia– 2 Periappendicitis– 4 Variety
• Old healed appendicitis, foreign body at tip, hemicolectomy (crohns), distal fibrous obliteration,
25 % NEGATIVE APPENDICECTOMY RATE
If you include diagnostic laparoscopies…Excluding 7 Cases…..
DISCUSSION OF RESULTS….
Conclusion
• We take too long to get suspected appendicitis to theatre
• Currently have a higher than average negative appendicetomy rate
• Clinic signs v’s radiological evidence• More data needed • Re-audit of practice to see improvement
Questions?