1. Operations for Suspected Appendicitis How good are we? Kim Bailey CT2

2. Background Methods Results Discussion Conclusions

3. 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

4. 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

5. 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 )

6. 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

7. So are we doing our surgery within 24 hours of hospital admission?? …………………………………………. No

8. 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

9. 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)

10. Consultant Data Consultant:No of CasesAverage time to Surgery Longest Waiter JA1715.4228.39 DM/Locum317.3727.14 IH619.3531.22 JG1223.0036.33 PS825.5746.09 KW731.3467.57 HOG933.1491.29 PJ635.2458.00 ZK1137.1482.02 JH1337.4096.11 GD439.1366.51 DD443.3070.56

12. 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,

13. 25 % NEGATIVE APPENDICECTOMY RATE If you include diagnostic laparoscopies… Excluding 7 Cases…..

14. DISCUSSION OF RESULTS….

15. 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

16. Questions?