Predictive Factors of Negative Appendectomy in Patients Diagnosed with Acute Appendicitis
Keywords:
Acute appendicitis, Appendectomy, Negative appendectomy, Normal appendix, false appendectomyAbstract
Background: Acute appendicitis is the most common cause of acute abdominal pain that leads the patients to the emergency room. The patients suspected of having appendicitis should be operated urgently to reduce the risk of complications. However, there are cases of patients undergoing unnecessary appendectomy as it has been observed that some individuals diagnosed preoperatively with acute appendicitis do not have histopathologic evidence of appendicitis.
Objective: The aim of this study is to evaluate the rate of negative appendectomy and the factors associated with negative appendectomy.
Methods: This case control study was conducted through a retrospective review of medical records. Data from the patients who were preoperatively diagnosed with acute appendicitis and underwent appendectomy from January 1, 2021 to June 30, 2023 were retrospectively collected. The patients were divided into two groups considering the pathological presence of inflammatory changes in the appendix. The patients with and without appendicitis on pathology were compared. Multivariate logistic regression model was used to identify predictors of negative appendectomies.
Results: The study population was 1,038 patients, with a negative appendectomy rate of 27.8%. The factors associated with increasing the negative appendectomy rate were age younger than 40 years (OR 1.84, P < 0.05), female gender (OR 1.97, P < 0.05), history of diarrhea (OR 1.69, P < 0.05) and no preoperative imaging (OR 2.38, P < 0.05). Whereas the factors associated with reducing the negative appendectomy rate were anorexia (OR 0.71, P < 0.05), migration of abdominal pain (OR 0.65, P < 0.05), white blood cell count greater than 10,000 cells/uL (OR 0.49, P < 0.05), neutrophil greater than 75% (OR 0.50, P < 0.05).
Conclusion: The diagnosis of acute appendicitis in female patients, in persons under 40 years of age or with concomitant diarrhea should be made with caution. Prudent use of comprehensive laboratory tests and diagnostic imaging study can reduce the rate of negative appendectomies.
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