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Appendicectomy: rethinking best practice

Tim Papadopoulos, Bruce Waxman

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Abstract

How close are we to reaching the combined goal of low perforation rates and low rates of unnecessary surgery in patients with suspected acute appendicitis?

Article Extract

Acute appendicitis remains the most common intra-abdominal condition requiring emergency surgery and carries a lifetime risk of approximately 6%. In 1990, the mortality rate in Australia from this condition was one of the lowest in the developed world (0.0001%). While early diagnosis and intervention has reduced the mortality rate for uncomplicated appendicitis to less than 0.1%, this has been at the expense of increased rates of removing appendices that are subsequently found to be normal. Some studies put the rate of these negative appendicectomies at greater than 20%.

In addition, there is an increased mortality rate with complicated appendicitis (e.g. 0.6% for gangrenous appendicitis and 5% for perforated appendicitis), with an attendant mortality increase in children less than 2 years of age or adults more than 65 years with appendicitis.

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