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 18 February 2018

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News

Considerable clinical and economic burden associated with misdiagnosed appendicitis

Removing a healthy appendix in patients with presumed appendicitis increases both the frequency of adverse clinical outcomes and financial burden, according to research published in the July issue of the Archives of Surgery.

News image

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A team from Seattle, Washington, USA, examined the clinical outcomes and economic costs associated with negative appendectomy (NA) - the nonincidental removal of a normal appendix.

The 1997 Nationwide Inpatient Sample of the Health Care Utilization Project was used to estimate the number of NAs performed.

All surveyed patients were assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy, but without an associated diagnosis of acute appendicitis.

The age- and sex-stratified rates of NA were measured.

In addition, the incidence of associated infectious complications and case fatality, and the average length of stay and hospitalization charges during those admissions were assessed.

The researchers estimated that, nationwide, 261,134 patients underwent nonincidental appendectomies in 1997, and 39,901 (15.3%) were negative for appendicitis.

$741.5 million in total hospital costs due to NA.
Archives of Surgery

Women had a higher rate of NA, as did patients younger than 5 years and older than 60 years.

It was found that, when compared with patients with appendicitis, NA was associated with a significantly longer length of hospital stay (5.8 vs 3.6 days) and increased total charge-admission ($18,780 vs $10,584).

Furthermore, the case fatality (1.5% vs 0.2%) and infectious complication (2.6% vs 1.8%) rates were higher amongst NA patients.

An estimated $741.5 million in total hospital charges resulted from admissions in which a NA was performed.

Dr David R. Flum, of the University of Washington, Seattle, concluded on behalf of his colleagues, "There are significant clinical and financial costs incurred by patients undergoing NA during the treatment of presumed appendicitis.

"These should be considered when evaluating system-level interventions to improve the management of appendicitis."

Arch Surg 2002; 137: 799-804
17 July 2002

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