Institutional members access full text with Ovid®

Share this article on:

Progress in the Diagnosis of Appendicitis: A Report From Washington State's Surgical Care and Outcomes Assessment Program

The SCOAP Collaborative; Drake, Frederick Thurston MD*; Florence, Michael G. MD; Johnson, Morris G. MD; Jurkovich, Gregory J. MD§; Kwon, Steve MD, MPH*; Schmidt, Zeila MLIS; Thirlby, Richard C. MD; Flum, David R. MD, MPH*,‖

doi: 10.1097/SLA.0b013e31826a9602
Papers of the 132nd ASA Annual Meeting

Background and Objectives: Studies suggest that computed tomography and ultrasonography can effectively diagnose and rule out appendicitis, safely reducing negative appendectomies (NAs); however, some within the surgical community remain reluctant to add imaging to clinical evaluation of patients with suspected appendicitis. The Surgical Care and Outcomes Assessment Program (SCOAP) is a physician-led quality initiative that monitors performance by benchmarking processes of care and outcomes. Since 2006, accurate diagnosis of appendicitis has been a priority for SCOAP. The objective of this study was to evaluate the association between imaging and NA in the general community.

Methods: Data were collected prospectively for consecutive appendectomy patients (age > 15 years) at nearly 60 hospitals. SCOAP data are obtained directly from clinical records, including radiological, operative, and pathological reports. Multivariate logistic regression models were used to examine the association between imaging and NA. Tests for trends over time were also conducted.

Results: Among 19,327 patients (47.9% female) who underwent appendectomy, 5.4% had NA. Among patients who were imaged, frequency of NA was 4.5%, whereas among those who were not imaged, it was 15.4% (P < 0.001). This association was consistent for men (3% vs 10%, P < 0.001) and for women of reproductive age (6.9% vs 24.7%, P < 0.001). In a multivariate model adjusted for age, sex, and white blood cell count, odds of NA for patients not imaged were 3.7 times the odds for those who received imaging (95% CI: 3.0–4.4). Among SCOAP hospitals, use of imaging increased and NA decreased significantly over time; frequency of perforation was unchanged.

Conclusions: Patients who were not imaged during workup for suspected appendicitis had more than 3 times the odds of NA as those who were imaged. Routine imaging in the evaluation of patients suspected to have appendicitis can safely reduce unnecessary operations. Programs such as SCOAP improve care through peer-led, benchmarked practice change.

This study evaluated the association between imaging and negative appendectomy (NA) across a diverse group of community and academic hospitals. Adjusted odds ratio of NA for patients not imaged were 3.7 times the odds for those who received imaging. Routine imaging in the evaluation of patients suspected to have appendicitis can safely reduce unnecessary operations.

*University of Washington Medical Center, Seattle

Swedish Medical Center, Seattle

Skagit Valley Hospital, Mt Vernon

§Harborview Medical Center, Seattle

University of Washington Surgical Outcomes Research Center

Virginia Mason Medical Center, Seattle, WA.

Reprints: Frederick Thurston Drake, MD, Department of Surgery, University of Washington, 1859 NE Pacific Street, Box 356410, Seattle, WA 98195. E-mail: ftdrake@u.washington.edu.

Disclosure: The authors declare no conflicts of interest.

Presented at the 132nd Annual Meeting at the American Surgical Association, April 27, 2012, San Francisco, CA.

© 2012 Lippincott Williams & Wilkins, Inc.