Patients may prefer radiation risk to surgical risk in diagnosing appendicitisBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3493 (Published 30 June 2015) Cite this as: BMJ 2015;350:h3493
- Nigel D’Souza, specialty registrar in general surgery, Department of General Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
Many normal appendixes are removed in the United Kingdom. I have worked at hospitals with negative appendicectomy rates (NARs) of 16.8% to 35%,1 consistent with the 20.6% NAR from over 3000 appendicectomies in a largely UK based audit.2 Colleagues from abroad are incredulous at this high rate despite the availability of accurate diagnostic tests.
I had always believed that, in cases of clinical uncertainty, diagnostic laparoscopy was a better option than computed tomography (CT)—until my wife, an anaesthetist, disagreed with me.
Several factors contribute to the UK’s high NAR. Emergency surgery teams work in shifts with frequent patient handover, which has eroded the role of observation and serial examination that can rule out appendicitis. Routine CT is not common, owing to surgeon preference or lack of access. Beds are frequently scarce, pushing surgeons towards an early, definitive management plan: discharge safely or operate. Yet premature discharge may result in a patient with early appendicitis deteriorating outside hospital, and complications can include peritonitis, infertility, and death.