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. 1997 Mar;225(3):252–261. doi: 10.1097/00000658-199703000-00003

Appendectomy: a contemporary appraisal.

D A Hale 1, M Molloy 1, R H Pearl 1, D C Schutt 1, D P Jaques 1
PMCID: PMC1190674  PMID: 9060580

Abstract

OBJECTIVE: The authors present an accurate and comprehensive snapshot of appendicitis and the practice of appendectomy in the 1990s. METHODS: Appendectomies were performed on 4950 patients in 147 Department of Defense hospitals worldwide over a 12-month period ending January 31, 1993. RESULTS: The median age was 23 years (range, 6 months to 82 years) with 64% males and 36% females. The patients were assigned a diagnosis of normal appendix in 632 (13%) cases, acute appendicitis in 3286 (66%) cases, and perforated appendicitis in 1032 (21%) cases. There were no differences in perforation and normal appendix rates between those operations performed in teaching hospitals versus community hospitals or between high-volume hospitals (> or = 100 appendectomies/year) versus low-volume hospitals. Both a preoperative temperature > or = 100.5 and a preoperative leukocyte count > or = 10,000 were incapable of discriminating between patients with appendicitis and those with a normal appendix. Multivariate analysis showed a significantly increased risk of perforation associated with age younger than or equal to 8 years (38% vs. 18%) and age older than or equal to 45 years (49% vs. 18%). Females had a significantly higher rate of normal appendices (19% vs. 9%) and a lower rate of perforation (18% vs. 23%). The complication rates to include reoperation and intraabdominal sepsis were markedly increased in those patients with perforation. There were four deaths in this series (0.08%). CONCLUSIONS: Despite a marked decline in associated mortality over the past 50 years, rates of perforation and negative appendectomy remain unchanged because they are influenced strongly by factors untouched by the intervening technologic advances.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agafonoff S., Hawke I., Khadra M., Munnings V., Notaras L., Wadhwa S., Burton R. The influence of age and gender on normal appendicectomy rates. Aust N Z J Surg. 1987 Nov;57(11):843–846. doi: 10.1111/j.1445-2197.1987.tb01277.x. [DOI] [PubMed] [Google Scholar]
  2. Andersson R. E., Hugander A., Thulin A. J. Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate. Eur J Surg. 1992 Jan;158(1):37–41. [PubMed] [Google Scholar]
  3. Arnbjörnsson E. Some factors affecting perforation in acute appendicitis. Ann Chir Gynaecol. 1983;72(2):50–52. [PubMed] [Google Scholar]
  4. Attwood S. E., Hill A. D., Murphy P. G., Thornton J., Stephens R. B. A prospective randomized trial of laparoscopic versus open appendectomy. Surgery. 1992 Sep;112(3):497–501. [PubMed] [Google Scholar]
  5. BABCOCK J. R., McKINLEY W. M. Acute appendicitis; an analysis of 1,662 consecutive cases. Ann Surg. 1959 Jul;150(1):131–141. doi: 10.1097/00000658-195907000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. BARNES B. A., BEHRINGER G. E., WHEELOCK F. C., WILKINSEW Surgical sepsis: analysis of factors associated with sepsis following appendectomy (1937-1959). Ann Surg. 1962 Nov;156:703–712. doi: 10.1097/00000658-196211000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bailey L. E., Finley R. K., Jr, Miller S. F., Jones L. M. Acute appendicitis during pregnancy. Am Surg. 1986 Apr;52(4):218–221. [PubMed] [Google Scholar]
  8. Berry J., Jr, Malt R. A. Appendicitis near its centenary. Ann Surg. 1984 Nov;200(5):567–575. doi: 10.1097/00000658-198411000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Doberneck R. C. Appendectomy during pregnancy. Am Surg. 1985 May;51(5):265–268. [PubMed] [Google Scholar]
  10. Frazee R. C., Roberts J. W., Symmonds R. E., Snyder S. K., Hendricks J. C., Smith R. W., Custer M. D., 3rd, Harrison J. B. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg. 1994 Jun;219(6):725–731. doi: 10.1097/00000658-199406000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Horowitz M. D., Gomez G. A., Santiesteban R., Burkett G. Acute appendicitis during pregnancy. Diagnosis and management. Arch Surg. 1985 Dec;120(12):1362–1367. doi: 10.1001/archsurg.1985.01390360028007. [DOI] [PubMed] [Google Scholar]
  12. Jones P. F. The influence of age and gender on normal appendicectomy rates. Aust N Z J Surg. 1988 Nov;58(11):919–920. doi: 10.1111/j.1445-2197.1988.tb01005.x. [DOI] [PubMed] [Google Scholar]
  13. Lewis F. R., Holcroft J. W., Boey J., Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 1975 May;110(5):677–684. doi: 10.1001/archsurg.1975.01360110223039. [DOI] [PubMed] [Google Scholar]
  14. Mahmoodian S. Appendicitis complicating pregnancy. South Med J. 1992 Jan;85(1):19–24. doi: 10.1097/00007611-199201000-00006. [DOI] [PubMed] [Google Scholar]
  15. Maxwell J. M., Ragland J. J. Appendicitis. Improvements in diagnosis and treatment. Am Surg. 1991 May;57(5):282–285. [PubMed] [Google Scholar]
  16. Mittelpunkt A., Nora P. F. Current features in the treatment of acute appendicitis: an analysis of 1,000 consecutive cases. Surgery. 1966 Nov;60(5):971–975. [PubMed] [Google Scholar]
  17. Pieper R., Kager L., Näsman P. Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand. 1982;148(1):51–62. [PubMed] [Google Scholar]
  18. Silberman V. A. Appendectomy in a large metropolitan hospital. Retrospective analysis of 1,013 cases. Am J Surg. 1981 Nov;142(5):615–618. doi: 10.1016/0002-9610(81)90437-2. [DOI] [PubMed] [Google Scholar]
  19. Temple C. L., Huchcroft S. A., Temple W. J. The natural history of appendicitis in adults. A prospective study. Ann Surg. 1995 Mar;221(3):278–281. doi: 10.1097/00000658-199503000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Vallina V. L., Velasco J. M., McCulloch C. S. Laparoscopic versus conventional appendectomy. Ann Surg. 1993 Nov;218(5):685–692. doi: 10.1097/00000658-199321850-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]

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