Is negative appendectomy becoming history? Ten-year results from a tertiary center
Öz
Aim: This study aimed to determine the rate of negative appendectomy between patients who underwent surgery with a pre-diagnosis of acute appendicitis and to evaluate the clinical, laboratory, and imaging parameters associated with negative appendectomy.
Materials and Methods: Between the years 2014-2024, over the age of 18 who underwent laparoscopic or open technique operation with a pre-diagnosis of acute appendicitis in the Ege University General Surgery Department were retrospectively analyzed. Based on postoperative pathological results, patients were divided into two groups: acute appendicitis (AA) and negative appendectomy (NA).
Results: Of the 2330 patients included, 58.2% (1355) were male and 41.8% (975) were female, with a mean age of 39.78±16.49 years.
The negative appendectomy rate was determined as 2.1%. The proportion of female patients was higher in the NA group(p=0.001). Regarding imaging modalities, the use of ultrasonography (USG) alone was associated with a higher rate of negative appendectomy(p<0.001). The use of computed tomography (CT) reduced the risk of negative appendectomy by 98.1% (OR:0.019; p<0.001), while the combined use of CT and USG further reduced the risk by up to 98.5% (OR:0.015; p<0.001). The neutrophil-to-lymphocyte ratio (NLR) was higher in the AA group compared to the NA group(p=0.001) and remained an independent predictive factor in multivariate analysis(p=0.035).
Conclusion: Female gender and reliance solely on USG increase the risk of negative appendectomy. The NLR was identified as an independent biomarker for predicting negative appendectomy. The findings support that integrating clinical evaluation, imaging studies, and laboratory parameters plays a critical role in reducing unnecessary surgical interventions in the diagnosis of acute appendicitis.
Anahtar Kelimeler
acute appendicitis negative appendectomy cross-sectional imaging
Kaynakça
- Golz RA, Flum DR, Sanchez SE, Liu X, Donovan C, Drake FT. Geographic Association Between Incidence of Acute Appendicitis and Socioeconomic Status. JAMA Surg. 2020 Apr 1;155(4):330-338. doi: 10.1001/jamasurg.2019.6030. PMID: 32129808; PMCID: PMC7057178
- Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015; 386:1278–87.
- Sartelli M, Baiocchi GL, Di Saverio S et al (2018) Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Med 13:19. https://doi.org/10.1186/s13017-018-0179-0
- Emre A, Akbulut S, Bozdag Z et al (2013) Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients. Int Surg 98:354–362. https://doi.org/10.9738/INTSURG-D-13-00098.1
- Di Saverio S, Podda M, De Simone B et al (2020) Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Med 15:27.
- Luksaite-Lukste, R.; Kliokyte, R.; Samuilis, A.; Jasiunas, E.; Luksta, M.; Strupas, K.; Poskus, T. Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT. J. Clin. Med. 2021, 10, 2456. https://doi.org/10.3390/jcm10112456
- Lu Y, Friedlander S, Lee SL. Negative Appendectomy: Clinical and Economic Implications. The American SurgeonTM. 2016;82(10):1018-1022. doi:10.1177/000313481608201036
- Ambe PC. Negative Appendectomy. It is Really Preventable? J Invest Surg. 2019 Aug;32(5):474-475. doi: 10.1080/08941939.2018.1453566. Epub 2018 Apr 2. PMID: 29608342.
- Şenocak R, Kaymak Ş. Diagnostic accuracy of ultrasonography and scoring systems: The effects on the negative appendectomy rate and gender. Ulus Travma Acil Cerrahi Derg. 2020 Mar;26(2):306-313. English. doi: 10.14744/tjtes.2019.86717. PMID: 32185777.
- Chan J, Fan KS, Mak TLA, Loh SY, Ng SWY, Adapala R. Pre-Operative Imaging can Reduce Negative Appendectomy Rate in Acute Appendicitis. Ulster Med J. 2020 Jan;89(1):25-28. Epub 2020 Feb 18. PMID: 32218624; PMCID: PMC7027177.
- Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, Baeyens PF, Khorasani R. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology. 2010 Aug;256(2):460-5. doi: 10.1148/radiol.10091570. Epub 2010 Jun 7. PMID: 20529988.
- Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med. 2012 Apr 26;366(17):1596-605. doi: 10.1056/NEJMoa1110734. PMID: 22533576.
- Soyer P, Dohan A, Eveno C, Naneix AL, Pocard M, Pautrat K, Hamzi L, Duteil C, Lavergne-Slove A, Boudiaf M. Pitfalls and mimickers at 64-section helical CT that cause negative appendectomy: an analysis from 1057 appendectomies. Clin Imaging. 2013 Sep-Oct;37(5):895-901. doi: 10.1016/j.clinimag.2013.05.006. Epub 2013 Jul 8. PMID: 23845254.
- Bates MF, Khander A, Steigman SA, Tracy TF Jr, Luks FI. Use of white blood cell count and negative appendectomy rate. Pediatrics. 2014 Jan;133(1):e39-44. doi: 10.1542/peds.2013-2418. Epub 2013 Dec 30. PMID: 24379236.
- Fujita T, Yanaga K. Appendectomy: negative appendectomy no longer ignored. Arch Surg. 2007 Nov;142(11):1023-5. doi: 10.1001/archsurg.142.11.1023. PMID: 18025327.
- Hou J, Feng W, Liu W, Hou J, Die X, Sun J, Zhang M, Wang Y. The use of the ratio of C-reactive protein to albumin for the diagnosis of complicated appendicitis in children. Am J Emerg Med. 2022 Feb;52:148-154. doi: 10.1016/j.ajem.2021.12.007. Epub 2021 Dec 11. PMID: 34922235.
- Chandni, Wasay A, Chaudhary MA, Qureshi MU. Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictive Marker of Postoperative Infectious Complications in Pediatric Patients With Acute Appendicitis. Cureus. 2024 Oct 13;16(10):e71353. doi: 10.7759/cureus.71353. PMID: 39624500; PMCID: PMC11610530.
- Delgado-Miguel C, Muñoz-Serrano A, San Basilio M, Miguel-Ferrero M, de Ceano-Vivas M, Martínez L. The role of the neutrophil-to-lymphocyte ratio in avoiding negative appendectomies. An Pediatr (Engl Ed). 2023 Jan;98(1):12-18. doi: 10.1016/j.anpede.2022.08.005. Epub 2022 Sep 7. PMID: 36088243.
- Augustin G, Čižmešija Z, Žedelj J, Petrović I, Ivković V, Antabak A, Mijatović D, Škegro M. LAPAROSCOPIC APPENDECTOMY DOES NOT INCREASE THE RATE OF NEGATIVE APPENDECTOMY along with a lower rate of perforated appendicitis - RESULTS IN 1899 PATIENTS at Zagreb UHC. Acta Clin Croat. 2018 Sep;57(3):503-509. doi: 10.20471/acc.2018.57.03.14. PMID: 31168184; PMCID: PMC6536279.
Negatif apendektomi tarih mi oluyor? Tersiyer bir merkezin 10 yıllık sonuçları
Öz
Amaç: Çalışmamızın amacı, akut apandisit ön tanısıyla opere edilen hastalarda negatif apendektomi oranını belirlemek ve negatif apendektomi ile ilişkili klinik, laboratuvar ve görüntüleme parametrelerini değerlendirmektir.
Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Anabilim Dalı’nda, 2014-2024 yılları arasında akut apandisit ön tanısıyla laparoskopik veya açık teknik ile cerrahi girişim uygulanan 18 yaş üstü hastalar retrospektif olarak incelenmiş; postoperatif patoloji sonuçlarına göre akut apandisit (AA) ve negatif appendektomi (NA) olmak üzere iki gruba ayrılmıştır.
Bulgular: İkibinüçyüzotuz hastanın %58,2’si (1355) erkek, %41,8’i (975) kadın olup, ortalama yaş 39,78±16,49 yıl olarak belirlenmiştir. Negatif apendektomi oranı %2,1 olarak tespit edilmiştir. NA grubunda kadın cinsiyetin oranı anlamlı derecede yüksek bulunmuştur (p=0,001). Görüntüleme yöntemleri incelendiğinde, yalnızca ultrasonografi (USG) kullanımının negatif apendektomi ile anlamlı düzeyde ilişkili olduğu saptanmıştır (p<0,001). Bilgisayarlı tomografi (BT) kullanımı, negatif apendektomi riskini %98,1 oranında azaltmış (OR: 0,019; p<0,001); BT ve USG birlikte kullanıldığında ise bu oran %98,5’e kadar azalttığı saptanmıştır (OR:0,015; p<0,001). Ayrıca AA grubunda nötrofil(p=0,004), lökosit(p=0,024), hemoglobin(p=0,007) ve hematokrit(p=0,013) düzeyleri anlamlı olarak daha yüksek; trombosit sayısı ise belirgin şekilde düşük bulunmuştur(p=0,002). Nötrofil/lökosit oranı (NLR), AA grubunda NAi grubuna göre anlamlı derecede yüksek olup (p=0,001), çok değişkenli analizlerde de bağımsız bir prediktif faktör olarak kalmıştır (p=0,035).
Sonuç: Kadın cinsiyet ve yalnızca USG kullanımı negatif apendektomi riskini anlamlı şekilde artırmaktadır. NLR değeri, negatif apendektomiyi öngörmede bağımsız bir biyobelirteç olarak kullanılabilir niteliktedir. Elde edilen veriler, akut apandisit tanısında klinik değerlendirme, görüntüleme bulguları ve laboratuvar parametrelerinin entegre edilmesinin, gereksiz cerrahi müdahaleleri azaltmada kritik bir rol oynadığını desteklemektedir.
Anahtar Kelimeler
Etik Beyan
Çalışmamız Ege Üniversitesi Etik Kurulu tarafından incelenmiş ve 2024-343824-8T/69 onay numarası ile etik kurul onayı alınmıştır.
Kaynakça
- Golz RA, Flum DR, Sanchez SE, Liu X, Donovan C, Drake FT. Geographic Association Between Incidence of Acute Appendicitis and Socioeconomic Status. JAMA Surg. 2020 Apr 1;155(4):330-338. doi: 10.1001/jamasurg.2019.6030. PMID: 32129808; PMCID: PMC7057178
- Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015; 386:1278–87.
- Sartelli M, Baiocchi GL, Di Saverio S et al (2018) Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Med 13:19. https://doi.org/10.1186/s13017-018-0179-0
- Emre A, Akbulut S, Bozdag Z et al (2013) Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients. Int Surg 98:354–362. https://doi.org/10.9738/INTSURG-D-13-00098.1
- Di Saverio S, Podda M, De Simone B et al (2020) Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Med 15:27.
- Luksaite-Lukste, R.; Kliokyte, R.; Samuilis, A.; Jasiunas, E.; Luksta, M.; Strupas, K.; Poskus, T. Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT. J. Clin. Med. 2021, 10, 2456. https://doi.org/10.3390/jcm10112456
- Lu Y, Friedlander S, Lee SL. Negative Appendectomy: Clinical and Economic Implications. The American SurgeonTM. 2016;82(10):1018-1022. doi:10.1177/000313481608201036
- Ambe PC. Negative Appendectomy. It is Really Preventable? J Invest Surg. 2019 Aug;32(5):474-475. doi: 10.1080/08941939.2018.1453566. Epub 2018 Apr 2. PMID: 29608342.
- Şenocak R, Kaymak Ş. Diagnostic accuracy of ultrasonography and scoring systems: The effects on the negative appendectomy rate and gender. Ulus Travma Acil Cerrahi Derg. 2020 Mar;26(2):306-313. English. doi: 10.14744/tjtes.2019.86717. PMID: 32185777.
- Chan J, Fan KS, Mak TLA, Loh SY, Ng SWY, Adapala R. Pre-Operative Imaging can Reduce Negative Appendectomy Rate in Acute Appendicitis. Ulster Med J. 2020 Jan;89(1):25-28. Epub 2020 Feb 18. PMID: 32218624; PMCID: PMC7027177.
- Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, Baeyens PF, Khorasani R. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology. 2010 Aug;256(2):460-5. doi: 10.1148/radiol.10091570. Epub 2010 Jun 7. PMID: 20529988.
- Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med. 2012 Apr 26;366(17):1596-605. doi: 10.1056/NEJMoa1110734. PMID: 22533576.
- Soyer P, Dohan A, Eveno C, Naneix AL, Pocard M, Pautrat K, Hamzi L, Duteil C, Lavergne-Slove A, Boudiaf M. Pitfalls and mimickers at 64-section helical CT that cause negative appendectomy: an analysis from 1057 appendectomies. Clin Imaging. 2013 Sep-Oct;37(5):895-901. doi: 10.1016/j.clinimag.2013.05.006. Epub 2013 Jul 8. PMID: 23845254.
- Bates MF, Khander A, Steigman SA, Tracy TF Jr, Luks FI. Use of white blood cell count and negative appendectomy rate. Pediatrics. 2014 Jan;133(1):e39-44. doi: 10.1542/peds.2013-2418. Epub 2013 Dec 30. PMID: 24379236.
- Fujita T, Yanaga K. Appendectomy: negative appendectomy no longer ignored. Arch Surg. 2007 Nov;142(11):1023-5. doi: 10.1001/archsurg.142.11.1023. PMID: 18025327.
- Hou J, Feng W, Liu W, Hou J, Die X, Sun J, Zhang M, Wang Y. The use of the ratio of C-reactive protein to albumin for the diagnosis of complicated appendicitis in children. Am J Emerg Med. 2022 Feb;52:148-154. doi: 10.1016/j.ajem.2021.12.007. Epub 2021 Dec 11. PMID: 34922235.
- Chandni, Wasay A, Chaudhary MA, Qureshi MU. Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictive Marker of Postoperative Infectious Complications in Pediatric Patients With Acute Appendicitis. Cureus. 2024 Oct 13;16(10):e71353. doi: 10.7759/cureus.71353. PMID: 39624500; PMCID: PMC11610530.
- Delgado-Miguel C, Muñoz-Serrano A, San Basilio M, Miguel-Ferrero M, de Ceano-Vivas M, Martínez L. The role of the neutrophil-to-lymphocyte ratio in avoiding negative appendectomies. An Pediatr (Engl Ed). 2023 Jan;98(1):12-18. doi: 10.1016/j.anpede.2022.08.005. Epub 2022 Sep 7. PMID: 36088243.
- Augustin G, Čižmešija Z, Žedelj J, Petrović I, Ivković V, Antabak A, Mijatović D, Škegro M. LAPAROSCOPIC APPENDECTOMY DOES NOT INCREASE THE RATE OF NEGATIVE APPENDECTOMY along with a lower rate of perforated appendicitis - RESULTS IN 1899 PATIENTS at Zagreb UHC. Acta Clin Croat. 2018 Sep;57(3):503-509. doi: 10.20471/acc.2018.57.03.14. PMID: 31168184; PMCID: PMC6536279.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Genel Cerrahi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Eylül 2025 |
| Gönderilme Tarihi | 2 Mayıs 2025 |
| Kabul Tarihi | 8 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 64 Sayı: 3 |
