Current opinions and practices for the management of acute appendicitis: an international survey
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ORIGINAL ARTICLE
Current opinions and practices for the management of acute appendicitis: an international survey Patrick Anthony Boland 1 & Noel E. Donlon 2,3 & Michael E. Kelly 2 & Timothy Nugent 2 & Ross Free 2 & Peadar Waters 4 & Peter Neary 5 & Emanuele Rausa 6 & David Proud 7 & Claire L. Donohoe 2 & Kevin M. Barry 1,8 & John V. Reynolds 2,3 Received: 14 June 2020 / Accepted: 13 August 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background In recent decades the management of acute appendicitis has evolved significantly. Improved access to early imaging and better clinical scoring algorithms have resulted in less negative appendicectomy rates. In addition, non-operative management has become increasingly utilized. The aim of this study was to assess the variability of management of acute appendicitis globally. Methods This was a multi-national targeted survey of general surgeons across 39 countries. A structured set of questions was utilized to delineate nuances between management styles of consultants and trainees. Opinions on the pathological diagnosis of appendicitis, acceptable negative appendicectomy rates, and the role of non-operative treatment of appendicitis (NOTA) were surveyed. Results A total of 304 general surgeons responded to this survey, 42% of which were consultants/attendings. Sixty-nine percent advocated that a histologically normal appendix was the most appropriate definition of a negative appendicectomy, while 29% felt that anything other than inflammation, necrosis, gangrene, or perforation was more appropriate. Forty-three percent felt that negative appendicectomy rates should be less than 10%, with 41% reporting that their own negative appendicectomy rate was < 5%. Interestingly, only 17% reported routinely using NOTA for uncomplicated appendicitis, with one-fifth stating that they would undergo NOTA if they themselves had uncomplicated appendicitis. Conclusion This study represents the largest sampling of management strategies for acute appendicitis. It shows substantial global heterogeneity between clinicians regarding what constitutes a negative appendicectomy as well as the appropriateness of non-operative management. Keywords Appendicitis . Negative appendicectomy . Non-operative treatment of appendicitis . Surgical management
Introduction Appendicitis is the most common cause of emergency surgical admission worldwide with an incidence of 86 cases per
100,000 per year [1]. Appendicectomy has been a standard treatment since McBurney described the procedure in 1889 [2, 3]. Numerous developments have occurred in the management of acute appendicitis over the last hundred years
Patrick Anthony Boland and Noel E. Donlon contributed equally to this work. * Patrick Anthony Boland [email protected] 1
Mayo University Hospital, Castlebar, Ireland
2
Department of Surgery, St. James’ Hospital, Dublin 8, Ireland
3
School of Medicine, Trinity College Dublin, Dublin, Ireland
4
Department of Surgery, Royal Brisbane and Women’s Hospital, Herston, Australia
5
D
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