WTP3.04 Assessing Negative Appendicectomy Rates in the Paediatric population: A review of Trends and Implications

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Abstract Introduction Acute appendicitis is the most common surgical presentation in the paediatric population, with appendicectomy the standard treatment. Despite the increasing use of imaging in diagnostics, there remains a clinical challenge in accurately diagnosing appendicitis. This can result in a proportion of patients undergoing unnecessary operations which risks surgical complications and can put a strain on resources. The accepted national average of negative appendicectomy (NA) in the literature is 20%. The aim of this study was to assess the negative appendicectomy rate (NAR) in NHS Grampian in the paediatric patient cohort. Methods A retrospective study was carried out of all patients aged 15 and under who underwent emergency appendicectomy between August 2022 and August 2023 in NHS Grampian. Patients’ health records were examined, and data collected. Patient demographics, presenting symptoms, investigations, management and histological findings were recorded. Negative appendicectomy was defined as the removal of an appendix without any signs of histological inflammation. Results Overall, 50 patients underwent emergency appendicectomy over the year-long period. A total of 3 specimens were histologically normal giving a NAR of 6%. Imaging was used in 18 (36%) patients in the form of ultrasound scan (US). Of the 3 negative appendixes, 2 underwent US preoperatively. Conclusion Abdominal pain is a frequent presentation in paediatric surgery. Appendicitis can be a challenging diagnosis with limits to imaging suitability and availability. Despite these challenges our NAR remains comparatively low with national rates with the majority of cases being diagnosed clinically.

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