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Negative Appendectomy Rate and Risk Factors That Influence Improper Diagnosis at King Abdulaziz University Hospital

Yara F. Alhamdani; Hisham A. Rizk; Mohammed R. Algethami; Asma M. Algarawi; Roia H. Albadawi; Sofana N. Faqih; Elaf H. Ahmed; Ohud J. Abukammas.

Abstract
Introduction: Acute Appendicitis is the most common emergent abdominal surgery worldwide. diagnosis based on clinical assessment, laboratory and radiological investigations and appendectomy is the treatment of choice. Removing a normal appendix is a relatively common surgical issue, defined as negative appendectomy (NA). Multiple risk factors contribute to NA; female gender, normal WBC, normal CRP count, and CT scan unavailability. However, recently NA is decreasing in incidence after CT scan and Alvarado scoring. Aim: We aimed to estimate the rate of negative appendectomy, and determine possible risk factors among King Abdulaziz University Hospital. Patients and Methods: Article has a retrospective character and included non-incidental 441 patients who undergo an appendectomy, during period 2008 to 2018. Results: Negative Appendectomy incidence (9.5%) was higher among females at (64.3%). Gynecological complaints were seen in (22.2%) of cases with a sign for Negative Appendectomy. Surgery reports documented (29.6%) of female ovarian cyst diseases. Alvarado scoring at presentation was less than 7 in (69%) of cases with statistical significance value. Normal WBC count (50%), for automated neutrophil (45.2%) was high, and same number were recorded with the normal neutrophil count, all of them have statically significant relation with NA. Conclusion: Proper clinical evaluation involves documenting Alvarado score, using CRP, efficient radiological utilization. Also, considering more referrals to gynecological specialists of similar presentation especially females at reproductive age. Investing in time and equipment for proper clinical assessment can avoid the unnecessary burden and save our resources for better use.

Key words: Appendectomy;Acute Appendicitis;Leukocytes;C-Reactive Protein



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