APPENDECTOMY - A CONTEMPORARY APPRAISAL

Objective The authors present an accurate and comprehensive snapshot o f appendicitis and the practice of appendectomy in the 1990s. Methods Appendectomies were performed on 4950 patients in 147 Department of De fense hospitals worldwide over a 12-month period ending January 31, 19 93. 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 (greater than or equal to 100 appende ctomies/year) versus low-volume hospitals. Both a preoperative tempera ture greater than or equal to 100.5 and a preoperative leukocyte count greater than or equal to 10,000 were incapable of discriminating betw een patients with appendicitis and those with a normal appendix. Multi variate 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 sign ificantly higher rate of normal appendices (19% vs. 9%) and a lower ra te of perforation (18% vs. 23%). The complication rates to include reo peration and intraabdominal sepsis were markedly increased in those pa tients with perforation. There were four deaths in this series (0.08%) . Conclusions Despite a marked decline in associated mortality over th e past 50 years, rates of perforation and negative appendectomy remain unchanged because they are influenced strongly by factors untouched b y the intervening technologic advances.