High rates of appendicectomy in a developing country: an attempt to contribute to a more rational use of surgical resources

Objective: In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiolog y of appendicitis. Design: Prospective clinical and pathological study. Setting: Teaching hospital, Madagascar. Subjects: 165 patients who underwent appendicectomy during a two month peri od. Interventions: Clinical investigation and histopathological examination of removed appendixes. Main outcome measures: Appendicitis score, local incidence of appendicectom y, appendicitis, perforation, and negative appendicectomy. Results: There was a high incidence of primary appendicectomy (51.1/10000 p opulation/year) in relation to the incidence of histologically confirmed ap pendicitis (7.7/10 000), resulting in a negative appendicectomy rate of 85% (43/10 000). There were considerable sex related differences in the incide nce of primary appendicectomy (81/10000 women/year; 22/10000 men), appendic ectomy for appendicitis (12/10000 women/year; 4/10000 men) and non-perforat ing appendicitis (8/10000 women/ year; 2/10000 men), but much less in that of perforating appendicitis (4/10000 women/year; 2/10000 men). Conclusion: There is potential for more economic use of medical resources b y reducing the rate of negative appendicectomy. The incidence of non-perfor ating appendicitis depends on the number of appendicectomies done, which ma y explain the differences observed in the incidence of appendicitis between industrialised and developing countries.