Mortality after appendectomy in Sweden, 1987-1996

Objective To study mortality after appendectomy. Summary Background Data The management of patients with suspected appendici tis remains controversial, with advocates of early surgery as well as of ex pectant management. Mortality is not known. Methods The authors conducted a complete follow-up of deaths within 30 days after all appendectomies in Sweden (population 8.9 million) during the yea rs 1987 to 1996 (n = 117,424) by register linkage. The case fatality rate ( CFR) and the standardized mortality ratio (SMR) were analyzed by discharge diagnosis. Results The CFR was 2.44 per 1,000 appendectomies. It was strongly related to age (0.31 per 1,000 appendectomies at 0-9 years of age, decreasing to 0. 07 at 20-29 years, and reaching 164 among nonagenarians) and diagnosis at s urgery (0.8 per 1,000 appendectomies after nonperforated appendicitis, 5.1 after perforated appendicitis, 1.9 after appendectomies for nonsurgical abd ominal pain, and 10.0 for those with other diagnoses). The SMR showed a sevenfold excess rate of deaths after appendectomy compare d with the general population. The relation to age was less marked (SMR of 44.4 at 0-9 years, decreasing to 2.4 in patients aged 20-29 years. and reac hing 8.1 in nonagenarians). The SMR was doubled after perforation compared with nonperforated appendicitis (6.5 and 3.5, respectively). Nonsurgical ab dominal pain and other diagnoses were associated with a high excess rate of deaths (9.1 and 14.9, respectively). The most common causes of deaths were appendicitis, ischemic heart diseases and tumors, followed by gastrointest inal diseases. Conclusions The CFR after appendectomy is high in elderly patients. The exc ess rate of death for patients with nonperforated appendicitis and nonsurgi cal abdominal pain suggests that the deaths may partly be caused by the sur gical trauma. Increased diagnostic efforts rather than urgent appendectomy are therefore warranted among frail patients with an equivocal diagnosis of appendicitis.