Negative appendectomy rate in urban referral hospitals Tanzania: a cross sectional analysis of associated factors

Masawa Klint Nyamuryekung’e, Ali Athar, Miten Ramesh Patel, Aidan Njau, Omar Sherman, Ahmed Jusabani, Ali Akbar Zehri

Section of General surgery, Department of Surgery, Aga Khan Hospital, Dar Es Salaam Tanzania.

Correspondence to:

Ali Akbar Zehri, MBBS, MCPS, FCPS, FACS

Section of General surgery, Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania

Tel (Off):  +255222115151 Ext: 5027, Email: draazehri@gmail.com, aliakbar.zehri@akhst.org

Abstract

Background: Acute Appendicitis has a lifetime risk of 8.3% with consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult leading high perforation rate or misdiagnoses and high negative appendectomy rates. This study aimed to establish the negative appendectomy rate, explore associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a cross-sectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected acute appendicitis with histological evaluation of specimen. The study was powered to detect the negative appendectomy rate at 95% confidence level and 80% power. Results: The histological negative appendectomy rate was 38.5% and the perforation rate was 25.3%. Alvarado score was rarely applied (6%), despite demonstrated ability to decrease the negative appendectomy rate by half in this study. Females were 4 times more likely to undergo negative appendectomy compared to males. Conclusion: The negative appendectomy rate is clinically significant as about a 2 out of every 5patients undergoing emergency appendectomy for suspected acute appendicitis do not require the procedure. Alvarado score is underutilized despite demonstrated ability to decrease negative appendectomy rate. We recommend that Alvarado Score should be in cooperated in management of patients with suspected appendicitis

Keywords: Negative Appendectomy Rate, Sub Saharan Africa, Alvarado Score, Appendectomy, suspected Acute Appendicitis.

Ann Afr Surg. ****; **(*):***

DOI: http://dx.doi.org/10.4314/aas.v*****

Conflicts of Interest: None

Funding: None

© 2020 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

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