We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Appendectomy Negative Appendectomy No Longer Ignored

Tetsuji Fujita, MD; Katuhiko Yanaga, MD
Arch Surg. 2007;142(11):1023-1025. doi:10.1001/archsurg.142.11.1023.
Text Size: A A A
Published online


Early appendectomy has been the treatment of choice for patients with confirmed or suspected acute appendicitis. The surgical residents have been taught that although observation may reduce the rate of unnecessary appendectomy, such a policy will increase the rate of perforation, which undoubtedly results in increased morbidity and mortality. Whereas appendectomy has been a safe procedure with a mortality rate of 0.4% to 0.08% for uncomplicated appendicitis,1,2 in some series perforated appendicitis is associated with an unacceptable mortality rate as high as 12%.1 For patients with acute appendicitis, therefore, the perforation rate has been used as an index of quality of care. In a recent study, the association between time from the onset of symptoms and risk of appendiceal rupture was retrospectively studied in 219 patients who had undergone appendectomy for pathologically proven appendicitis.3 The risk was negligible within the first 24 hours, climbed to 6% by 36 hours, and then rose by 5% for each ensuing 12-hour period until day 4. Based on these data, most surgeons offer early appendectomy to patients with suspected acute appendicitis. The policy on early surgical intervention for suspected appendicitis results in relatively high rates of negative appendectomy, quoted as between 15% and 25%.4,5 The error rate can increase up to 40% in young women or in elderly patients.6 Deaths from a normal appendectomy in young adults were extremely rare (0.02%).1 A retrospective computer-based study in Sweden, however, revealed a 30-day mortality rate of 0.19% after appendectomy for nonsurgical abdominal pain and showed that appendectomy for a normal appendix was associated with an excess rate of deaths.2 In a nationwide analysis in the United States including 261 134 patients with appendectomy, negative appendectomy was associated with a significantly longer hospital stay and total admission charges compared with patients with appendicitis.4 In the 5 years following lower abdominal surgery, appendectomy was associated with a lower rate of hospital readmission (0.9%) directly related to adhesions compared with other procedures, such as total colectomy (8.8%) and ileostomy (10.6%).7 However, appendectomy accounted for as high as 30% of all procedures, and 7% of all patients contributed to the overall burden of adhesion-related readmissions. Could we continue to allow such a high rate of negative appendectomy?

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

8 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Appendicitis, Child

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Clinical Scenario—Resolution