Author(s): Lahaye MJ, Lambregts DM, Mutsaers E, Essers BA, Breukink S, , Lahaye MJ, Lambregts DM, Mutsaers E, Essers BA, Breukink S,
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Abstract OBJECTIVE: To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. METHODS: In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. RESULTS: After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5\% received preoperative imaging (42\% US/12.8\% CT/3.7\% both), compared with 98.7\% after the guidelines (61.6\% US/4.4\% CT/ 32.6\% both). The percentage of unnecessary surgeries before the guidelines was 22.9\%. After implementation, it dropped significantly to 6.2\% (p<0.001). The surgical complication rate dropped from 19.9\% to 14.2\%. The average cost-per-patient decreased by 594 from 2,482 to 1,888 (CL:-1081; -143). CONCLUSION: Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. KEY POINTS: • The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. • This led to a considerable increase in the use of preoperative imaging. • Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. • Use of mandatory imaging seems to reduce health care costs.
This article was published in Eur Radiol and referenced in Journal of Medical Diagnostic Methods