Women in the UK have a disproportionately high risk of undergoing unnecessary appendectomy compared with men. That is the finding of research published in the BJS (British Journal of Surgery).
The study identified 5345 patients aged 16-45 years presenting to one of 154 UK hospitals with acute right iliac fossa (RIF) pain in March to June 2017. Approximately two-thirds of this cohort were women.
The overall normal appendicectomy rate (NAR) was 20.0 per cent. This represents one of the highest NARs in the world.
Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix than men (28.2% vs 12.1%, respectively; relative risk [RR], 2.33; 95% CI, 1.92-2.84; P<.001). Of all patients presenting with RIF pain, women were less likely to have a confirmed diagnosis of appendicitis than men (17.3% vs 48.6%, respectively; RR, 0.36; 95% CI, 0.33-0.39; P<.001).
Only 0.6 per cent of patients were recorded as having been formally risk-scored on admission. The authors say all adults presenting with acute RIF pain or suspected appendicitis should be scored routinely. To support calculation and application of appropriate cut-off scores, a web application has been developed (https://appy-risk.org).
The authors advise that if a patient is stratified as low risk and suspicion of appendicitis remains, low radiation dose computed tomography should be undertaken to confirm the diagnosis. Ultrasound imaging is preferable in women if the principal differential diagnosis is gynaecological pathology, they say.
