Sun Jul 14, 2002
By LINDSEY TANNER, AP Medical Writer
CHICAGO (AP) - Removing a healthy appendix may be more harmful than many have thought, requiring longer hospitals stays and an increased rate of side effects, according to a new study showing the dangers of misdiagnosing appendicitis.
The findings suggest that overlooked ailments cause the increased risks and underscore the harm in mistaking other serious conditions for appendicitis, the researchers said.
The study bolsters previous research showing that appendix removal surgeries often are inadvertently done on people who don't have appendicitis, in part because other ailments mimic the condition. But also, doctors may rush to operate because not removing a diseased appendix can have life-threatening consequences, including rupture of the narrow, worm-shaped structure.
Determining whether the appendix is truly diseased generally requires testing it after removal.
"This study emphasizes the importance of developing more effective diagnostic strategies in the management of presumed appendicitis," Drs. David Flum and Thomas Koepsell of the University of Washington said in their report.
The findings appear in July's Archives of Surgery.
The researchers examined data involving 52,969 appendix removals in 1997. Statistically, that equals approximately 261,134 such surgeries nationwide, the researchers said.
About 15 percent of the surgeries were on normal appendixes. Rates were higher among children under age 5, women and patients over age 70.
The appendix, which has no real function, is located at the lower right of the large intestine. Women are more at risk for misdiagnoses because their reproductive organs also are located in the lower abdomen, and if diseased, these organs can cause right-sided pain similar to that of an inflamed appendix. Older people and young children may have difficulty accurately describing their pain.
Misdiagnosed patients had higher death rates, 1.5 percent versus 0.2 percent; more infectious side effects, 2.6 percent versus 1.8 percent; and longer hospital stays, 5.8 days versus 3.6 days.
The data don't indicate what ailments may have contributed to the higher complication rates, but several serious conditions including ectopic pregnancy, intestinal infections and bowel obstructions may mimic appendicitis.
An accompanying editorial by California surgeon Dr. Russell Williams says the results don't mean the normal appendix is somehow to blame. Removing a normal appendix can even be beneficial by preventing the patient from ever developing true appendicitis, Williams said.
Williams also suggested that it's unrealistic and risky to strive for eliminating surgeries on normal appendixes. Doing so would mean subjecting all patients with appendicitis-like symptoms to longer observation times and hospital stays, and could mean more ruptured appendixes and even deaths, Williams said.
A previous Flum study suggested that use of newer diagnostic tests including CT scans and ultrasound hasn't reduced misdiagnoses.
But Dr. Francis Counselman of Eastern Virginia Medical School said rates likely would decrease if such tests were used only for patients without classic symptoms of appendicitis, which include pain starting in the belly and moving to the right side, mild fever, appetite loss, vomiting and reduced white blood cell levels.