FREQUENCY OF NEGATIVE APPENDECTOMIES IN A TERTIARY CARE HOSPITAL OF RAWALPINDI

Abstract

Background:  One of the most frequent surgical emergencies worldwide is acute appendicitis. Even with the availability of numerous imaging modalities and clinical scoring systems like the Alvarado score, the current negative appendectomy rates in tertiary care facilities remain unacceptable. The prevalence of acute appendicitis in Rawalpindi's general population ranges from 6% to 10% [1, 2], and diagnostic precision and decision-making need to be reassessed. This study sought to determine the prevalence of negative appendectomies performed in a Rawalpindi tertiary care hospital using histopathological correlation and standardized clinical criteria.Methods: Between October 31, 2024, and February 28, 2025, a prospective cross-sectional study was carried out at Holy Family Hospital's Department of Surgery, Unit 1. The study included 305 patients, ages 18 to 60, who were clinically diagnosed with acute appendicitis (Alvarado score ≥7 [3]) and, when necessary, ultrasonographically diagnosed with the condition using non-random consecutive sampling. Appendicular mass or a history of conservatively treated appendicitis were exclusion criteria. Every patient had an open appendectomy; the gold standard for diagnosis was histopathological examination of the specimens. Using a 95% confidence level, a 5% margin of error, and an expected negative appendectomy frequency of 5%, the sample size was determined using the WHO calculator.

Results : Out of the 305 patients, 31 (10.2%) had negative appendectomies and 274 (89.8%) had acute appendicitis with histopathological confirmation. Compared to men (7.1%), women had a higher negative appendectomy rate (13.4%) (p < 0.05). The positive group's mean Alvarado scores were 8.1 ± 1.1, while the negative group's were 6.4 ± 1.0 (p = 0.001). Figure 1 (bar graph) and Figure 2 (pie chart) show the histopathological results.Conclusion: The need to improve preoperative diagnostic procedures is highlighted by our setting's 10.2% negative appendectomy rate. It may be possible to decrease needless surgeries by increasing clinical scoring thresholds and using advanced imaging selectively.