Negative Appendectomy and Imaging Accuracy in the Washington State Surgical Care and Outcomes Assessment Program

被引:158
作者
Cuschieri, Joseph
Florence, Michael [2 ]
Flum, David R. [1 ,3 ]
Jurkovich, Gregory J.
Lin, Paul [4 ]
Steele, Scott R. [5 ]
Symons, Rebecca Gaston [3 ]
Thirlby, Richard [6 ]
机构
[1] Univ Washington, Dept Surg, Hlth Sci Ctr, Seattle, WA 98195 USA
[2] Univ Washington, Swedish Med Ctr, Seattle, WA 98195 USA
[3] Univ Washington, Dept Surg Outcomes Res Ctr, Seattle, WA 98195 USA
[4] Sacred Heart Med Ctr, Spokane, WA USA
[5] Madigan Army Med Ctr, Tacoma, WA 98431 USA
[6] Virginia Mason Med Ctr, Hlth Sci Ctr, Seattle, WA 98101 USA
关键词
D O I
10.1097/SLA.0b013e318187aeca
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To evaluate negative appendectomy (NA) and the relationship of NA and computed tomography (CT) and/or ultrasound (US). Summary Background Information: NA may be influenced by the use and accuracy of preoperative CT/US. The Surgical Care and Outcomes Assessment Program (SCOAP) gathers chart-abstracted process of care data (such as CT/US accuracy) for general surgical procedures (including appendectomy) at most Washington State hospitals. Methods: We determined the prevalence of NA and CT/US concordance at the 15 SCOAP hospitals with >50 consecutive patients undergoing appendectomy (2006-2007). Results: The number of patients who underwent urgent appendectomies was 3540. The percentage of patients who had imaging (CT-91%) was 86% (women-89%, men-83%). The use of imaging ranged across hospitals from 56% to 97%. There was 91% agreement between imaging and pathology report findings (92.3%-CT and 82.4%-US). The overall rate of NA was 6% (women-8%, men-4%). The prevalence of NA was 9.8% among patients having no imaging, 8.1% among those having an US, and 4.5% in those having a CT. Among patients with NA, CT/US was obtained in 75%; correct in 10% and incorrect or ambiguous in 65%. Higher rates of NA were correlated with lower rates of CT/US concordance (r = -0.57). There was no significant difference in rates of perforation between those with (17%) and without (15%) imaging (P = 0.2). There were significant increases in the use of CT/US and decreases in NA over the time period (P < 0.01). Conclusions: The prevalence of NA at SCOAP hospitals decreased significantly. Variation in NA between hospitals was linked closely to CT/US accuracy suggesting CT/US accuracy should be considered a measure of quality in the care of patients with presumed appendicitis.
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页码:557 / 562
页数:6
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