Reducing the mortality of perforated appendicitis: A study of one hundred cases

Abstract

In summary, it is regrettable but none the less true that in spite of all advances in medical science, the death rate for appendicitis, as apparent in the chart, is higher in the United States today than it was thirty years ago. During this period, the number of deaths from appendicitis in this country alone has approximated the number of persons now residing in the city of Milwaukee. The unfortunate feature of this is that, barring rare complications, the death rate from nonperforated appendicitis is almost negligible, while the death rate for perforated appendicitis may be as high as 50 per cent in series of cases. The greatest cause of the high death rate for appendicitis is delay on the part of someone who allows the appendix to rupture. The use of purgatives and laxatives is a predisposing cause and the inexperience of some surgeons a contributing factor in maintaining this high death rate. Even if there is delay and perforation does occur, the mortality rate can still be lower if certain complications are anticipated and properly prevented. Adequate drainage maintained sufficiently long is important. The use of spinal anesthesia, hypodermoclysis, duodenal suction, carbon dioxide inhalations, oxygen, postural change, digitalis, and other drugs as indicated are all helpful in the prevention and treatment of complications. In this study, a series of one hundred cases of perforated appendicitis with localized and generalized peritonitis is reported. There were twelve deaths, a mortality of 12 per cent. It is reasonable to conclude that all of these deaths might have been prevented. During a period of fourteen years in which these cases were observed, 2,215 appendectomies on cases of nonperforated appendicitis were done without a death occurring that might be directly attributable to appendicitis. That spinal anesthesia was a definite factor in lowering the mortality is shown by the fact that of the forty cases operated upon in which fourteen complications of various kinds occurred, there were only two deaths; of thirty-three cases operated upon under gas and ether, there were seven complications and six deaths. Under local anesthesia alone the death rate was high also, but these patients were in extremely bad condition. If the mortality rate is to be lowered, there must be a greater distribution of facts regarding appendicitis to the lay public. There must be a wider dissemination of knowledge by postgraduate teaching regarding surgical principles in the treatment of perforated appendicitis to those surgeons who, either through training or practice, have had an opportunity to treat but few cases.