Value of Preoperative Physical Examination in Diagnosing Acute Appendicitis

Abstract

Background and Purpose: To justify the detail preoperative physical examination is effective and economic method in diagnosing acute appendicitis under the Payment System of National Health Insurance in Taiwan. Methods: During the past 6-month period, a prospective study was done. Forty-two suspected acute appendicitis patients (age from 8 to 88 years old) were consecutively admitted under the same duty surgeon's service. Routine laboratory examinations and chest plus abdominal x rays were essentially performed in each patient. Results: All thirty-four patients with persistent local tenderness received appendectomy (male 20, female 14). The mean age was 33 years old. Nineteen patients (55.9%) had simple appendicitis; fifteen patients (44.1%) had complicated appendicitis. Patient's delay (onset to hospital) is significantly longer in complicated appendicitis compared to patients with simple appendicitis (41.5 hours vs. 22.5 hours, p＜0.05). The mean hospital stay was 4.7 days. One patient had wound infection (2.9%). None negative appendectomy was done in this study. The other eight patients were discharged without operation after essential investigations. Conclusion: Negative appendectomy can be avoided by an experienced surgeon. Physical examination is effective and economic method in diagnosing acute appendicitis under the payment system of National Health Insurance in Taiwan.