One in six children have unnecessary appendix surgery

A study the University of Birmingham has found that thousands of UK children undergo unnecessary appendix surgery each year in the NHS.

Published in The Lancet Child & Adolescent Health journal, the study found that the UK has the highest reported national rate of ‘normal appendicectomy,’ where children undergo surgery for suspected appendicitis but laboratory examination of the removed appendix finds it to be normal.

Although most children who are misdiagnosed as having appendicitis improve without further treatment, the unnecessary surgery can be stressful for children and their parents, and can lead to postoperative complications.

Surgery for appendicitis is the most common emergency operation in children, with 28,700 cases. A third of children, some 9,900, undergo appendicectomy but 1,600 of these operations are found not to have been needed with the number much higher in girls.

Researchers highlight that urgent improvements are needed to reduce the number of patients undergoing unnecessary surgery. They propose that all children presenting with suspected appendicitis should be routinely risk scored using the Shera score, which they found to be the best performing risk score for appendicitis. The study suggests that most low-risk children can be discharged early; over half of these patients have non-specific abdominal pain, and most other diagnoses do not require any specific treatment.

Ensuring that all medium-risk and high-risk children undergo high-quality ultrasound imaging prior to surgery could also reduce unnecessary surgery and produce an overall saving for the NHS of £4.4 million each year.

Dr. Dmitri Nepogodiev, one of the study leads, said: “It’s important that children receive the right diagnosis before a decision is made to operate. Ultrasound scans have the advantage that unlike CAT scans they do not expose children to radiation. They have been found to be an effective diagnostic tool in other countries, but we found that in the UK ultrasound is frequently inconclusive. Hospitals should ensure seven-day-a-week availability of ultrasound done by staff specially trained to assess for acute appendicitis in children.”

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