OBJECTIVE: In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiology of appendicitis. DESIGN: Prospective clinical and pathological study. SETTING: Teaching hospital, Madagascar. SUBJECTS: 165 patients who underwent appendicectomy during a two month period. INTERVENTIONS: Clinical investigation and histopathological examination of removed appendixes. MAIN OUTCOME MEASURES: Appendicitis score, local incidence of appendicectomy, appendicitis, perforation, and negative appendicectomy. RESULTS: There was a high incidence of primary appendicectomy (51.1/10,000 population/year) in relation to the incidence of histologically confirmed appendicitis (7.7/10,000), resulting in a negative appendicectomy rate of 85% (43/10,000). There were considerable sex related differences in the incidence of primary appendicectomy (81/10,000 women/year; 22/10,000 men), appendicectomy for appendicitis (12/10,000 women/year; 4/10,000 men) and non-perforating appendicitis (8/10,000 women/year; 2/10,000 men), but much less in that of perforating appendicitis (4/10,000 women/year; 2/10,000 men). CONCLUSION: There is potential for more economic use of medical resources by reducing the rate of negative appendicectomy. The incidence of non-perforating appendicitis depends on the number of appendicectomies done, which may explain the differences observed in the incidence of appendicitis between industrialised and developing countries.
OBJECTIVE: In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiology of appendicitis. DESIGN: Prospective clinical and pathological study. SETTING: Teaching hospital, Madagascar. SUBJECTS: 165 patients who underwent appendicectomy during a two month period. INTERVENTIONS: Clinical investigation and histopathological examination of removed appendixes. MAIN OUTCOME MEASURES: Appendicitis score, local incidence of appendicectomy, appendicitis, perforation, and negative appendicectomy. RESULTS: There was a high incidence of primary appendicectomy (51.1/10,000 population/year) in relation to the incidence of histologically confirmed appendicitis (7.7/10,000), resulting in a negative appendicectomy rate of 85% (43/10,000). There were considerable sex related differences in the incidence of primary appendicectomy (81/10,000 women/year; 22/10,000 men), appendicectomy for appendicitis (12/10,000 women/year; 4/10,000 men) and non-perforating appendicitis (8/10,000 women/year; 2/10,000 men), but much less in that of perforating appendicitis (4/10,000 women/year; 2/10,000 men). CONCLUSION: There is potential for more economic use of medical resources by reducing the rate of negative appendicectomy. The incidence of non-perforating appendicitis depends on the number of appendicectomies done, which may explain the differences observed in the incidence of appendicitis between industrialised and developing countries.
Authors: Imre Ilves; Hannu E K Paajanen; Karl-Heinz Herzig; Anne Fagerström; Pekka J Miettinen Journal: World J Surg Date: 2011-04 Impact factor: 3.352