P Primatesta1, M J Goldacre. 1. Department of Public Health and Primary Care, University of Oxford, UK.
Abstract
BACKGROUND: Appendicectomy is one of the commonest operations in most developed countries, especially in children and young adults. We used routine abstracts of hospital inpatient records to study the demographic and temporal profiles of emergency appendicectomy for acute appendicitis and appendicectomy in other circumstances. METHODS: Records held in the Oxford record linkage study (ORLS) from 1970-1986 inclusive were analysed. Age- and sex-specific admission rates were studied, subdividing appendicectomy into three main categories: emergency appendicectomy for acute appendicitis, emergency appendicectomy as the main operation without appendicitis recorded as a diagnosis, and prophylactic or incidental appendicectomy with other operations but without appendicitis. RESULTS: A total of 47,505 records of appendicectomy were analysed. Emergency appendicectomy for acute appendicitis was more common in males than females, peaked in the 10-19 year age groups, and declined over time. Emergency appendicectomy without appendicitis was more common in women than men (female to male ratio 1.8:1), peaked at age 15-19 years and did not decline over time. Incidental appendicectomy was much commoner in women (female to male ratio 3:1), peaked at older ages than the first two groups, and declined significantly over time. CONCLUSIONS: The demographic profiles of patients in these categories were quite different. The data on trends suggest confirmation of a true decline in acute appendicitis, no decline for conditions which may mimic it, and a decline in the use of prophylactic and incidental appendicectomy. The operations in the latter categories--appendicectomy without acute appendicitis--were much commoner in women than men and their appropriateness would be worthwhile topics for medical audit.
BACKGROUND: Appendicectomy is one of the commonest operations in most developed countries, especially in children and young adults. We used routine abstracts of hospital inpatient records to study the demographic and temporal profiles of emergency appendicectomy for acute appendicitis and appendicectomy in other circumstances. METHODS: Records held in the Oxford record linkage study (ORLS) from 1970-1986 inclusive were analysed. Age- and sex-specific admission rates were studied, subdividing appendicectomy into three main categories: emergency appendicectomy for acute appendicitis, emergency appendicectomy as the main operation without appendicitis recorded as a diagnosis, and prophylactic or incidental appendicectomy with other operations but without appendicitis. RESULTS: A total of 47,505 records of appendicectomy were analysed. Emergency appendicectomy for acute appendicitis was more common in males than females, peaked in the 10-19 year age groups, and declined over time. Emergency appendicectomy without appendicitis was more common in women than men (female to male ratio 1.8:1), peaked at age 15-19 years and did not decline over time. Incidental appendicectomy was much commoner in women (female to male ratio 3:1), peaked at older ages than the first two groups, and declined significantly over time. CONCLUSIONS: The demographic profiles of patients in these categories were quite different. The data on trends suggest confirmation of a true decline in acute appendicitis, no decline for conditions which may mimic it, and a decline in the use of prophylactic and incidental appendicectomy. The operations in the latter categories--appendicectomy without acute appendicitis--were much commoner in women than men and their appropriateness would be worthwhile topics for medical audit.