Health & Fitness 1 in 6 children have unnecessary appendix surgery each year

01:55  13 february  2020
01:55  13 february  2020 Source:   inews.co.uk

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One in six children who underwent surgery for appendicitis actually had a healthy organ removed Hundreds of children in the UK are having needless operations to remove their appendix ever year Regardless, with each child appendicectomy costing about £3,700, avoiding needless surgery could

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Around 1 in 6 children have unnecessary appendix surgery each year in the NHS, a study reveals. Surgery for appendicitis is the most common emergency operation in children with 28,700 cases. Some 9,900 undergo appendicectomy - where the appendix is removed - but 1,600 of these operations are found not to have been needed with the number much higher in girls.

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.

The study, led by surgical experts at the University of Birmingham, included children aged between 5 and 15 with suspected appendicitis from across 139 hospitals in the UK and Republic of Ireland. The study captured data from both district general hospitals and specialist paediatric hospitals in every UK region.

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Almost a third of women end up having normal appendix removed, study finds.

The appendix (or vermiform appendix ; also cecal [or caecal] appendix ; vermix; or vermiform process) is a finger-like, blind-ended tube connected to the cecum, from which it develops in the embryo.

Overall, just over a third (34.5 per cent) of children admitted to hospital with suspected appendicitis had an appendicectomy. However, some 11.9 per cent of children aged 5-10 years, 16 per cent of boys aged 11-15, and 22.4 per cent of girls aged 11-15 were later found to have had a healthy appendix.

Mr Aneel Bhangu, senior lecturer in surgery at the University of Birmingham and consultant colorectal surgeon at University Hospitals Birmingham, said: “Our study found that overall the diagnosis is wrong for one in six children who undergo appendicectomy, and a normal appendix is removed. This places an unacceptable burden on both children and their carers.”

'Urgent improvements'

The researchers call for "urgent improvements" to ultrasound services reduce the number of patients undergoing unnecessary surgery. Ensuring that all medium-risk and high-risk children undergo high-quality ultrasound imaging prior to surgery could reduce unnecessary surgery and produce an overall saving for the NHS of £4.4m per year.

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Removal of a noninflamed appendix during unrelated abdominal surgery (prophylactic or incidental appendectomy) can prevent the downstream risks and costs of appendicitis. This isn't the first time researchers have found antibiotics can do the job well enough that surgery becomes unnecessary .

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They also propose that all children presenting with suspected appendicitis should be routinely risk scored using a clinical scoring system called the Shera score, which they found to be the best performing risk score for appendicitis.

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Almost one in three UK women have healthy appendix removed, claims new research

The study, published in The Lancet Child & Adolescent Health, 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.

Dr Dmitri Nepogodiev, study co-author, told i: “Although many children already undergo ultrasound in the UK, the quality of this is variable and often the ultrasound report does not definitely confirm or exclude appendicitis.

"So we propose that an NHS-wide programme is needed to provide clear guidance for doctors on diagnosis and importantly to train staff to do high-quality ultrasound scans that are able to accurately diagnose appendicitis. These steps would help to reduce the rates of misdiagnosis and unnecessary surgery in the NHS. Hospitals should ensure 7-day-a-week availability of ultrasound done by staff specially trained to assess for acute appendicitis in children.”

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