Some thoughts on complications of appendectomy (where should I have my surgery?)

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I made a study of the complication rate after appendectomy. (Click here to read the paper)

The graph above contains the gist of the article and is showing the morbidity (complication rate of appendicitis reported in the medical literature over the past one hundred years at academic medical centers. As you can see, there was a steady, statistically significant decline in the complication rate for appendectomy in the United States and England until about 1960, and then, a slower, but still statistically significant rise in the complication rate for the same surgery. In 1994 Long and others from Mayo Clinic reported a 27.7% complication rate for appendectomy at Mayo Clinic. This was the single morbidity rate since a report in 1940, before the discovery of antibiotics.

Mayo is certainly not alone in reporting high complication rates, other institutions have also reported high complication rates. The interesting aspect of these high complication rates is that the complication rate was not commented upon in the articles, the articles were, for the most part discussions of whether open or laparoscopic hernia repair was better.

Interestingly, the complication rate for appendectomy at community, non-teaching hospitals has remained low (less than 6%). Since appendicitis is an emergent surgical disease, that is if you are concerned that you have appendicitis, you need to go to a hospital in your geographic area, your hospital choice is usually limited. But most people do have choices. Nevertheless, I have a few suggestions:

1. Your community hospital may be a better place to have your appendix removed than the large academic medical center. If your local community hospital has a good reputation and is JACHO certified, then your surgery is likely to be safe.

2. Make sure that your surgeon, the person actually doing the surgery, is qualified, experienced, and board certified. In some instances at larger teaching hospitals appendectomy was thought to be "beneath the dignity" of the attending surgeon, who never came in for the surgery, and the appendectomy was done at night by an intern under the "supervision" of a junior resident. Remember that it is okay to be teaching people how to take out an appendix, but it is not okay for the "teacher" to be unqualified when they are operating on you. The American College of Surgeons, the largest organization of practicing surgeons in the US has an excellent page on determining the qualifications of your surgeon. Click here to see the ACS site "Looking for a qualified surgeon?"

3. If you are at a major medical center or teaching hospital, make sure that the person giving you anesthesia is qualified. The American Board of Anesthesiology can help you with this.

4. You can check up on the overall quality of your hospital prior to an emergency.

The most important aspect of any emergency response is preparedness. If you live in a town that has just a wretched hospital, then plan for your emergency to go somewhere else. One suggested method of checking on the quality of your hospital is the Delta Group's "CareChex" hospital quality rankings site.

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Click logo to check out the American College of Surgeons website. They are working hard to improve surgical quality in the United States.