One in six children undergo unnecessary appendix surgery – study

One in six children in the UK undergo unnecessary appendix surgery every year, new research suggests.

Scientists found that the UK has the highest reported national rate of “normal appendicectomy” in children.

Normal appendicectomy is where patients undergo surgery for suspected appendicitis, but lab tests of the removed appendix find the organ to be normal.

The misdiagnosis is due to the lack of high quality ultrasound services and the challenges doctors face in diagnosing the disease, as symptoms can be similar to other conditions that cause abdominal pain, like gastroenteritis, the researchers said.

Mr Aneel Bhangu, a senior lecturer in surgery at the University of Birmingham and consultant colorectal surgeon at University Hospitals Birmingham, said: “Appendicectomy is the most common emergency operation in children.

“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.”

The study looked at data on 1,827 children aged five to 15 years with suspected appendicitis across 139 hospitals in the UK and the Republic of Ireland.

Of them, 630 underwent surgery to remove their appendix, with 100 (15.9%) cases of normal appendicectomy.

Data was gathered from four two-week collection windows from both district general hospitals and specialist paediatric hospitals in every UK region, making the findings generalisable across the UK, the researchers said.

Dr Dmitri Nepogodiev, a research fellow at the University of Birmingham and one of the study leaders, told the PA news agency: “Although we did not collect national data for a full year, we believe that we collected sufficient data from across the UK for it to be broadly representative.”

He said that according to NHS figures, 8,401 children aged between five and 15 underwent appendicectomy in England between 2018 and 2019.

He added: “This scales up to 9,886 children undergoing surgery across the UK, based on proportional increase in number of children aged five to 15 in England versus the whole of the UK.”

Based on their findings, published in The Lancet Child & Adolescent Health, the researchers say urgent improvements are needed to reduce the number of patients undergoing unnecessary surgery.

They propose improving the quality of NHS ultrasound services and using a form of risk score assessment for all children presenting with suspected appendicitis.

Reducing unnecessary surgery can produce an overall saving for the NHS of £4.4 million per year, they add.

Dr Nepogodiev told PA: “Diagnosis of appendicitis can be challenging because the symptoms of appendicitis can be similar to other conditions like mesenteric adenitis or gastroenteritis.

“Taking a careful medical history and doing a thorough physical examination can be particularly challenging in younger children compared to adults.

“Currently in the NHS we do not have a standardised approach to diagnosis of appendicitis, leading to variation in practice.

“We propose that the medium and high-risk patients should routinely undergo ultrasound imaging at the point of initial assessment in the emergency department or surgical unit.

“We hope our study provided better guidance for doctors across the country, with a particular focus on using risk-scoring to risk-stratify patients.”