A National survey of surgeons' perspectives on the treatment of adults with acute appendicitis

AIMS: Management of patients with suspected acute appendicitis (AA) varies and often depends on the admitting surgeon's preferences. Here we investigated surgeons' perspectives on the management of AA and their own preferences if they themselves were admitted with suspected AA.

METHODS: A 17-point web-based questionnaire was distributed to all acute general surgical departments in Denmark over a 1-month period. Four items regarded demographics, 9 items addressed the treatment of patients with suspected AA and the last 4 items explored surgeons' personal treatment preferences.

RESULTS: 213 complete responses were received, with most respondents < 50 years old (86%). Most respondents rarely or never use scoring systems (77%) when assessing patients with suspected AA. Most felt pre-operative imaging wasn't indicated in patients < 50 years with typical presentations (4%), although this rose in the case of atypical presentations (56%). Less than 5% routinely discuss non-operative management with patients who are otherwise fit for surgery. In afebrile patients with AA, 9% would operate during the night based on a clinical diagnosis, rising to 21% if the diagnosis was confirmed on imaging, and to 49% if the patient also had raised inflammatory markers. Regarding preferences for their own treatment, only a minority would want to be assessed using scoring systems (13%), whereas almost half would want pre-operative imaging (47%).

CONCLUSION: Considerable variation is noted in surgeons' perspectives on the management of patients with AA. Discrepancies are noted in surgeons' routine clinical practice and their preferences for their own treatment, particularly regarding pre-operative imaging.