181 An Analytical Study: Adult Negative Appendicectomy Rate in Barnsley District General Hospital

Background Patients presenting with right iliac fossa (RIF) pain are common in acute surgical takes; a key differential being acute appendicitis. NA (negative appendicectomy) is defined as histologically confirmed normal, congested, or cancerous appendix. In the United Kingdom, the NA rate (NAR) is more than 20%. Increased NAR leads to increased complications and financial burdens on the National Health Service. Aim The objectives of this study were to determine the histopathology proven NAR in Barnsley District General Hospital (BDGH) and assess whether this is in line with the national percentage. Methodology Our methodology was based on the RIF treatment (RIFT) audit. This closed-loop retrospective study includes all 155 adult patients attending BDGH, who underwent an appendicectomy between April 2021 and April 2022. The exclusion criteria: previous appendicectomy, right hemicolectomy or colectomy. The results were presented in the BDGH multi-disciplinary team meeting. Results 17% of patients had a NA. Of which, 54% of patients had a normal appendix, and 19% showed signs of malignancy. 8 patients had pre-operative scans showing appendicitis but were negative on histopathology. Of which, 7 were an ultrasound scan (USS), and 1 was a Computed Tomography (CT) scan. Conclusions The NAR improved significantly since the previous cycle, due to changes in practice. BDGH now has low NAR, in line with national rates. Pre-operative CT scans are more sensitive than USS. To further improve, Adult Appendicitis Score [4] will be added to the surgical clerking proforma, and we will re-audit this in a prospective study.