Proactive Clinical Auditing and Continuous Surgical Practice Monitoring in Reducing the Rate of Negative Appendectomy in Children

Introduction:Acute appendicitis is the most common intra-abdominal paediatric surgical emergency, with appendectomy being its standard treatment. In most centres, acute appendectomy is performed based on clinical diagnosis and hence has been associated with a negative appendectomy rate of 10-25%. Negative appendectomy has been associated with morbidity to the extent of 10-12% and mortality of 1%. We herein present our experience with proactive clinical auditing and a surgical monitoring approach in reducing the rate of negative appendectomy in children.Materials and Methods: We conducted a prospective clinical audit in a tertiary pediatric surgical center. All children with suspected acute abdominal pain and suspected appendicitis were treated on a standardized clinical pathway. The diagnostic workup included clinical scoring (Alvarado score), laboratory studies, and imaging (ultrasound and CT, as needed). All cases undergoing appendectomy were evaluated through histopathology. Negative appendectomy cases were reviewed weekly. Diagnostic and management algorithms were modified for subsequent cases.Results:Implementation of proactive auditing and continuous monitoring reduced the negative appendectomy rate to below 2%. This compares with the 10-25% rate reported in the literature. Multidisciplinary case discussions and real-time feedback helped identify diagnostic pitfalls. These efforts also refined clinical pathways.Conclusion: Proactive auditing and surgical monitoring appear effective in minimizing negative appendectomy rates. This approach improves compliance with diagnostic protocols, enhances surgical decision-making, and reduces morbidity associated with negative appendectomy.