An audit of the investigation and management of acute appendicitis at a tertiary referral centre in Ireland

Abstract Aim Acute appendicitis (AA) is among the most common emergency surgical presentations to Irish hospitals. In 2020, the World Society of Emergency Surgery (WSES) updated its Jerusalem guidelines for the investigation, diagnosis, and management of AA. We aimed to evaluate our institutional compliance with these guidelines in the COVID era and outline potential areas for improvement. Methods We performed a retrospective chart review of all patients admitted to our institution with the diagnosis of AA in July 2021 and compared them against the standards outlined in the WSES Jerusalem guidelines. Results 39 patients were identified. Average age was 25.4 years. 2.6% (n=1) had clinical scores documented. 33.3% (n=13) had computerised tomography scans performed, 33.3% (n=13) underwent ultrasound scans and 33.3% (n=13) had no diagnostic imaging. 100% proceeded with surgical management. Average time to theatre was 16.9 hours. 23.1% (n=9) were open appendectomies, 74.4% (n=29) were laparoscopic appendectomies and 2.6% (n=1) was a laparoscopic converted to open appendectomy. 100% had histopathological analyses. 69.2% (n=27) were true AAs, 15.4% (n=6) were negative appendectomies and 15.4% (n=6) were non-inflamed appendices with other pathology including lymphoid hyperplasia, fecolith or enterobius. Average length of stay (AvLOS) was 3.6 days. Conclusions As regards timely surgical intervention and routine histopathology, we are compliant with the guidelines. However increased utilisation of validated clinical scoring systems could potentially reduce negative appendectomy rates and AvLOS. We believe an educational intervention is required to improve our compliance with these standards.