Surgical decision-making in acute appendicitis

作者：Eva Sandell, M.A.M.C. van den Berg, Gabriel Sandblom, Joar Sundman, Ulf Fränneby, Lennart Boström, Åke Andrén‐Sandberg · 发表于：BMC Surgery · 年份：2015 · DOI：10.1186/s12893-015-0053-x · 被引用次数：29 · 研究领域：Appendicitis Diagnosis and Management、Hernia repair and management、Diverticular Disease and Complications

BACKGROUND: Acute appendicitis is one of the most common acute abdominal conditions. Among other parameters, the decision to perform surgical exploration in suspected appendicitis involves diagnostic accuracy, patient age and co-morbidity, patient's own wishes, the surgeon's core medical values, expected natural course of non-operative treatment and priority considerations regarding the use of limited resources. Do objective clinical findings, such as radiology and laboratory results, have greater impact on decision-making than "soft" clinical variables? In this study we investigate the parameters that surgeons consider significant in decision-making in cases of suspected appendicitis; specifically we describe the process leading to surgical intervention in real settings. The purpose of the study was to explore the process behind the decision to undertake surgery on a patient with suspected appendicitis as a model for decision-making in surgery. METHODS: All appendectomy procedures (n = 201) at the Department of Surgery at Karolinska University Hospital performed in 2009 were retrospectively evaluated. Every two consecutive patients seeking for abdominal pain after each case undergoing surgery were included as controls. Signs and symptoms documented in the medical records were registered according to a standardized protocol. The outcome of this retrospective review formed the basis of a prospective registration of patients undergoing appendectomy. During a three- month period...