Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

M.J. Lahaye, D.M.J. Lambregts, E. Mutsaers, B.A.B. Essers, S. Breukink, V.C. Cappendijk, G.L. Beets, R.G.H. Beets-Tan

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11 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. METHODS: In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. RESULTS: After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 <euro> from 2,482 to 1,888 <euro> (CL:-1081; -143). CONCLUSION: Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. KEY POINTS: * The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. * This led to a considerable increase in the use of preoperative imaging. * Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. * Use of mandatory imaging seems to reduce health care costs.
Original languageEnglish
Pages (from-to)1464-1470
JournalEuropean Radiology
Volume25
Issue number5
DOIs
Publication statusPublished - 1 Jan 2015

Cite this

@article{75b6b21b830544c9848bdd2c7f68f93e,
title = "Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis",
abstract = "OBJECTIVE: To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. METHODS: In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. RESULTS: After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5{\%} received preoperative imaging (42{\%} US/12.8{\%} CT/3.7{\%} both), compared with 98.7{\%} after the guidelines (61.6{\%} US/4.4{\%} CT/ 32.6{\%} both). The percentage of unnecessary surgeries before the guidelines was 22.9{\%}. After implementation, it dropped significantly to 6.2{\%} (p<0.001). The surgical complication rate dropped from 19.9{\%} to 14.2{\%}. The average cost-per-patient decreased by 594 from 2,482 to 1,888 (CL:-1081; -143). CONCLUSION: Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. KEY POINTS: * The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. * This led to a considerable increase in the use of preoperative imaging. * Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. * Use of mandatory imaging seems to reduce health care costs.",
author = "M.J. Lahaye and D.M.J. Lambregts and E. Mutsaers and B.A.B. Essers and S. Breukink and V.C. Cappendijk and G.L. Beets and R.G.H. Beets-Tan",
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language = "English",
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Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis. / Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Essers, B.A.B.; Breukink, S.; Cappendijk, V.C.; Beets, G.L.; Beets-Tan, R.G.H.

In: European Radiology, Vol. 25, No. 5, 01.01.2015, p. 1464-1470.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

AU - Lahaye, M.J.

AU - Lambregts, D.M.J.

AU - Mutsaers, E.

AU - Essers, B.A.B.

AU - Breukink, S.

AU - Cappendijk, V.C.

AU - Beets, G.L.

AU - Beets-Tan, R.G.H.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - OBJECTIVE: To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. METHODS: In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. RESULTS: After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 from 2,482 to 1,888 (CL:-1081; -143). CONCLUSION: Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. KEY POINTS: * The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. * This led to a considerable increase in the use of preoperative imaging. * Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. * Use of mandatory imaging seems to reduce health care costs.

AB - OBJECTIVE: To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. METHODS: In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. RESULTS: After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 from 2,482 to 1,888 (CL:-1081; -143). CONCLUSION: Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. KEY POINTS: * The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. * This led to a considerable increase in the use of preoperative imaging. * Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. * Use of mandatory imaging seems to reduce health care costs.

U2 - 10.1007/s00330-014-3531-0

DO - 10.1007/s00330-014-3531-0

M3 - Article

VL - 25

SP - 1464

EP - 1470

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 5

ER -