The need for crossover in management and recurrent appendicitis were low among all studies .
For those patients who ultimately required surgery , no increased complications were observed .
Antibiotics may be safely recommended in patients with high surgical risk , such as the elderly or those with multiple comorbidities
AIM To review outcomes of  surgical and antibiotic management of acute appendicitis .
Progress in the Diagnosis of Appendicitis: A Report From Washington State's Surgical Care and Outcomes Assessment Program
Background and Objectives : Studies suggest that computed tomography and ultrasonography can effectively diagnose and rule out appendicitis , safely reducing negative appendectomies ( NAs ) ; however , some within the surgical community remain reluctant to add imaging to clinical evaluation of patients with suspected appendicitis . The Surgical Care and Outcomes Assessment Program ( SCOAP ) is a physician-led quality initiative that monitors performance by benchmarking processes of care and outcomes . Since 2006 , accurate diagnosis of appendicitis has been a priority for SCOAP . The objective of this study was to evaluate the association between imaging and NA in the general community . Methods : Data were collected prospect ively for consecutive appendectomy patients ( age > 15 years ) at nearly 60 hospitals . SCOAP data are obtained directly from clinical records , including radiological , operative , and pathological reports . Multivariate logistic regression models were used to examine the association between imaging and NA . Tests for trends over time were also conducted . Results : Among 19,327 patients ( 47.9 % female ) who underwent appendectomy , 5.4 % had NA . Among patients who were imaged , frequency of NA was 4.5 % , whereas among those who were not imaged , it was 15.4 % ( P < 0.001 ) . This association was consistent for men ( 3 % vs 10 % , P < 0.001 ) and for women of reproductive age ( 6.9 % vs 24.7 % , P < 0.001 ) . In a multivariate model adjusted for age , sex , and white blood cell count , odds of NA for patients not imaged were 3.7 times the odds for those who received imaging ( 95 % CI : 3.0–4.4 ) . Among SCOAP hospitals , use of imaging increased and NA decreased significantly over time ; frequency of perforation was unchanged . Conclusions : Patients who were not imaged during workup for suspected appendicitis had more than 3 times the odds of NA as those who were imaged . Routine imaging in the evaluation of patients suspected to have appendicitis can safely reduce unnecessary operations . Programs such as SCOAP improve care through peer-led , benchmarked practice change
The need for crossover in management and recurrent appendicitis were low among all studies .
For those patients who ultimately required surgery , no increased complications were observed .
Antibiotics may be safely recommended in patients with high surgical risk , such as the elderly or those with multiple comorbidities
AIM To review outcomes of  surgical and antibiotic management of acute appendicitis .