Right Iliac Fossa Treatment-Turkey Audit

Study Overview
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Brief Summary
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Background: There is significant variation in the management of patients with right iliac fossa (RIF) pain. Whilst laparoscopy has become first line in many units, the 2012 UK National Appendicitis Audit identified that a third of appendicectomies at that time were being performed using an open approach1. The results of this study were widely presented at local units and national meetings as well as being published in several journals. New Guidelines: New guidelines published by the World Society of Emergency Surgery (WSES) in 20165 and the European Association of Endoscopic Surgeons (EAES) in 20156 provide an opportunity to close the loop on the 2012 audit and to re-audit the modern management of RIF pain. Aim: The primary audit aim is to determine the laparoscopic appendicectomy rate in 2017. The secondary aim is to audit the normal appendicectomy rate. Variation in centres' case mix may influence the normal appendicectomy rate. Patients can be stratified into low, medium, and high risk for appendicitis using the Alvarado or Appendicitis Inflammatory Response (AIR) scores (see Appendix E). Baseline variation will be addressed by adjustment using risk scoring.

Detailed Description
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Audit standarts: An initial laparoscopic approach should be used for appendicectomy unless contraindicated.This standard is based on WSES Statement 5.15-7 The normal appendicectomy rate should be <20%1. For centres with higher or lower rates, risk stratification data will allow interpretation of this rate in relation to the baseline case-mix.

Official Title
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Right Iliac Fossa Treatment-Turkey Audit

Conditions
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Right Iliac Fossa Pain

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All consecutive patients referred to general surgeons, or pediatric general surgeons, with undifferentiated right iliac fossa pain or suspected appendicitis. All patients who undergo an appendicectomy during the study period. Age restriction is existing; all patients over the age of 16 should be included. Exclusion Criteria: Previous appendicectomy, right hemi-colectomy or total colectomy. Previous abdominal surgery in the last 90 days. Pregnancy. Patiens confirmed with COVID-19.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Rate of Laparoscopic Appendicectomy. | The primary outcome measure is the rate of laparoscopic appendicectomy. The audit standard is provided by the World Society of Emergency Surgery's Jerusalem Consensus Guidelines which states that laparoscopic appendectomy should represent the first choice where laparoscopic equipment and skills are available, since it offers clear advantages in terms of less pain, lower incidence of surgical site infection, decreased length of stay, earlier return to work and overall costs. | 30 days from operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Normal Appendicectomy Rate | The secondary outcome measure will be the normal appendicectomy rate.The National Appendicectomy Audit reported the rate as 20.6% for the UK1. Centres should have a normal appendicectomy rate <20%. Risk stratification data using Alvarado/ AIR score will allow interpretation of individual centres' rates in light of their baseline casemix. | 30 days from operation |