AB076. SOH22ABS113. An audit of the investigation and management of acute appendicitis at a tertiary referral centre in Ireland

Background: Acute appendicitis (AA) is one of the most common emergency surgical presentations to Irish hospitals. The approach to investigating AA varies across and indeed within hospitals. In 2020, the World Society of Emergency Surgery (WSES) updated its Jerusalem guidelines for the investigation, diagnosis and management of AA. We set out to evaluate our institutional compliance with these guidelines in the COVID era and assess for 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: A total of 39 patients were identified. The average age was 25.4 years. Approximately two percent (n=1) had clinical scores documented. 0 had risk stratification recorded. Approximately thirty-three percent (n=13) had computerised tomography scans requested, another 33.3% (n=13) had ultrasound scans requested and 33.3% (n=13) had no diagnostic imaging ordered. One hundred percent proceeded with surgical management. Approximately twenty-three percent (n=9) were open appendectomies, 74.4% (n=29) were laparoscopic appendectomies and 2.6% (n=1) was a laparoscopic converted to open appendectomy. Approximately sixty-nine percent (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 hospital stay was 3.6 days.

Conclusions: We demonstrated multiple areas where our unit performs well. However, there are areas for potential improvement. We believe an educational intervention is required to improve compliance with these standards and patient outcomes.

Keywords: Appendectomy; appendicitis; laparoscopic; pathology; ultrasound