A Clinical Audit of Emergency Appendectomies in a Tertiary Care Centre: Negative Appendectomy Rate, Complications and Outcomes

Abstract

Introduction: Acute appendicitis is a common surgical emergency. Despite advances in imaging and diagnostics, negative appendectomy and postoperative complications remain clinical concerns. This audit was conducted to measure the diagnostic precision and surgical outcomes of emergency appendectomies at a tertiary care center against international benchmarks, identifying specific areas for protocol standardisation and quality improvement Methods: A retrospective audit was conducted on 147 patients who underwent emergency appendectomy for suspected acute appendicitis at a tertiary care hospital between September 2024 and March 2025. Practice was audited against World Society of Emergency Surgery (WSES) Jerusalem guidelines. Demographics, clinical presentation, preoperative imaging utilisation, surgical approach, histopathological reports, and postoperative complications were assessed. The primary audit endpoints were the negative appendectomy rate (NAR) and post-operative morbidity, which were compared with established national and international benchmarks. This audit followed the SQUIRE 2.0 reporting guidelines for quality improvement Results: Laparoscopic appendectomy was the primary surgical approach in 69% (n=101) of cases, with a conversion to open done in 4%. Histopathological analysis confirmed acute appendicitis in most patients yielding a NAR of 6.8%. Complicated appendicitis was noted in 26.5% of the cases. The overall postoperative complication rate was 21%, with wound infections (9.5%) and intra-abdominal collections (4.7%) being the most common. No mortality was reported. Conclusion: With a NAR of 6.8%, institutional practices successfully meet international benchmarks. Favourable outcomes are attributed to routine preoperative imaging and laparoscopic surgery. To further optimise care, we recommend standardising clinical scoring systems and refining infection control protocols, with a planned re-audit to close quality improvement cycle.