Appendicitis—Is it on the wane?

Appendicitis-

Is It on the Wane?

LOUIS T. PALUMBO, M.D., Des Moines, From tbe Department oj .Sur~e7y, Veterans Administration Hospital, Des Moines, Iowa.

deaths since 1953, in 439 appendectomies. (TabIe I.) Even though the workIoad has remained fairIy stable during the Iast seven years of this survey, the incidence of appendicitis and the number of appendectomies performed has shown a steady decline from a peak of 252 appendectomies in 1949 to 72 in 1958. (Table I.) The emergency appendectomies performed Iikewise showed a simiIar decrease. The incidence of appendicitis and appendectomies performed, calculated on a percentage basis, against the tota number of surgica1 patients treated and the number of surgical operations performed are shown in Table II. The incidence in all three categories studied, namely tota patients, appendectomies, and emergency appendectomies reveaIed a continuous decrease during the twelve years of this survey. Appendectomies represented 15.4 per cent of aII surgica1 procedures performed in 1947 whereas in 1958 they were only 6.4 per cent. Figures I and 2 depict these relationships. In Figure I, the solid portions represent the

CUTE appendicitis and appendectomy were more serious problems in the practice of medicine and surgery in the twenties and thirties than they are today. The death rate, complications and proIonged invalidism associated with this disease in the past certainly have changed in a favorabIe manner during the Iast eighteen years. These favorabIe changes have been due to the many advances which have occurred in medicine and surgery during and since World War II. Current evidence in some localities indicates a definite decrease both in the incidence of acute appendicitis and number of appendectomies performed. This downward trend, which is progressive and continuous, may be nationa1. A recent review of our annual surgica1 reports supports this fact. During the past tweIve fisca1 years, 1947 through 1958, 1,823 appendectomies were performed at our hospita1 in Des Moines. Of this number, 1,600 were for acute appendicitis. There were four postoperative deaths, a mortaIity rate of 0.2 per cent. There have been no

A

TABLE INCIDENCE

-

Patients

3,000 3,677 4.226 3,880 335-0 3.68~ 3,181 2,965 3.r II,

1947

1948 I949 1950 1951 1952 1953 1954 1955 r956 l957 1958

3,361 3,043.13-I

?‘OLRIS.

4%840

No. of

Journal

TTOW.1

No. of

Major Operations

Appendlectomie

1,262

194 252 245 22R r 66 169

I.665 1,613 1,723 1,420

1,s62 1,259 1,126

130

I LV 99 95 $8 72

1.324 1,32<, 1,150 I,ljZ 16,356

American

TWELVE-YEAR

-

No. of

TABLE APPENDICITIS-PERCENTAGE

I

OF APPENDECTOMY-A

1,823

No. of Emer-

-i-

Volume

TABLE

Appendectomies (%)

No. of 1Deaths

BASED

ON

I

Incidence of Emergency Appendectomies (%)

-I1947 1948 1949 1950 ‘951

135 176 152 146 II’

61 hz 11 45

j

6.5 6.9 5.8 5.9 4.6 4-6 4. ’ 4 0 3 0

1952 ‘953 1954 ‘955 1956 ‘957 1958

113 7x 76

4

2.8 I .9 2.3

98. November,

INCIDENCE IN

Incidence of

Incidence of Patients (70)

Year

of Surgery.

WORKLOAD

II

SURVEY

gency Appencctomie s

1,194

Iowa

1959

702

15.4 15.1

15.2 13.2 11.7 12.4 10.3 10.6 7.2 7.2 5 0 6.4

10.7

10.6 ::: 8.2 8.3 6.2 6.7 4.8 4.7 2.7 4. 0

Appendicitis-Is

FllCLL

It on the

Meane?

“ELR

total in-patient load and total major surgical proceclurcs performed for each of the twelve years. The two lines represent the downward trend noted in both the total appendectomies and the emergency appendectomies performed. Roth these lines follow thesamedownward trend. Even though there has been a fairly stable workload during the last six k-ears of this stud\-, it is interesting to note that the rate of appendectomies performed continues in a downward direction. This trend is more effectivcllshown in Figure 2. The basic total patient load and operations performed, as shonn at the bottom of the graph, remain fairI\constant throughout these years. However, the incidence of appendicitis, the number of appendectomies, and the number of emergenqappendectomies performed are defrniteIy and progrcssi\~el> less frequent non than they were in 1947. II is dillictrlt to account for this significant in the incidence of appendicitis reduction among our adult population with no change in the type of patients admitted to our Center. It is difficult to assume that there has heen a tlifl‘usion of these acute cases to other hospitals

either 1ocalIy or in smaller communities. Tfre significant and progressive decline is apparentI> due to other causes which are not readily apparent. This downward trend of the disease in the adult population may in some wad’ be connected with the many favorable features of life which acccJl~lpan~ a better national econom,v. SL’MMAR-I

The incidence of acute appendicitis and the total number of appendectomies performed in the adult popuIation admitted to our Medical Center are decreasing. A twelve->;ear surve?, 1947 through 1958, of our surgical records revealed a progressive don-nwarcl trend in both instances, The incidence of‘ this disease and the operation for it decreased from 15.4 to 0.4 per cent in the twelve-year period. This significant and progressive downward trend in the adult population may be in some way connected with the many l’avorable aspects of a fxtter national econon~~-. The medical reasons for this l’a\orablr change are not presently known. 703