Indian Journal of Surgery

, Volume 80, Issue 1, pp 61–67 | Cite as

Efficacy of the Evaluation of Inflammatory Markers for the Reduction of Negative Appendectomy Rates

  • Fatih Mehmet Yazar
  • Aykut Urfalioglu
  • Murat Bakacak
  • Ömer Faruk Boran
  • Ertan Bülbüloğlu
Original Article


Unnecessary appendectomy can cause complications; ways of reducing negative appendectomy rates (NAR) using biochemical and imaging methods are desirable. We retrospectively examined 640 patients who underwent appendectomy for suspected AA. Patients with histologically confirmed appendicitis were designated the positive appendectomy group (n = 565), whereas those with unconfirmed appendicitis were designated the negative appendectomy group (n = 75). The positive appendectomy group was subdivided into the non-perforated (n = 511) and perforated (n = 54) appendectomy groups according to pathology reports. We compared the age, sex, lymphocyte count, neutrophil percentage, pathologic positivity or negativity for appendicitis, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) of the patients. When the perforated, non-perforated, and negative appendectomy groups were compared, the highest CRP level, NLR, and PLR were evident in the perforated appendectomy group (p = 0.001), whereas the lowest neutrophil percentage was found in the non-perforated appendectomy group (p = 0.001). Multiple logistic regression analysis identified neutrophil percentage, CRP value, and NLR as independent variables and demonstrated that AA could be diagnosed with 88.9 % accuracy using the cutoff values determined. In patients with suspected AA, particularly in rural areas with limited access to advanced imaging modalities, the evaluation of neutrophil percentage, CRP level, and NLR, in combination with the findings of a physical examination, may aid diagnosis and reduce NAR.


Acute appendicitis Negative appendectomy rate Neutrophil-to-lymphocyte ratio C-reactive protein Neutrophil percentage 


Author’s Contribution

Each author’s contribution to the manuscript: conception and design: Fatih Mehmet Yazar and Murat Bakacak; data collection: Fatih Mehmet Yazar, Murat Bakacak, and Ömer Faruk Boran; writing the article: Fatih Mehmet Yazar and Aykut Urfalioğlu; and critical revision of the article: Ertan Bülbüloğlu.

Compliance with Ethical Standards

This manuscript has not been published elsewhere and is not under consideration by another journal.

In this article, there was no conflict with ethical standards as no data of human beings were created and approval for this study was obtained from the institutional Medical Ethics Committee.

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Association of Surgeons of India 2016

Authors and Affiliations

  • Fatih Mehmet Yazar
    • 1
  • Aykut Urfalioglu
    • 2
  • Murat Bakacak
    • 3
  • Ömer Faruk Boran
    • 2
  • Ertan Bülbüloğlu
    • 1
  1. 1.Department of General SurgerySütçü Imam University School of MedicineKahramanmaraşTurkey
  2. 2.Department of Anesthesiology and ReanimationSütçü Imam University School of MedicineKahramanmaraşTurkey
  3. 3.Department of Obstetrics and GynecologySütçü Imam University School of MedicineKahramanmaraşTurkey

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