This posters were presented at the ASiT Conference in 2018. The initial results from the RIFT Study on RIF pain and appendicitis from 200 centres across Europe and over 11,000 patients. There was a lot of data to analyse and many papers to produce. The first paper was published in BJS in Dec 2019. The data was collected from March 2017. The planning began in 2015. https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.11440

1. The 2012 National Appendicectomy Audit: Re-audited
The Right Iliac Fossa pain Treatment Audit (RIFT) group
Introduction
Methods
Results
Discussion
RIFTstudy@gmail.com | @WMRC_UK | #RIFTaudit
International guidelines recommend that all
appendicectomies should be performed laparoscopically
unless contraindicated.
The 2012 UK National Appendicectomy Audit identified
that 66.3% of appendicectomies were performed
laparoscopically.
In 2012, the negative appendicectomy rate (NAR) was
20.6%.
The RIFT study re-audited the laparoscopy and negative
appendicectomy rate across the UK and Ireland in 2017.
Prospective, multicentre international ‘snapshot’ audit.
Four 2-week data collection periods across 2017.
Follow-up to 30 days post admission.
Inclusion criteria: Consecutive patients referred with RIF pain
or suspected appendicitis aged 16 years and over.
Exclusion criteria: previous appendicectomy or right
hemicolectomy, pregnancy.
Primary endpoint: the laparoscopy rate.
Secondary endpoints: the negative appendicectomy (NAR;
removal of a histologically normal appendix), and perforation
rate (proportion of histologically proven appendicitis with a
gangrenous or perforated appendix; 32.4% in 2012).
Laparoscopy is now almost universal for adult
appendicectomy in Great Britain and Ireland.
Whilst the NAR has reduced, this has been
associated with an increase in the perforation rate.
Women disproportionately undergo negative
appendicectomy compared to men.
Of the 3388 appendicectomies captured across 185
centres in the UK and Ireland:
• The laparoscopy rate was 94.2%
• The perforation rate was 34.9%
• The overall NAR was 16.0%
• The NAR was highest amongst women aged 16-29
• The NAR was higher for women than men aged
30-59
The commonest reasons for planned open surgery:
consultant preference (n=293); disease severity
(n=141); trainee preference (n=125); local policy for
adults (n=35); patient preference (n=1)
Age Total patients % patients
undergoing
appendicectomy
Negative
appendicectomy
rate
Males Female Males Female Males Female
16-
29
1039 2315 57.8% 27.1% 13.7% 33.7%
30-
39
559 998 58.1% 27.6% 10.3% 17.9%
40-
59
599 1002 53.4% 33.0% 5.3% 15.1%
60+ 321 458 41.4% 31.0% 1.6% 1.5%

2. International variation in the imaging of patients with
right iliac fossa pain
The Right Iliac Fossa pain Treatment Audit (RIFT) group
Introduction
Methods
Results
Discussion
RIFTstudy@gmail.com | @WMRC_UK | #RIFTaudit
This study aimed to investigate variation in utilisation of
diagnostic imaging for patients presenting with right iliac
fossa (RIF) pain across five European countries.
Prospective, multicentre international ‘snapshot’ audit.
Four 2-week data collection periods across 2017.
Follow-up to 30 days post admission.
Inclusion criteria: Consecutive patients referred with RIF pain
or suspected appendicitis aged 16 years and over.
Exclusion criteria: previous appendicectomy or right
hemicolectomy, pregnancy.
Primary endpoint: the overall imaging rate, including
computed tomography (CT), magnetic resonance (MRI), and
ultrasound imaging.
Secondary endpoints: the negative appendicectomy rate
(NAR; removal of a histologically normal appendix).
The rates of CT and MRI imaging were similar
across the five countries.
NAR was lowest in Italy and Spain/Portugal where
they had much higher USS rates.
This suggests that it may be possible to decrease
the NAR in Ireland/UK without increasing the rate
of CT scanning.
Data were collected in Ireland/UK (n=7665; 169 centres), Italy
(n=782; 50 centres), and Spain/Portugal (n=1046; 55 centres).
Imaging rates were lower in Ireland/UK (women: 74%, men:
41%) than in Italy (women: 87%, men: 84%) and
Spain/Portugal (89% for both women and
men).
Overall CT and MRI scans rates were similar across all
countries, but ultrasound was more commonly used in Italy
(77%) and Spain/Portugal (81%) than Ireland/UK (46%).
The overall NAR was higher in Ireland/UK (16%) than in Italy
(3%) and Spain/Portugal (6%).
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
UK/ROI Italy SP/PT
NAR
US usage rate
US diagnosis rate
NAR & US usage rates in adults
US CT MRI None
Females, age 16-50
UK/ROI 60.7% 18.9% 1.2% 26.3%
Italy 78.4% 18.8% 0.9% 13.1%
Spain/Portugal 82.8% 20.1% 0% 11.1%
Males, age 16-50
UK/ROI 15.4% 28.1% 0.7% 59.0%
Italy 74.8% 20.7% 0.4% 15.9%
Spain/Portugal 78.4% 23.6% 0% 11.2%