Background: Negative appendectomy rate (NAR) is the proportion of all vermiform appendices submitted without pathologic evidence of appendicitis. The acceptable NAR was 20% in females of reproductive age versus 10% in young males; the rate has decreased over the years due to the use of scoring systems and preoperative imaging. Aim: To audit the NAR within the facility and to assess the factors contributing to it. Methodology: A 5-year (2017–2022) single-center retrospective audit was conducted among adolescents (aged 10–19 years) and adults (aged ≥20 years) who underwent appendectomies (open or laparoscopic) for suspected appendicitis. Medical records were used to obtain data, and histological specimens were analyzed to confirm diagnosis. Results: A total of 147 patients were evaluated (66% males and 34% females), with a mean age of 34 years; the NAR was 7.5% (males: 5.15% vs. females: 12.0%), and the Alvarado scoring system was used in 41% of patients with a sensitivity of 80%, a specificity of 22%, and a positive predictive value of 74%. The preoperative imaging modalities used, computed tomography and ultrasound, were noted to be equally predictive of appendicitis (80.2% and 80.0%, respectively). Among those who had both imaging modalities done, appendicitis was noted in 91.6% of cases. Conclusion: Our institutional NAR is within the internationally acceptable thresholds. This audit demonstrates the value of clinical audits in improving diagnostic accuracy, guiding evidence-based practice, and optimizing patient care. Routine use of scoring systems and preoperative imaging may further reduce unnecessary appendectomies.