Appendectomy: prognostic factors in the brazilian unified health system

Abstract

SUMMARY INTRODUCTION: Acute appendicitis (AA) is the most common cause of surgical acute abdomen. Postoperative complications in emergency care are reflections of the surgical procedure and pre- and postoperative factors. OBJECTIVE: Define prognostic factors for patients who underwent appendectomy, comparing them with the literature. METHODS: Descriptive observational study with a cross-sectional design based on data from the emergency/urgency appendectomy records between September 2018 and April 2019. Variables of interest were considered based on intrinsic patient data, clinical status, and perioperative management factors. Primary outcomes considered: postoperative complications from hospital admission discharge and prolonged hospital stay for > 2 days. Secondary outcome: death. The results were evaluated by Fisher's exact test (p <0.05). RESULTS: We identified 48 patients undergoing an appendectomy. Young adults accounted for 68.7%. From the total, 58.3% were males, 6 (12.5%) had hospitalization> 2 days, 4 (8.3%) had complications and no deaths. Among the variables, the stage of AA, the time of complaint up until seeking care, and advanced age were correlated with worse prognosis during hospitalization (p <0.05). The emergence of immediate postoperative complications was correlated with longer hospital stay (p <0.05). DISCUSSION: The descriptive data of the sample converge with the epidemiological profile of patients with AA in the literature, corroborating the applicability of conventional guidelines. The results strengthen the hypothesis that the patient's flow with abdominal manifestations is complicated from the first contact with SUS to the resolution of the condition. CONCLUSION: Knowledge of the epidemiological profile and perioperative predictors that are most related to complications favor the appropriate management of patients.

Relevant aspects of acute appendicitis

“…There are many theories about the pathogenesis of appendicitis, most of which are associated with obstructive factors and intraluminal hypertension, but none of them has been proven to be true in experimental and clinical studies [1][2][3][4] . Another theory describes the neuroimmunoendocrine appendicopathy, whose clinical picture is similar to that of acute appendicitis, but without inflammation [4][5][6][7][8][9] . This disease, known since the beginning of the past century, may clarify the morphologically normal appendices found in patients with clinical and radiological manifestations of acute appendicitis.…”

“…Antibiotics and clinical control are the most widely recommended treatments in the presence of uncomplicated abdominal inflammatory diseases, such as diverticulitis, salpingitis, enterocolitis, and cholecystitis. Acute appendicitis has also been conservatively treated on special occasions over the past 70 years, with good immediate results in 60% of the cases [23][24][25] . The other 40% of the patients worsen their health condition or experience recurrence of symptoms during the early post-treatment period.…”

“…The other 40% of the patients worsen their health condition or experience recurrence of symptoms during the early post-treatment period. All of these cases must be immediately submitted to appendectomy [23][24][25] .…”

“…The conservative treatment starts with parenteral large-spectrum antibiotics against gram-negative bacteria. If the patients are in a good healthy condition, they may be discharged from the hospital and are advised to take the prescribed oral antibiotics for 2 weeks [23][24][25] .…”

Análise Comparativa Entre Apendicectomia Aberta E Videolaparoscópica No Rio De Janeiro Nos Últimos 5 Anos

“…Este tipo de abdome agudo inflamatório é a maior indicação de retirada do apêndice (apendicectomia), uma vez que até mesmo tumores apendiculares, que são extremamente raros, se apresentam com um quadro de apendicite aguda e acabam sendo diagnosticados pelo exame histopatológico da peça cirúrgica 7,8,9,10 . Os sinais e sintomas clássicos desta doença podem ser definidos como dor abdominal com início em hipogástrio que migra para fossa ilíaca direita, anorexia, febre, leucocitose e outros sinais laboratoriais de inflamação e podem estar presente em mais de 60% dos casos 3 .…”