Predictors of a histopathologic diagnosis of complicated appendicitis

Imran, Jonathan B.; Madni, Tarik D.; Minshall, Christian T.; Mokdad, Ali H.; Subramanian, Madhu; Clark, Audra T.; Phelan, Herbert; Cripps, Michael W.

doi:10.1016/j.jss.2017.02.051

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…This was surprising because the majority of published studies did not find an association between patients' sex and the rate of complicated AA. [35][36][37] Additionally, we confirmed that patients with complicated AA are, overall, older. A possible explanation for this observation was previously described.…”

Section: Discussionsupporting

confidence: 77%

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Pędziwiatr

Lasek

Wysocki

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA. METHODS: The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni-and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis. RESULTS: In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were:

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Section: Discussionsupporting

confidence: 77%

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Pędziwiatr

Lasek

Wysocki

et al. 2018

Ulus Travma Acil Cerrahi Derg

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“…Ishiyama et al found an association of appendicoliths that were large and present at the base of the appendix with appendiceal perforation and gangrene [11]. Imran et al described the increased odds of perforated appendicitis with greater symptom duration and the presence of an appendicolith [20]. The odds of complicated appendicitis in this study were increased by 2.4 times for those who had appendicoliths.…”

Section: Discussionsupporting

confidence: 49%

“…Appendicoliths, a non-modifiable risk factor, is estimated to be present in up to 30% of asymptomatic population [19]. Both of these factors have been shown to increase the risk of complicated appendicitis in other recent studies as well [11,20,21].…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated with Complicated Appendicitis: View from a Low-middle Income Country

Khan¹,

Siddiqui²,

Shahzad³

et al. 2019

Cureus

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Introduction Factors associated with complicated appendicitis have been inconsistently identified. Moreover, studies are lacking from low and low-middle countries where access to surgical care is limited. Our objective was to identify factors predicting complicated appendicitis as diagnosed intraoperatively in a low-middle income country hospital. Methodology Retrospective case-control study of patients who underwent laparoscopic appendectomy from 01/2008 to 12/2015 was completed. Based on intraoperative diagnosis of complicated appendicitis, patients were divided into two groups; those with complicated appendicitis (CA) and those who had non-complicated appendicitis (NCA). CT scans were further reviewed to identify presence of appendicolith. Result Of the 442 patients included, 88 (20%) patients were in the CA group while 354 (80%) patients were in the NCA group. Patients in the CA group were older [CA vs. NCA: 34.6 ± 14 vs. 30.4 ± 11.5; p-value < 0.001], had symptoms for longer duration [CA vs. NCA: 2 ± 1.2 vs. 1.5 ± 0.8; pvalue: 0.001] and had a greater proportion of patients with appendicoliths [CA vs. NCA: 37 (42%) vs. 84 (23.7%); p-value: 0.001]. On multivariable regression analysis, patients with complicated appendicitis had greater odds of having appendicoliths (OR: 2.4, 95% CI: 1.4-4.07; p-value < 0.001) and symptoms for a longer duration (OR: 1.57, 95% CI: 1.25-1.97; p-value < 0.001).

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“…The only variable significantly associated with unexpected re-hospitalization was appendicolith, also known as fecalith, corpolith, or stercolith. Appendicolith, which is composed of firm feces and some mineral deposits, is a well-established risk factor for perforation [ 28 – 30 ], inflammation [ 31 ], and failure of antibiotics treatment [ 32 ] or post-operative adverse events [ 31 , 33 , 34 ]. In our series, BMI was not associated with unexpected re-consultations or re-hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Gignoux¹,

Blanchet²,

Lanz³

et al. 2018

World J Emerg Surg

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BackgroundAppendectomy is increasingly performed as a ‘short stay’ or ‘ambulatory’ procedure, yet there is no consensus for selection of patients with acute appendicitis for ambulatory surgery (AS). We aimed to compare characteristics and outcomes of complicated and uncomplicated appendectomies performed in ambulatory vs. conventional settings, and to determine factors associated with unexpected re-consultations and re-hospitalizations.MethodsThe authors reviewed a consecutive series of 185 laparoscopic appendectomies. Whenever possible, patients were offered AS, defined as ‘discharge on the same working day.’ Multivariable regressions were performed to determine associations of unexpected re-consultations and re-hospitalizations with surgery type (ambulatory or conventional) and patient characteristics (age, gender, obesity, symptoms, appendicolith, perforations, appendix diameter, serologic results, American Society of Anesthesiologists score, and Saint-Antoine score).ResultsFrom the initial cohort, 117 patients (63.2%) were eligible for AS, of which 8 had peri- or post-operative contraindications. Therefore, 109 patients (58.9%) were operated by AS, with median length of stay 8.5 h (range, 3.3–20.5). Ambulatory cases had a lower incidence of complications (11.9%) than conventional cases (25.0%) (p = 0.029). Uni- and multi-variable regressions revealed that unexpected re-consultations were not significantly associated with any of the pre- or peri-operative variables but that unexpected re-hospitalizations were 4 times more likely for patients with appendicolith (OR, 4.32; p = 0.04).ConclusionsAmbulatory surgery could be considered as a standard procedure for both complicated and uncomplicated acute appendicitis. Appendicolith was found to be an independent risk factor for unexpected re-hospitalization and should therefore trigger closer monitoring.

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Predictors of a histopathologic diagnosis of complicated appendicitis

Cited by 18 publications

References 21 publications

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Factors Associated with Complicated Appendicitis: View from a Low-middle Income Country

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

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