Risk Factors for Perforated Appendicitis in the Acute Care Surgery Era-Minimizing the Patient's Delayed Presentation...

Area of Science:

• Medical research
• Surgical outcomes
• Appendicitis management

Background:

• Numerous factors contribute to advanced disease or increased complications in patients with acute appendicitis (AA).
• Identifying risk factors for AA perforation is crucial for improving patient outcomes.
• Understanding the impact of system time (ST) delay, independent of patient time (PT) delay, is essential.

Purpose of the Study:

• To identify risk factors associated with acute appendicitis (AA) perforation.
• To determine the effect of system time (ST) delay on AA perforation, while controlling for patient time (PT) delay.

Main Methods:

• Retrospective review of medical records for patients undergoing surgery for AA from October 2009 to September 2013.
• Data collected included demographics, body mass index, fecalith presence, PT (symptom onset to ED arrival), and ST (ED arrival to OR).
• AA was classified as simple (nonperforated) or advanced (gangrenous, perforated).

Main Results:

• Of 445 patients with PT ≤ 24 hours, 358 had simple AA and 87 had advanced AA.
• Advanced appendicitis patients were older, had higher BMI, longer PT, higher WBC, and more fecaliths.
• Multiple regression analysis identified age >50, WBC >15,000, fecaliths, and PT delay >12 hours as risk factors for advanced appendicitis.

Conclusions:

• Limiting PT delay to ≤ 24 hours showed that ST delay > 12 hours did not adversely affect the incidence of advanced AA.
• Age > 50 years, WBC > 15,000, PT delay > 12 hours, and the presence of fecaliths are significant risk factors for advanced AA.