Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study.

Area of Science:

• General Surgery
• Emergency Medicine
• Radiology

Background:

• Delaying appendicectomy up to 24 hours is generally safe.
• Appendicoliths are known risk factors for appendicitis perforation.
• The time-dependent relationship between appendicoliths and perforation risk is understudied.

Purpose of the Study:

• To investigate the hypothesis that appendicolith presence, confirmed by preoperative CT (pCT), shortens the time to complicated appendicitis.
• To explore the temporal association between appendicolith presence and the development of complicated appendicitis.

Main Methods:

• Retrospective single-centre cohort study of 310 patients admitted between 2018-2020.
• Inclusion criteria: age ≥18, appendicitis confirmed by histopathology, and pCT scan.
• Complicated appendicitis defined as abscess, gangrene, or perforation on intraoperative findings.

Main Results:

• Appendicoliths were present in 25.5% of patients and identified as a significant risk factor for perforation (OR 3.50, p=0.027).
• Patients with appendicoliths had a significantly higher proportion of complicated appendicitis within 12 hours of admission (56.7% vs 43.3%, p=0.003).
• Appendicolith presence increased the likelihood of complicated appendicitis within 12 hours by 2.05 times (95% CI 1.28-3.29).

Conclusions:

• Appendicitis with appendicoliths warrants consideration for early appendicectomy.
• Further large-scale multicentre prospective studies are needed to validate these findings and inform clinical guidelines.