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Factors associated with increased risk of perforation of acute appendicitis
Furat Shani Aoda1, Sura Saeed Abood2, Ibrahim Falih Noori1
1Department of Surgery, Basra Medical College, University of Basra, Iraq.
Background:
Acute appendicitis is the most common cause of acute abdomen encountered in general surgical practice, with the life time risk of 7-9 %. While early treatment usually prevent complications, perforated appendicitis remains a serious concern leading to higher morbidity, longer hospital stay .
Objectives:
To determine clinical, demographic, laboratory, and radiological predictors of perforation in adults with acute appendicitis.
Methods:
This retrospective cohort study included 200 patients diagnosed with acute appendicitis and treated at a major teaching hospital between January 2018 and December 2022. Patients were categorized into perforated and non-perforated based on intra-operative and histopathological findings. Data on demographics, co-morbidities, symptom duration, laboratory markers, imaging results, complications, and hospital stay were collected. Multivariate logistics regression was applied to identify independent predictors of perforation.
Results:
Acute appendicitis was more prevalent among patients in their second decade of life (44%) and more common in males (56%) than females (44%). Perforation occurred in 20% of cases. Risk factors significantly associated with perforation include old age, delayed presentation (>48 hours; co-morbidities, particularly diabetes). Elevated WBC count (>18.000\mm3) with negative shift and increased C-reactive protein level. Ultrasound showed modest diagnostic accuracy, while Computed Tomography (cCT) scan outperformed ultrasound in detecting perforation (sensitivity: 92 vs. 65%). Postoperative complications and hospital stay were significantly higher in patients with perforated appendicitis (P-value < 0. 05).
Conclusion:
Delayed presentation, elevated inflammatory markers, old age, and co-morbidities are strong, independent predictors of appendiceal perforation. Early diagnosis and prompt surgical intervention, especially in patients with known risk factors, are crucial to prevent complications such as perforation and minimize hospital stay.
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