Factors associated with hospitalization or surgery for abdominal pain: a retrospective study

Acute abdominal pain (AAP) causes 6-11% of emergency department (ED) visits. Distinguishing severe from benign AAP remains challenging. We aimed at identifying factors associated with hospitalization or emergency surgery. We performed a single-center retrospective observational study, including all the patients who presented in the ED with AAP during one whole year. Through direct access to medical records, 86 factors were studied. Patients who were hospitalized or who underwent emergency surgery were compared to patients who were discharged. We analyzed 2201 patients with AAP: 432 patients in the hospitalized group, and 1769 patients in the ambulatory group. Five factors associated with hospitalization or emergency surgery were identified through multivariable analysis: pain location in the right iliac fossa region (OR 2.8, 1.9-4.2; p < 10^-3), abdominal guarding (OR 3.0; 1.02-8.9; p < 10^-3), neutrophilia (OR 2.4, 1.7-3.6; p < 10^-3), serum lipase greater than 3 times the upper limit of normal (OR 26.4; 8.1-85.9; p < 10^-3), and CRP over 6 mg/L (OR 2.8; 2.0-4.1; p < 10^-3). When present, contributory abdominal CT scan was the only factor remaining associated with hospitalization or emergency surgery (OR 21.4, 4.8-94.8, p = 0.009), in multivariable analysis. This large retrospective cohort study confirms the value of abdominal guarding, neutrophilia, and elevated CRP for distinguishing severe from benign AAP and identifies pain location in the right iliac fossa region and elevated serum lipase as associated with hospitalization or emergency surgery. Further research focusing on more homogenous groups of patients could lead to helpful scores to distinguish severe from benign AAP.