Frequency of Complicated Appendicitis and Associated Risk Factors Among Patients With Acute Appendicitis in Taiz,...

Background Complicated appendicitis - defined here as gangrenous appendicitis, perforation, peri-appendicular abscess, or generalized purulent peritonitis - causes substantial surgical morbidity where access to emergency care is constrained. This study determined the frequency and associated factors among patients with acute appendicitis in Taiz, Yemen. Methods This hospital-based, prospective, two-center, observational analytical study was conducted at the Authority of Al-Thawra Hospital and Al-Jumhoori Teaching Hospital in Taiz, Yemen, from February 2024 to February 2025. Consecutive patients of any age who underwent appendectomy for intraoperatively confirmed acute appendicitis were enrolled. Complication status was classified from macroscopic intraoperative findings. Associations were evaluated using bivariate analysis and multivariable binary logistic regression. Results A total of 207 patients were included, of whom 49 (23.7%) had complicated appendicitis. Pre-hospital delay showed a strong crude association with complicated appendicitis (crude odds ratio (cOR): 26.57, 95% confidence interval (CI): 9.04-78.08), whereas in-hospital delay was not statistically significant. Pre-hospital delay was not entered into the multivariable model because its major component causes were analyzed separately. In multivariable analysis, misdiagnosis at the primary healthcare level (adjusted odds ratio (aOR): 19.98, 95% CI: 7.56-52.80), consultation with a traditional healer (aOR: 22.11, 95% CI: 4.54-107.63), poor recognition of symptom severity (aOR: 18.08, 95% CI: 4.63-70.59), comorbidity (aOR: 7.13, 95% CI: 1.81-28.06), and appendicolith (aOR: 3.95, 95% CI: 1.24-12.58) were independently associated with complicated appendicitis. The apparent area under the receiver operating characteristic curve (AUC) was 0.879, the optimism-corrected value was 0.860, the Hosmer-Lemeshow p-value was 0.994, and the Brier score was 0.108. Conclusions Among 207 patients, 49 (23.7%) had complicated appendicitis. The strongest independent associations involved prior primary-level misdiagnosis, traditional-healer consultation, poor recognition of symptom severity, comorbidity, and appendicolith. These observational findings identify potentially modifiable points in the care pathway but do not establish causality. They support the evaluation of earlier recognition and referral strategies in conflict-affected Yemen.