Prevalence of Postoperative Unfavorable Outcome and Associated Factors in Patients with Appendicitis: A Cross-Sectional Study

Factors associated with early inhospital adverse outcome following surgery for acute appendicitis in Uganda: a multicenter cohort

INTRODUCTION

Surgery for acute appendicitis has been associated with significant morbidity. This study aimed to determine the factors associated with early inhospital adverse outcomes following surgery for acute appendicitis in Uganda.

METHODS

This was a multicentre, prospective cohort in which early inhospital outcome following surgery for acute appendicitis was assessed at 4 regional referral hospitals in Uganda. The occurrence of complications during the admission period was documented as well as the length of hospital stay. Factors associated with adverse outcomes were determined using Poisson regression.

RESULTS

Of the 102 patients who underwent surgery for acute appendicitis, the majority were males 79(77.5%) with a mean age of 23.8(SD = 12.5) years. The perforated appendix was seen in 26 (25.5%) patients. Post-operative complications occurred in 21(20.6%) with the commonest being surgical site infection in 19(18.6%) patients. The median length of hospital stay was 3(IQR = 3-4) days with 43(42.2%) staying in hospital for more than 3 days. The presence of anemia (Hb < 8) (aRR = 1.376, CI = 1.159-1.634, P =  < 0.001) and having a perforated appendix (aRR = 1.263, CI = 1.026-1.555, P = 0.027) were independently associated with occurrence of complications while being HIV positive (aRR = 1.379, CI = 1.105-1.721, P = 0.005) and having a perforated appendix (aRR = 1.258, CI = 1.019-1.554, P = 0.033) were independently associated with prolonged hospital stay.

CONCLUSION

Community education about early presentation is still required in order to reduce the number of patients that present late which should, in turn, reduce the risk of complications and length of hospital stay.

Factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the emergency department

BACKGROUND

Unfavorable outcomes occur in patients with acute abdominal pain who visit the emergency department (ED). We aimed to determine the factors associated with unfavorable outcomes in patients with acute abdominal pain visiting the ED.

METHODS

This retrospective cohort study was conducted from July 1, 2015 to June 30, 2016. The inclusion criterion was patients aged older than 18 years who presented to the ED with acute abdominal pain. Significant factors associated with unfavorable outcomes were examined using univariate and multivariate logistic regression analyses.

RESULTS

A total of 951 patients were included in the study. Multivariate logistic regression analysis showed that the ED length of stay (EDLOS) > 4 h (adjusted odds ratio (AOR) 2.62, 95% confidence interval [CI]: 1.33-5.14; p = 0.005), diastolic blood pressure (DBP) < 80 mmHg (AOR 3.31, 95% CI: 1.71-6.4; p ≤ 0.001), respiratory rate ≥ 24 breaths/min (AOR 2.03, 95% CI: 1.07-3.86; p ≤ 0.031), right lower quadrant (RLQ) tenderness (AOR 3.72, 95% CI: 1.89-7.32; p ≤ 0.001), abdominal distension (AOR 2.91, 95% CI: 1.29-6.57; p = 0.010), hypoactive bowel sounds (AOR 2.89, 95% CI: 1.09-7.67; p = 0.033), presence of specific abdominal signs (AOR 2.07, 95% CI: 1.1-3.88; p = 0.024), white blood cell count ≥ 12,000 cells/mm³ (AOR 2.37, 95% CI: 1.22-4.6; p = 0.011), and absolute neutrophil count (ANC) > 75% (AOR 2.83, 95% CI: 1.39-5.75; p = 0.004) were revealed as significant factors associated with unfavorable outcomes.

CONCLUSIONS

The present study revealed that the significant clinical signs associated with the occurrence of unfavorable outcomes were DBP < 80 mmHg, tachypnea (≥ 24 breaths/min), RLQ tenderness, abdominal distension, hypoactive bowel sounds, and presence of specific abdominal signs. Moreover, the associated laboratory results identified in this study were leukocytosis and ANC > 75%. Additionally, patients with abdominal pain visiting the ED who had an EDLOS longer than 4 h were associated with unfavorable outcomes.

Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis

INTRODUCTION

Non-operative antibiotic therapy is now considered as an alternative to surgery for acute appendicitis (AA). This is in part due to the reported surgical complication rates. We report a patient who developed wound infection and port site hernia following a laparoscopic appendectomy, analyze our post-operative wound infection rates, and discuss the treatment options for AA globally.

PRESENTATION OF CASE

We report a 40-year-old woman who developed a wound infection and subsequent port site hernia following laparoscopic appendectomy (LA) and analyze surgical site infection (SSI) and readmission rates for patients who underwent LA at our medical center. Analysis of our surveillance data demonstrated that 15/865 (1.7%) patients developed SSIs and 7/15 (47%) of these patients had positive wound cultures. Patients who developed SSIs were more likely to be male (80% vs 20%; P = 0.03), be older (43.0 vs 34.0; P = 0.04), have higher surgical wound classification scores (66.7% vs 38.2%; P = 0.009), and have longer operative times (82 vs 62 min; P = 0.003). The overall readmission rate was 2.8%.

DISCUSSION

We report a lower SSI rate after LA than usually reported. Surgical site infection following LA is rare and may be challenging to diagnose early. Additional complications such as port-site hernia may also be encountered in this setting.

CONCLUSION

This data should inform both physicians and surgeons who must consider the expected complication rates associated with surgery for AA globally.

Prehospital Delay and Its Associated Factors in Sudanese Patients Presenting With Acute Appendicitis at a Teaching Hospital

Background

Delayed prehospital presentation of acute appendicitis may increase the risk of perforation and other complications. This study investigated the prevalence of prehospital delay in the presentation of acute appendicitis, clinical features, and outcomes in Sudanese patients.

Method

A retrospective study conducted from January 2017 to December 2020 in a teaching hospital affiliated with Gezira University enrolled 191 patients with prehospital delay presentation of acute appendicitis (at least 48 hours from symptom onset). Patient characteristics, causative factors, primary treatment, and complication rate were gathered and analyzed.

Result

The mean age of the patients was 36.55 ± 16.3 years (range: 15-78 years), with 122 (64%) males and 69 (36%) females. Most cases of prehospital delay were misdiagnosed firstly as other diseases (n = 124, 65%). The physicians made misdiagnosis of acute appendicitis in 65 (53%) patients. Age less than 30 years, male gender, living in rural areas, and lower educational level are associated with a high incidence of prehospital delay presentation of acute appendicitis (p < 0.05). Most cases have appendicular mass (46%, p < 0.001). Wound infection was the most common postoperative complication (7.85%, p < 0.001).

Conclusion

The high incidence rate of prehospital delay presentation of acute appendicitis is associated with patients' age ofless than 30 years, male gender, living in a rural area, and lower educational level. With the high rate of misdiagnosed acute appendicitis, it is essential to increase the knowledge about the signs and symptoms of appendicitis among our physicians and health practitioners.