Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis

Abstract

PurposeRecently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.MethodsA total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis.ResultsThe mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction's diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant.ConclusionSeveral factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis

“…In clinical practice, diagnosis of complicated appendicitis rarely relies on a single individual CT feature, but on multiple CT features combined with clinical findings. In fact, there have been attempts to build diagnostic models for complicated appendicitis that combine both clinical and imaging findings (32,54). This study may contribute to future studies on diagnostic algorithms for complicated appendicitis by providing more comprehensive inclusion of CT features as potential predictors.…”

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

“…Complicated appendicitis is defined as acute appendicitis with associated peritonitis, rupture, gangrene, or intra-abdominal abscess (IAA) and accounts for 14%-55% of all cases of appendicitis [4]. Complicated appendicitis is associated with a higher incidence of major complications after appendectomy [5,6]. Major postoperative complications after appendectomy include wound infection and IAA, which are common causes of prolonged hospital stay, greater cost, and lower quality of life [7].…”

Laboratory in complicated appendicitis prediction and predictive value of monitoring

“…Moon and his friends had showed that risen CRP level was related to complicated appendicitis (19). Also, when CRP values that were over 5 mg/dL were compared with leucocytosis, there were studies indicating that the only meaningful factor was the discrimination of complicated and non-complicated appendicitis (20). CRP values that were over 5.98 mg/dL had been obtained as meaningful for complicated appendicitis.…”