Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2131-2139
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2131
Determination of surgical priorities in appendicitis based on the probability of undetected appendiceal perforation
Sang Chul Lee, Geon Park, Byung-Jo Choi, Say-June Kim
Sang Chul Lee, Byung-Jo Choi, Say-June Kim, Department of Surgery, Daejeon St. Mary’s Hospital, the Catholic University of Korea, Daejeon 420-743, South Korea
Geon Park, Department of Radiology, Daejeon St. Mary’s Hospital, the Catholic University of Korea, Daejeon 420-743, South Korea
Author contributions: All authors contributed to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Say-June Kim, MD, PhD, Department of Surgery, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Joong-gu, Daejeon 420-743, South Korea. sejoonkim@hanmail.net
Telephone: +82-42-2209520 Fax: +82-42-2209565
Received: June 16, 2014
Peer-review started: June 16, 2014
First decision: June 27, 2014
Revised: July 9, 2014
Accepted: August 13, 2014
Article in press: August 18, 2014
Published online: February 21, 2015
Processing time: 240 Days and 5.4 Hours
Abstract

AIM: To identify risk factors of actual appendiceal perforation when computed tomography (CT) scans suggest nonperforated appendicitis and accordingly determine surgical priority.

METHODS: We collected database of 1362 patients who underwent an appendectomy for acute appendicitis between 2006 and 2013. A single radiologist selected 1236 patients whose CT scans were suggestive of nonperforated appendicitis. Patients were divided into 2 groups: actual nonperforation group and actual perforation group according to intraoperative and pathologic features. Comparison of the 2 groups were made using binary logistic regression.

RESULTS: Of 1236 patients, 90 (7.3%) were found to have actual appendiceal perforation. Four risk factors related with actual appendiceal perforation were identified: body temperature ≥ 37.6  °C (HR = 1.912, 95%CI: 1.161-3.149; P = 0.011), out-of-hospital symptom duration ≥ 72 h (HR = 2.454, 95%CI: 1.292-4.662; P = 0.006), age ≥ 35 years (HR = 3.358, 95%CI: 1.968-5.728; P < 0.001), and appendiceal diameter on CT scan ≥ 8 mm (HR = 4.294, 95%CI: 1.034-17.832; P = 0.045). Actual appendiceal perforation group showed longer operation time, later initiation of diet, longer use of parenteral narcotics, longer hospital stay, and higher incidence of postoperative complications (P < 0.05).

CONCLUSION: We proposed here new criteria to select patients with adverse clinical outcomes after appendectomy among the patients with radiologically nonperforated appendicitis. Surgical appendectomy outcomes could be improved by determining the surgical priority according to our criteria.

Keywords: Appendicitis; Appendiceal perforation; Operative priority; Prognosis; Practice guideline

Core tip: This study analyzed surgical outcomes of 1236 patients whose computed tomography (CT) scans were suggestive of nonperforated appendicitis, and showed in-hospital gross perforation rate was very low (7.3%) and it was predicted by several factors: body temperature ≥ 37.6  °C, out-of-hospital symptom duration ≥ 7 d, age ≥ 35 years, and appendiceal diameter on CT scan ≥ 8 mm. Therefore, determining operative priority based on risk factors of in-hospital perforation is expected to improve surgical outcomes by reducing perforation rates.