Title : Predictors for appendicectomy severity and outcomes
Abstract:
Aim: This retrospective analysis aimed at evaluating appendicectomy outcomes in view of in-hospital delay and identifying predictive factors for complicated appendicitis.
Methods: Data collection of consecutive appendicectomies over eight months period was executed. Primary outcome was the impact of in-hospital (decision to incision) delay on severity of operative findings, operative time, length of hospital stays (LOS) and morbidity. Secondary outcomes included possible predictors for complicated operative findings. Patients were categorised into 3 groups: <8 hours, 8-24 hours, and >24 hours. Widespread peritoneal pus, gangrene and perforation of appendix were considered as complicated findings.
Results: 198 patients were included, with 74% diagnosed by CT, 5% by USS/MRI and 21% by clinical examination. Appendicectomy was delayed for <8 hours in 38% of patients, 8-12 hours in 52%, and >24 hours in 9%.There was no statistically significant difference between the 3 groups in operative findings, escalated CT to operative findings, operative time or early complications. Similarly, no notable difference was found in 30-day readmissions or complications rates. Despite the evident increased LOS with longer delay (2, 2.57, 2.61 in respective groups), this impact was statistically non-significant (P=0.077). The presence of fever and raised CRP above 100 were significantly correlated to complicated operative findings (P<0.0001). Isolated hyperbilirubinemia (P=0.004) and imaging confirmed complicated findings (P<0.0001) were also strong predictors.
Conclusion: Appendicectomy can be delayed safely to facilitate effective theatre prioritisation, bearing in mind clinical context and WSES 2020 recommended safe 24-hour delay. Patients with positive predictor criteria should be prioritised for surgery.
