Khan Muhammad Sohaib, Siddiqui Muhammad Tayyab H, Shahzad Noman, Haider Aleezay, Chaudhry Mustafa Belal Hafeez, Alvi Rehman
Surgery, Aga Khan University, Karachi, PAK.
General Surgery, East Kent Hospitals University National Health Service Foundation Trust, Margate, GBR.
Cureus. 2019 May 28;11(5):e4765. doi: 10.7759/cureus.4765.
Introduction Factors associated with complicated appendicitis have been inconsistently identified. Moreover, studies are lacking from low and low-middle countries where access to surgical care is limited. Our objective was to identify factors predicting complicated appendicitis as diagnosed intraoperatively in a low-middle income country hospital. Methodology Retrospective case-control study of patients who underwent laparoscopic appendectomy from 01/2008 to 12/2015 was completed. Based on intraoperative diagnosis of complicated appendicitis, patients were divided into two groups; those with complicated appendicitis (CA) and those who had non-complicated appendicitis (NCA). CT scans were further reviewed to identify presence of appendicolith. Result Of the 442 patients included, 88 (20%) patients were in the CA group while 354 (80%) patients were in the NCA group. Patients in the CA group were older [CA vs. NCA: 34.6 ± 14 vs. 30.4 ± 11.5; p-value < 0.001], had symptoms for longer duration [CA vs. NCA: 2 ± 1.2 vs. 1.5 ± 0.8; p-value: 0.001] and had a greater proportion of patients with appendicoliths [CA vs. NCA: 37 (42%) vs. 84 (23.7%); p-value: 0.001]. On multivariable regression analysis, patients with complicated appendicitis had greater odds of having appendicoliths (OR: 2.4, 95% CI: 1.4-4.07; p-value < 0.001) and symptoms for a longer duration (OR: 1.57, 95% CI: 1.25-1.97; p-value < 0.001). Conclusion Patients with complicated appendicitis had greater odds of having appendicoliths and symptoms for a longer duration. Further studies are warranted in low and low-middle income countries to gauge the impact delay in presentation and intervention has on appendicitis and its outcomes.
与复杂性阑尾炎相关的因素一直未得到一致确认。此外，在获得外科治疗机会有限的低收入和中低收入国家，相关研究匮乏。我们的目标是确定在一家中低收入国家医院术中诊断为复杂性阑尾炎的预测因素。方法：完成了一项对2008年1月至2015年12月期间接受腹腔镜阑尾切除术患者的回顾性病例对照研究。根据术中对复杂性阑尾炎的诊断，将患者分为两组；患有复杂性阑尾炎（CA）的患者和患有非复杂性阑尾炎（NCA）的患者。进一步复查CT扫描以确定阑尾结石的存在。结果：在纳入的442例患者中，88例（20%）患者属于CA组，而354例（80%）患者属于NCA组。CA组患者年龄更大[CA组与NCA组：34.6±14岁对30.4±11.5岁；p值<0.001]，症状持续时间更长[CA组与NCA组：2±1.2天对1.5±0.8天；p值：0.001]，且阑尾结石患者比例更高[CA组与NCA组：37例（42%）对84例（23.7%）；p值：0.001]。多变量回归分析显示，患有复杂性阑尾炎的患者有阑尾结石的几率更高（比值比：2.4，95%置信区间：1.4 - 4.07；p值<0.001）且症状持续时间更长（比值比：1.57，95%置信区间：1.25 - 1.97；p值<0.001）。结论：患有复杂性阑尾炎的患者有阑尾结石的几率更高且症状持续时间更长。在低收入和中低收入国家有必要开展进一步研究，以评估就诊和干预延迟对阑尾炎及其结局的影响。
