Ng Teng Fong General Hospital, Department of Surgery, Jurong Health Campus, National University Health System, Singapore.
Jurong Community Hospital, Jurong Health Campus, National University Health System, Singapore.
Med J Malaysia. 2022 May;77(3):331-337.
Acute appendicitis is one of the most common causes of intra-abdominal emergency surgery worldwide. This study was conducted to contribute to global databases by presenting data from our institution, which consist of multi-racial population. We aimed to evaluate the presentation, diagnosis, and management of acute appendicitis and post-operative outcome in our institution and evaluate the risks factors associated with severe complications and prolonged length of stay (LOS).
We performed a retrospective analysis using multivariate regression analysis of all patients who underwent appendectomy (2009-2014) in our institution. The primary outcomes included demographics, presentation, and perioperative management, and the secondary outcomes included risk factors associated with prolonged LOS.
Of the 1185 patients, the mean age was 36.4 years, and 940 (79.3%) were male. Majority (98.1%) of patients were ASA (American Society of Anaesthesiologists) 1 or 2. Most of them (83.9%) were from the four racial subgroups (Chinese, Malay, Bangladeshi, and Indian). There was no racial variation in the diagnosis and presentation of disease. The mean duration of symptoms was 1.8 days. The history was commonly a localised or migratory abdominal pain associated with anorexia, nausea, vomiting, and fever. The commonest physical findings were right-sided abdominal tenderness associated with rebound and guarding. About 42.9% of the patients underwent pre-operative CT scan to establish the diagnosis of appendicitis prior to surgery, whilst 57.1% underwent surgery on clinical diagnosis and blood investigation (NWR and CRP). An open appendectomy was performed in 13.2% of the patients. The conversion rate of laparoscopic appendectomy was 4.9% (n = 50). The mean length of hospital stay was 3.6 days. On multivariate Cox regression, patients of Burmese and Thai descent were independently associated with a prolonged LOS. The postoperative morbidity was 5.5%. The 30-day readmission rate was 2.4%. There was no mortality in our study.
Our study showed that pre-operative diagnosis of acute appendicitis can be made accurately by classical clinical presentation or by imaging. Independent risk factors associated with increased LOS included increased age, male gender, prolonged duration of symptoms pre-admission, fever, generalised tenderness, and prolonged operative time. The effect of race on LOS has been observed in the literature for other surgical procedures. The prolonged LOS found in Burmese and Thai patients contribute to the possibility of intrinsic racial differences in the post-surgery recovery. However, the numbers are small and therefore prone to type I error. Compared to the open approach, the use of laparoscopic appendectomy was associated with shorter LOS. This has similar outcomes to those reported in the literature.
The identification of risks factors could help surgical team to predict the clinical outcomes and develop risk reduction strategy in post-operative care of these patients.
急性阑尾炎是全球范围内最常见的腹部急症手术原因之一。本研究旨在为全球数据库做出贡献，展示我院多民族人群的数据。我们旨在评估我院急性阑尾炎的表现、诊断和治疗以及术后结果，并评估与严重并发症和住院时间延长（LOS）相关的风险因素。
我们对我院所有接受阑尾切除术（2009-2014 年）的患者进行了回顾性多变量回归分析。主要结果包括人口统计学、表现和围手术期管理，次要结果包括与 LOS 延长相关的风险因素。
在 1185 名患者中，平均年龄为 36.4 岁，940 名（79.3%）为男性。大多数（98.1%）患者为 ASA（美国麻醉师协会）1 或 2 级。他们中的大多数（83.9%）来自四个种族亚组（华人、马来人、孟加拉人和印度人）。在疾病的诊断和表现方面没有种族差异。症状的平均持续时间为 1.8 天。病史通常为局部或迁移性腹痛，伴有食欲不振、恶心、呕吐和发热。最常见的体格检查是右侧腹部压痛，伴有反弹和保护。约 42.9%的患者在术前进行 CT 扫描以明确阑尾炎的诊断，而 57.1%的患者在术前根据临床诊断和血液检查（NWR 和 CRP）进行手术。13.2%的患者行开腹阑尾切除术。腹腔镜阑尾切除术的转化率为 4.9%（n=50）。平均住院时间为 3.6 天。多变量 Cox 回归分析显示，缅甸和泰国裔患者的 LOS 延长与独立相关。术后发病率为 5.5%。30 天再入院率为 2.4%。本研究无死亡病例。
我们的研究表明，急性阑尾炎的术前诊断可以通过经典的临床表现或影像学检查准确做出。与 LOS 延长相关的独立风险因素包括年龄增加、男性、入院前症状持续时间延长、发热、全腹压痛和手术时间延长。种族对 LOS 的影响在其他手术程序的文献中已经观察到。在缅甸和泰国患者中发现的 LOS 延长可能表明手术后恢复存在内在的种族差异。然而，这些数字较小，因此容易出现 I 类错误。与开放方法相比，腹腔镜阑尾切除术与 LOS 缩短相关。这与文献报道的结果相似。
识别风险因素可以帮助外科团队预测临床结果，并制定术后护理中降低这些患者风险的策略。
