Zewdu Dereje, Wondwosen Mekete, Tantu Temesgen, Tilahun Tamiru, Teshome Tewodros, Hamu Ahmed
Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Department of Surgery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Ann Med Surg (Lond). 2022 Jul 14;80:104194. doi: 10.1016/j.amsu.2022.104194. eCollection 2022 Aug.
Previous studies have found an association between various predictors and perforated appendicitis. However, there is limited evidence of studies determining the severity of acute appendicitis (AA) in resource-limited settings. Thus, this study aimed to identify predictors and outcomes of perforated appendicitis (PA) in sub-Saharan countries.
This is a retrospective cohort study of 298 adult patients who underwent surgical intervention for acute appendicitis. Demographic characteristics, clinical parameters, intraoperative findings, length of hospital stay, and postoperative complications were collected. We computed multivariate logistic regression to identify predictors of PA. P-value <0.05 was considered statistically significant.
Of 298 patients, PA was 142(47.65%). The identified risk factors for PA are referred patients (AOR = 3.932; 95% CI (2.201-7.027), fever >38 °C (AOR = 4.569; 95% CI (2.249-9.282), and duration of symptoms >2 days (AOR = 2.704; 95% CI (1.400-5.222). Perforation was associated with an increased rate of postoperative complications (45.07vs. 6.41%; P < 0.001) and a longer length of hospital stay (3 vs. 5 days; P < 0.001).
The incidences of PA in our study are consistent with other reports in developing countries. Referred patients, longer duration of symptoms >2 days, and presence of fever >38 °C were the best predictors of PA. The overall total postoperative complications and the length of hospital stays were higher in PA. Based on our findings, we recommend that the identified predictors should be considered during the preoperative diagnosis and subsequent management.
先前的研究已经发现各种预测因素与穿孔性阑尾炎之间存在关联。然而，在资源有限的环境中，确定急性阑尾炎（AA）严重程度的研究证据有限。因此，本研究旨在确定撒哈拉以南国家穿孔性阑尾炎（PA）的预测因素和结局。
这是一项对298例接受急性阑尾炎手术干预的成年患者进行的回顾性队列研究。收集了人口统计学特征、临床参数、术中发现、住院时间和术后并发症。我们进行了多因素逻辑回归分析以确定PA的预测因素。P值<0.05被认为具有统计学意义。
在298例患者中，PA患者有142例（47.65%）。确定的PA危险因素为转诊患者（比值比[AOR]=3.932；95%置信区间CI）、发热>38°C（AOR=4.569；95%CI(2.249-9.282)）以及症状持续时间>2天（AOR=2.704；95%CI(1.400-5.222)）。穿孔与术后并发症发生率增加（45.07%对6.41%；P<0.001）以及住院时间延长（3天对5天；P<0.001）相关。
我们研究中PA的发生率与发展中国家的其他报告一致。转诊患者、症状持续时间>2天以及发热>38°C是PA的最佳预测因素。PA患者术后总体并发症和住院时间更高。基于我们的研究结果，我们建议在术前诊断和后续管理过程中应考虑所确定的预测因素。
