Dölling Maximilian, Klös Michael, Pachmann Jonas, Stockheim Jessica, Rahimli Mirhasan, Al-Madhi Sara, Kahlert Ulf D, Perrakis Aristotelis, Herrmann Martin, Croner Roland S, Andric Mihailo
Faculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Molecular and Experimental Surgery, Department of General-, Visceral-, Vascular and Transplant Surgery, Faculty of Medicine and University Hospital Magdeburg, Otto-Von-Guericke University, 39120, Magdeburg, Germany.
Surg Endosc. 2025 Aug 18. doi: 10.1007/s00464-025-12038-z.
The clinical course of phlegmonous appendicitis (PHL) appears less severe than other complicated forms, which led to the discussion if PHL should be classified as complicated acute appendicitis (CAA). According to the guidelines of the European Association for Endoscopic Surgery (EAES) from 2015, PHL is classified as a CAA, which requires usually surgery. Therefore, this study aimed to evaluate the relevance of classifying PHL as CAA, with a focus on inflammatory markers, postoperative complications, and hospital length of stay.
We conducted a retrospective single-center study including 559 adult patients who underwent appendectomy between 2016 and 2020. Intraoperative classification followed the EAES 2015 guidelines. Preoperative C-reactive protein (CRP) and leucocyte counts were analyzed with respect to disease severity, postoperative complications, and length of hospital stay.
Complicated appendicitis was diagnosed in 62.5% of patients, with phlegmonous appendicitis accounting for 30.8%. CRP levels were significantly higher in CAA than uncomplicated acute appendicitis (UAA; Median 48.4 vs. 8.8 mg/L; p < 0.001) and increased progressively with disease severity. CRP showed good diagnostic performance in distinguishing CAA from UAA (AUC: 0.76), whereas leucocyte count demonstrated limited diagnostic utility (AUC: 0.57). With suspected appendicitis at a CRP threshold of 52.5 mg/L, at least PHL could be expected (49% sensitivity, 95% specificity, AUC 0.72). The risk of postoperative complications was higher in all CAA subtypes, including PHL (adjusted OR: 2.3; p = 0.015). Elevated preoperative CRP levels were associated with both complications (p < 0.001) and prolonged hospital stay (IRR: 1.21 for PHL; p < 0.001). Leucocyte counts were neither predictive of complications nor hospital duration.
Phlegmonous appendicitis shows a distinct clinical profile with moderate CRP elevation, a 2.3-fold increased risk of postoperative complications, and a 21% increase in hospital stay. These findings support its classification under EAES 2015 guidelines as complicated appendicitis.
蜂窝织炎性阑尾炎（PHL）的临床病程似乎不如其他复杂类型严重，这引发了关于PHL是否应归类为复杂性急性阑尾炎（CAA）的讨论。根据2015年欧洲内镜外科学会（EAES）的指南，PHL被归类为CAA，通常需要手术治疗。因此，本研究旨在评估将PHL归类为CAA的相关性，重点关注炎症标志物、术后并发症和住院时间。
我们进行了一项回顾性单中心研究，纳入了2016年至2020年间接受阑尾切除术的559例成年患者。术中分类遵循EAES 2015指南。分析术前C反应蛋白（CRP）和白细胞计数与疾病严重程度、术后并发症及住院时间的关系。
62.5%的患者被诊断为复杂性阑尾炎，其中蜂窝织炎性阑尾炎占30.8%。CAA患者的CRP水平显著高于非复杂性急性阑尾炎（UAA；中位数48.4 vs. 8.8 mg/L；p < 0.001），且随疾病严重程度逐渐升高。CRP在区分CAA和UAA方面具有良好的诊断性能（AUC：0.76），而白细胞计数的诊断效用有限（AUC：0.57）。当CRP阈值为52.5 mg/L怀疑阑尾炎时，至少可以预期为PHL（敏感性49%，特异性95%，AUC 0.72）。所有CAA亚型（包括PHL）术后并发症的风险均较高（校正OR：2.3；p = 0.015）。术前CRP水平升高与并发症（p < 0.001）和住院时间延长均相关（PHL的IRR：1.21；p < 0.001）。白细胞计数既不能预测并发症，也不能预测住院时长。
蜂窝织炎性阑尾炎表现出独特的临床特征，CRP中度升高，术后并发症风险增加2.3倍，住院时间增加21%。这些发现支持根据EAES 2015指南将其归类为复杂性阑尾炎。
