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Factors influencing the course of acute appendicitis in adults and children

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Abstract

Purpose

Our aim was to determine predictive factors for the diagnosis and postoperative complications of acute appendicitis.

Materials and patients

Data sets of 1,439 consecutive adults and children who had an appendectomy between 1999 and 2008 were retrospectively analyzed.

Results

A mild acute appendicitis was present in 50 % (n = 722) and a severe acute appendicitis in 25 % (n = 355) of the patients. No signs of any pathology were found in 6 % (n = 82). Gender, white blood count (WBC), C-reactive protein (CRP), and ultrasound (US) examination were important indicators of mild acute and severe acute appendicitis in adults and children. Postoperative complications occurred in 16 % (237/1,439), mainly consisting of wound infections (8 %, n = 122) and bowel dysfunction (5 %, n = 76). Sixty-two patients (4.3 %) required reoperations. One patient died (1/1,439, 0.07 % mortality rate). Age, pathology, and the presence of bacteria in the intraoperative swab were important predictive factors for postoperative complications in adults and children. Time since onset of symptoms and type of operation were also associated with postoperative complications among adults. Complications developed in 21 and 9 % of the adults (155/754 and 10/125) who had open and laparoscopic surgery, respectively.

Conclusions

Besides history and clinical examination, WBC, CRP, and US examination remain important factors for diagnosing acute appendicitis. Complications are related to the pathology, presence of bacteria, and type of operation. Early diagnosis within 48 h may be important. A laparoscopic procedure in adults may also cause fewer wound infections.

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Acknowledgments

The authors would like to acknowledge Mrs. U. Kemmer and Mrs. H. Keller-Veith for the excellent assistance in the data collection for this study.

Conflicts of interest

None of the authors have any financial or other personal interest associated with the publication of this article.

Author information

Authors and Affiliations

  1. Clinic of General and Visceral Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    C. Tsioplis, C. Brockschmidt, D. Henne-Bruns & M. Kornmann

  2. Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstrasse 13, 89075, Ulm, Germany

    S. Sander

  3. Department of General and Visceral Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    M. Kornmann

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  1. C. Tsioplis
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  2. C. Brockschmidt
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Corresponding author

Correspondence to M. Kornmann.

Electronic Supplementary Material

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Supplemental Table S1

Odds ratios of risk factors for mild acute appendicitis or severe acute appendicitis from multiple logistic regressions (DOC 54 kb)

Supplemental Table S2

Odds ratios of risk factors for postoperative complications from multiple logistic regressions for younger and older adults (DOC 41 kb)

Supplemental Table S3

Patient characteristics of open and laparoscopic appendectomies excluding 82 patients with negative appendectomy (DOC 50 kb)

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Tsioplis, C., Brockschmidt, C., Sander, S. et al. Factors influencing the course of acute appendicitis in adults and children. Langenbecks Arch Surg 398, 857–867 (2013). https://doi.org/10.1007/s00423-013-1096-z

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  • DOI: https://doi.org/10.1007/s00423-013-1096-z

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