Factors Associated with Early Inhospital Adverse Outcome Following Surgery for Acute Appendicitis in Uganda: a Multicenter Cohort

Overview

Journal Perioper Med (Lond)

Publisher Biomed Central

Date 2024 Jun 3

PMID 38831345

Authors

Sharif Yusuf Farhan

Demoz Abraha

Isaac Edyedu

Selamo Fabrice Molen

William Mauricio

Samuel Oledo Odong

Michael Mugeni

Joshua Muhumuza

Affiliations

Soon will be listed here.

Abstract

Introduction: Surgery for acute appendicitis has been associated with significant morbidity. This study aimed to determine the factors associated with early inhospital adverse outcomes following surgery for acute appendicitis in Uganda.

Methods: This was a multicentre, prospective cohort in which early inhospital outcome following surgery for acute appendicitis was assessed at 4 regional referral hospitals in Uganda. The occurrence of complications during the admission period was documented as well as the length of hospital stay. Factors associated with adverse outcomes were determined using Poisson regression.

Results: Of the 102 patients who underwent surgery for acute appendicitis, the majority were males 79(77.5%) with a mean age of 23.8(SD = 12.5) years. The perforated appendix was seen in 26 (25.5%) patients. Post-operative complications occurred in 21(20.6%) with the commonest being surgical site infection in 19(18.6%) patients. The median length of hospital stay was 3(IQR = 3-4) days with 43(42.2%) staying in hospital for more than 3 days. The presence of anemia (Hb < 8) (aRR = 1.376, CI = 1.159-1.634, P = < 0.001) and having a perforated appendix (aRR = 1.263, CI = 1.026-1.555, P = 0.027) were independently associated with occurrence of complications while being HIV positive (aRR = 1.379, CI = 1.105-1.721, P = 0.005) and having a perforated appendix (aRR = 1.258, CI = 1.019-1.554, P = 0.033) were independently associated with prolonged hospital stay.

Conclusion: Community education about early presentation is still required in order to reduce the number of patients that present late which should, in turn, reduce the risk of complications and length of hospital stay.

References

Ayele W . Prevalence of Postoperative Unfavorable Outcome and Associated Factors in Patients with Appendicitis: A Cross-Sectional Study. Open Access Emerg Med. 2021; 13:169-176. PMC: 8112252. DOI: 10.2147/OAEM.S305905. View

Ferris M, Quan S, Kaplan B, Molodecky N, Ball C, Chernoff G . The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies. Ann Surg. 2017; 266(2):237-241. DOI: 10.1097/SLA.0000000000002188. View

Snyder M, Guthrie M, Cagle S . Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018; 98(1):25-33. View

Salminen P, Tuominen R, Paajanen H, Rautio T, Nordstrom P, Aarnio M . Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. JAMA. 2018; 320(12):1259-1265. PMC: 6233612. DOI: 10.1001/jama.2018.13201. View

Waledziak M, Lasek A, Wysocki M, Su M, Bobowicz M, Mysliwiec P . Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Sci Rep. 2019; 9(1):14793. PMC: 6794313. DOI: 10.1038/s41598-019-51172-2. View

Talan D, Di Saverio S . Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021; 385(12):1116-1123. DOI: 10.1056/NEJMcp2107675. View

Minutolo V, Licciardello A, Di Stefano B, Arena M, Arena G, Antonacci V . Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years experience in a district hospital. BMC Surg. 2014; 14:14. PMC: 3984427. DOI: 10.1186/1471-2482-14-14. View

Monrabal Lezama M, Casas M, Angeramo C, Bras Harriott C, Schlottmann F . Conversion from Laparoscopic to Open Appendectomy: Trends, Risk Factors and Outcomes. A 15-Year Single-Center Analysis of 2193 Adult Patients. World J Surg. 2022; 46(11):2642-2647. PMC: 9309015. DOI: 10.1007/s00268-022-06670-2. View

White M, Longstaff L, Lai P . Effect of Pre-operative Anaemia on Post-operative Complications in Low-Resource Settings. World J Surg. 2016; 41(3):644-649. PMC: 5391871. DOI: 10.1007/s00268-016-3785-6. View

10.

Monttinen T, Kangaspunta H, Laukkarinen J, Ukkonen M . Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies. Scand J Surg. 2020; 110(2):227-232. PMC: 8258730. DOI: 10.1177/1457496920938605. View

11.

Prystowsky J, Pugh C, Nagle A . Current problems in surgery. Appendicitis. Curr Probl Surg. 2005; 42(10):688-742. DOI: 10.1067/j.cpsurg.2005.07.005. View

12.

Knaapen M, van Amstel P, van Amstel T, The S, Bakx R, van Heurn E . Outcomes after appendectomy in children with acute appendicitis treated at a tertiary paediatric centre: results from a retrospective cohort study. Langenbecks Arch Surg. 2020; 406(1):163-169. PMC: 7870764. DOI: 10.1007/s00423-020-01976-y. View

13.

Lasek A, Pedziwiatr M, Kenig J, Waledziak M, Wysocki M, Mavrikis J . The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study. Medicine (Baltimore). 2018; 97(50):e13621. PMC: 6320074. DOI: 10.1097/MD.0000000000013621. View

14.

Nshuti R, Kruger D, Luvhengo T . Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath academic hospital. Int J Emerg Med. 2014; 7(1):12. PMC: 3938026. DOI: 10.1186/1865-1380-7-12. View

15.

Yuan J, Chen Q, Hong W, Yu L, Li X . Comparison of Clinical Features and Outcomes of Appendectomy in Elderly vs. Non-Elderly: A Systematic Review and Meta-Analysis. Front Surg. 2022; 9:818347. PMC: 8899017. DOI: 10.3389/fsurg.2022.818347. View

16.

Tankel J, Keinan A, Blich O, Koussa M, Helou B, Shay S . The Decreasing Incidence of Acute Appendicitis During COVID-19: A Retrospective Multi-centre Study. World J Surg. 2020; 44(8):2458-2463. PMC: 7250252. DOI: 10.1007/s00268-020-05599-8. View

17.

Biondi A, Di Stefano C, Ferrara F, Bellia A, Vacante M, Piazza L . Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg. 2016; 11(1):44. PMC: 5006397. DOI: 10.1186/s13017-016-0102-5. View

18.

Carr N . The pathology of acute appendicitis. Ann Diagn Pathol. 2000; 4(1):46-58. DOI: 10.1016/s1092-9134(00)90011-x. View

19.

Humes D, Simpson J . Acute appendicitis. BMJ. 2006; 333(7567):530-4. PMC: 1562475. DOI: 10.1136/bmj.38940.664363.AE. View

20.

Giiti G, Mazigo H, Heukelbach J, Mahalu W . HIV, appendectomy and postoperative complications at a reference hospital in Northwest Tanzania: cross-sectional study. AIDS Res Ther. 2010; 7:47. PMC: 3022665. DOI: 10.1186/1742-6405-7-47. View