Predictors of Complicated Appendicitis in a Tertiary Hospital in Southern Nigeria.
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Abstract
Background:
Acute Appendicitis (AA) is the commonest abdominal surgical emergency making appendicectomy the commonest abdominal surgical operation performed worldwide. This is to prevent the progression of uncomplicated acute appendicitis (UAA) to complicated acute appendicitis (CAA) characterised by perforation, gangrene, abscess formation and generalised peritonitis. Complicated acute appendicitis comes with a higher rate of complications, longer hospital stay and increased hospital costs. Identification of the predictors of CAA will help with prioritisation of resources and a reduction in morbidity, mortality and health care costs. The aim of this study was to identify the predictors of CAA in our setting.
Methods:
This is a retrospective study conducted at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria. It involved all patients with histologically confirmed acute appendicitis from January 2021 to December 2022. Data was extracted from patient folders, theatre and ward records. Descriptive statistics were used to analyse patient demographics. Bivariate analysis was performed to assess associations between independent variables and adverse outcomes using appropriate statistical tests. Variables with p<0.1 were entered into multivariate logistic regression analysis to identify independent predictors. A P-value <0.05 was considered to be significant.
Results:
There were 145 cases of confirmed AA with a female to male ratio of 1.3:1. The incidence of CAA was 19.3%. Male gender, Alvarado score of 7-10 and the duration of symptoms before presentation greater than 24 hours were found to be significant factors in the prediction of CAA with O.R. of 2.66, 6.67 and 11.14 respectively, CI 95%.
Conclusion:
There is a high incidence of CAA in our study. A high index of suspicion in the male gender, use of the Alvarado score as a clinical tool and taking the duration of symptoms into cognisance will help identify patients with complicated appendicitis. A lower threshold for, and shorter time to surgery may help prevent the complications associated with CAA.
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