Usefulness of preoperative predictors of pathological complicated Appendicitis

Introduction: Complicated appendicitis (CA) is often indicated for emergency surgery; however, preoperative predictors of pathological complicated appendicitis (pCA) remain unclear. Furthermore, characteristics of CA that can be treated conservatively have not yet been established.Methods: Three hundred and five consecutive patients diagnosed with acute appendicitis were reviewed. The patients were divided into two groups: an emergency surgery and a conservative treatment group. The emergency surgery group was pathologically classified as having uncomplicated appendicitis (pUA) and pCA, and the preoperative predictors of pCA were retrospectively assessed. Based on the preoperative pCA predictors, a predictive nomogram whether conservative treatment would be successful or not was created. The predictors were applied to the conservative treatment group, and the outcomes were investigated. Results: In the multiple logistic regression analysis of the factors contributing to pCA, C-reactive protein >= 3.5 mg/dL, ascites, appendiceal wall defect, and periappendiceal fluid collection were independent risk factors. Over 90% of cases without any of the above four preoperative pCA predictors were pUA. The accuracy of the nomogram was 0.938.Conclusion: Our preoperative predictors and nomogram are useful to aid in distinguishing pCA and pUA and to predict whether or not conservative treatment will be successful. Some CA can be treated with conservative treatment.

Automated summary

This study retrospectively analyzed 305 patients with acute appendicitis, dividing them into an emergency surgery group and a conservative treatment group. Through multiple logistic regression analysis, C-reactive protein, ascites, appendiceal wall defect, and periappendiceal fluid collection were found to be independent risk factors for complicated appendicitis. The predictive nomogram based on these factors had an accuracy of 0.938 and can assist in distinguishing complicated appendicitis from uncomplicated appendicitis and predicting the success of conservative treatment.