P-O14 The predictive role of pre-operative liver function tests in outcomes following emergency appendicectomy

Abstract

Abstract Background Acute appendicitis remains one of the most common diagnoses in emergency general surgery, with recent evidence from the COMMA trial confirming that appendicectomy is the cornerstone of definitive management in most patients. With a wide range of severity and of patient physiology, complications are a burden to patients and the health service. We hypothesised that liver function tests have predictive value for complications following emergency appendicectomy. Methods A multicentre retrospective observational study was carried out across 4 hospitals (2 teaching centres and 2 district general hospitals) for adult patients who underwent emergency appendectomy between August 2018 and November 2020. Patients were identified through pathology records and data was extracted from electronic case records for patient demographics, pre-operative routine laboratory results, operative details, and clinical outcomes. Peak perioperative liver function parameters were analysed using unpaired two-way T-tests, Pearson’s correlation coefficient, ANOVA and multivariate regression to determine their relationship with conversion to open surgery, superficial and deep surgical site infection (SSI), length of stay (LOS) and 30-day re-admission rates. Results Of 1131 patients included, 57.4% were male, 80.5% were laparoscopic, with 7.3% converted to open, 10.8% performed open, and 1.5% by laparotomy. Mean LOS was 3.81 (SD4.0) days, 6.3% readmission rate, with 2.3% superficial SSI and 5.0% deep SSI. ALP was higher in patients with superficial SSI (p < 0.001). Lower ALT was associated with wound dehiscence (p < 0.001). Bilirubin, AST and ALT were lower in patients with chest infections (p < 0.001). ALP correlated with increased LOS (p < 0.001). On multivariable regression, ALP was associated with superficial SSI (p < 0.001), and LOS (p < 0.001). ROC curve analysis demonstrated AUC of 0.655 for ALP and superficial SSI. Conclusions Emergency appendicectomy is completed laparoscopically in more than 80% of patients and complication rates are acceptable. Routine liver function tests were associated with important clinical outcomes including superficial SSI, wound dehiscence, chest infection, LOS and readmission rate. Patients who had superficial SSI, wound dehiscence, chest infection and readmission with 30 days had lower transaminase levels compared with those with uncomplicated recovery.