Risk factors for intra-abdominal abscess post laparoscopic appendicectomy for gangrenous or perforated appendicitis: A retrospective cohort study

Abstract

IntroductionAcute appendicitis is one of the most common causes of abdominal pain. Post-operative Intra-abdominal Abscess (PIA) frequently complicates appendicectomy and increases morbidity and cost (1). Its incidence is increased in perforated or gangrenous appendicitis (2). Risk factors for the development of PIA within this high-risk group have not been established in adults. This study aimed to identify risk factors associated with PIA following laparoscopic appendicectomy for gangrenous or perforated appendicitis in adults. Secondary aims were to describe the timing and anatomical location of PIA occurrence. MethodsA retrospective cohort study was performed. The data of all adults that underwent laparoscopic appendicectomy for gangrenous or perforated appendicitis at Logan Hospital (Queensland, Australia) from July 2010 to June 2014 were reviewed using a database from a previous study (3). The Primary outcome was the association between the development of PIA and; age, gender, American Society of Anaesthesiologists class, Disease Severity Score (4), blood tests on admission (white cell count (WCC), C-reactive protein, total bilirubin) and histopathology of the appendix. ResultsOf 143 patients, 13 developed PIA (9.1%). There was a weakly positive association between elevated preoperative WCC and the risk of PIA (Spearman’s correlation coefficient 0.174, P = 0.038). No other factors were significantly associated with increased risk of PIA. The median post-operative day of diagnosis was day nine (mean 7.9, range 2–17). ConclusionsIn this cohort, there was a weakly positive association between preoperative WCC and PIA. Prospective trials investigating other potential risk factors are required.