Surgical determinants, perioperative course and outcome of a representative patient cohort with acute appendicitis undergoing appendectomy over 3 decades.

Abstract

Acute appendicitis, one of the most frequent emergencies in general surgery, has been repeatingly investigated with regard to specific aspects such as medical history, clinical symptoms, the perioperative management and follow up. The aim of the study was to investigate relevant and combined determinants for the perioperative management of acute appendicitis a systematic clinical prospective unicenter observational study was conducted. A representative patient cohort was studied (n=9,991; middle Europe) to reflect daily surgical practice through a time period of 27 years divided into 3 separate periods and the frequency of specific categories (e.g., characteristics of the medical history, clinical and intraoperative findings as well as complications), their correlation and relative risk factors for the disease as well as prognosis. 1. The wound abscess rate was 10.9%. Perforation, surgical intervention in time, acute, gangrenous and chronic appendicitis, age, accompanying diseases such as obesity, arterial hypertension, diabetes mellitus, sex, and missing pathological finding intraoperatively had a significant impact on the postoperative development of a wound abscess. 2. The longer the specific appendicitis-associated medical history was, the more frequent a perforated appendicitis occurred, greater the appendectomy (AE) rate in a non-inflamed appendix and higher the rate of required second interventions. 3. The average hospital stay was 11 days. 4. There was a significantly decreased percentage of patients with no pathological finding intraoperatively at the appendix vermiformis (p<0.001), who underwent AE, in particular, through the last investigation period from 1997 to 2000 onto only 6.8% (1974-1985, 15.5%; 1986-1996, 10.3%). 5. The mortality was 0.6%, with no significant difference comparing male and female patients (p=1), the three investigation periods (p=0.077), or the patients with AE in non-inflamed appendix (0.4%) and AE in acute appendicitis (0.6%; p=0.515). The study showed a positive, partially significant quality improvement within the presenting clinic with regard to a decreased rate of AE in non-inflamed appendix, wound abscess rate and, in particular, to mortality. Despite this, there is a trendy increase of the perforation rate in the investigated cohort. Quality control remains indispensable for the assessment of the disease´s surgical treatment. A further significant improval of this control might be achieved by multicenter studies and multifactorial evaluations.