Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-80103 | DOI: 10.5505/tjtes.2018.80103  

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Michal Pedziwiatr1, Anna Lasek1, Michal Wysocki1, Judene Mavrikis2, Piotr Mysliwiec3, Maciej Bobowicz4, Wojciech Karcz5, Maciej Michalik6, Wojciech Makarewicz7, Piotr Major1, Mateusz Rubinkiewicz1, Tomasz Stefura2, Jakub Kenig8, Malgorzata Polanska-Plachta9, Pol-LA Polish Laparoscopic Appendectomy10
12nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
2Students’ Scientific Society of 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
31st Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
4Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
5Clinic of General, Visceral and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
6Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury, Olsztyn, Poland
7Department of General Surgery and Surgical Oncology, Specialist Hospital in Kościerzyna, Kościerzyna, Poland
8Department of General, Oncological and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland
92nd Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Second Faculty of Medicine, Warsaw, Poland
10Polish Laparoscopic Appendectomy Collaborative Study Group

Background
Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitates the establishment of risk factors in developing complicated AA. We analyzed the clinical outcomes of laparoscopic appendectomies (LA), as well as, identified preoperative risk factors for the development of complicated AA.

Methods
The data from 4618 patients undergoing LA in 18 surgical units, across Poland and Germany, were collected in the online web-based database created by Polish Videosurgery Society. Surgical outcomes of the patients with complicated and uncomplicated appendicitis were compared. Uni- and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis.

Results
1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated (Group 2). Conversion rate, intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rates were higher in Group 1. Preoperative risk factors associated with complicated appendicitis were: female sex (OR 1.58), obesity (OR 1.51), age > 50 years (OR 1.51), symptoms > 48h (OR 2.18), higher Alvarado score (OR 1.29 with every point), and CRP > 100 mg/l (OR 3.92).

Conclusions
Several demographic and clinical risk factors for complicated AA were identified. LA for complicated appendicitis was associated with worse outcomes.

Keywords: complicated appendicitis, acute appendicitis, laparoscopic appendectomy




Corresponding Author: Michal Pedziwiatr, Poland


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