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Acute Appendicitis in Patients with End-Stage Renal Disease

Journal of Gastrointestinal Surgery volume 16, pages 1940–1946 (2012)Cite this article

Abstract

Background

Acute appendicitis in patients with end-stage renal disease (ESRD) poses a diagnostic challenge. Delayed surgery can contribute to higher morbidity and mortality rates. However, few studies have evaluated this disease among ESRD patients. Our study focused on the lack of data on the incidence and risk factors of acute appendicitis among ESRD patients and compared the outcomes in patients who underwent different dialysis modalities.

Methods

This national survey was conducted between 1997 and 2005 and included ESRD patients identified from the Taiwan National Health Insurance database. The incidence rate of acute appendicitis in ESRD patients was compared with that in randomly selected age-, sex-, and Charlson comorbidity score-matched non-dialysis controls. A Cox regression hazard model was used to identify risk factors.

Results

Among 59,781 incident ESRD patients, matched one-to-one with controls, there were 328 events of acute appendicitis. The incidence rate of 16.9 per 10,000 person-years in the ESRD cohort was higher than that in the control cohort (p = 0.003). The independent risk factors were atrial fibrillation (hazard ratio [HR], 2.08), severe liver disease (HR, 1.74), diabetes mellitus (HR, 1.58), and hemodialysis (HR, 1.74). Compared with the control cohort, subsequent perforation and mortality rates of acute appendicitis were also higher in the ESRD cohorts. There was no effect of dialysis modality on the patient outcomes.

Conclusions

ESRD patients had a higher risk for acute appendicitis and poorer outcomes than non-dialysis populations. A careful examination of ESRD patients presenting with atypical abdominal pain to avoid misdiagnosis is extremely important to prevent delayed surgery.

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Acknowledgments

This study was based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institutes. The conclusions presented in this study are those of the authors and do not necessarily reflect the views of the Bureau of National Health Insurance, the Department of Health, or the National Health Research Institute.

Funding

Research was funded by Taipei Veterans General Hospital research grant (V100B-030).

Author information

Affiliations

  1. Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Pei-Wen Chao

  2. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Shuo-Ming Ou

  3. Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan

    Yung-Tai Chen

  4. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Yung-Tai Chen

  5. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Yi-Jung Lee

  6. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi-Jung Lee

  7. Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    Feng-Ming Wang & Tzen-Wen Chen

  8. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Chia-Jen Liu

  9. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chia-Jen Liu

  10. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Wu-Chang Yang

  11. Department of Family Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Tzeng-Ji Chen

  12. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Szu-Yuan Li

Authors
  1. Pei-Wen Chao
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  2. Shuo-Ming Ou
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  7. Wu-Chang Yang
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  8. Tzeng-Ji Chen
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  9. Tzen-Wen Chen
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  10. Szu-Yuan Li
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Corresponding author

Correspondence to Szu-Yuan Li.

Additional information

Contributorship: Chao PW and Ou SM designed the study, ran the data, performed the statistical analysis, analyzed the data, and helped write the manuscript. Chen YT contributed to the study design and ran the data. Wang FM, Lee YJ, and Liu CJ advised on data analysis. Chen TJ and Yang WC contributed to the study design. Li SY designed the study, helped write the manuscript, and is the guarantor.

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Chao, PW., Ou, SM., Chen, YT. et al. Acute Appendicitis in Patients with End-Stage Renal Disease. J Gastrointest Surg 16, 1940–1946 (2012). https://doi.org/10.1007/s11605-012-1961-z

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  • DOI: https://doi.org/10.1007/s11605-012-1961-z

Keywords

  • Acute appendicitis
  • End-stage renal disease
  • Epidemiology
  • Renal replacement therapy
  • Mortality