Abstract
Background
Acute appendicitis is the most common indication for acute surgical abdominal intervention. In this study, we analyzed the gender correlation with demographic, epidemiologic, diurnal, and seasonal trends in relation to the incidence and management of patients with acute appendicitis in our medical center.
Methods
Data of patients, 18 years of age or older who underwent emergency appendectomies at the Rabin Medical Center during the last 13 years, were collected. The data collected included demographic parameters, hospitalization, procedures, and use of preoperative imaging.
Results
Data were available for 3,736 patients. Males had more appendicitis attacks than females (p < 0.0001), whereas females had more normal appendixes than males (p < 0.0001). The overall rate of normal appendixes was 19.6 %, with a decline in the past 10 years from a yearly average of 23.5 % between 1998 and 2002 to 15 % between 2003 and 2007 (p < 0.0001) with a reverse correlation with the preoperative use of abdominal CT. A distinct seasonal pattern was observed; more appendectomies for acute appendicitis occurred during the summer months (p < 0.0001). Ten percent of patients had a complicated course with a mortality rate of 0.33 %; most of them were elderly, male/female ratio 0.4.
Conclusions
We found distinct gender, epidemiological, seasonal, and diurnal trends influencing the incidence of acute appendicitis. The incidence rate of false-positive surgery has been gradually declining, probably due to the increased use of preoperative abdominal CT and ultrasound. Acute appendicitis was more common in males and during the summer months.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925
Howie JG (1966) Death from appendicitis and appendicectomy. An epidemiological survey. Lancet 2(7477):1334–1337
Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR (2001) Mortality after appendectomy in Sweden, 1987–1996. Ann Surg 233(4):455–460
Humes DJ, Simpson J (2006) Acute appendicitis. BMJ 333(7567):530–534
Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137(7):799–804
Paulson EK, Kalady MF, Pappas TN (2003) Clinical practice. Suspected appendicitis. N Engl J Med 348(3):236–242
Appendicitis BM (1970) Seasonal incidence and postoperative wound infection. Br J Surg 57(2):93–99
Al-Omran M, Mamdani M, McLeod RS (2003) Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg 46(4):263–268
Ashley DJ (1967) Observations on the epidemiology of appendicitis. Gut 8(6):533–538
Lee SL, Ho HS (2006) Acute appendicitis: is there a difference between children and adults? Am Surg 72(5):409–413
Graff L, Russell J, Seashore J et al (2000) False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med 7(11):1244–1255
Khan GM, Grillo IA, Abu-Eshy SA, Khan AR, Mubarak J, Jastaniah S (2000) Pathology of the appendix. J Natl Med Assoc 92(11):533–535
Florence M, Flum DR, Jurkovich GJ et al (2008) Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg 248(4):557–563
Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21(2):119–123
Nathan RO, Blackmore CC, Jarvik JG (2008) Therapeutic impact of CT of the appendix in a community hospital emergency department. AJR Am J Roentgenol 191(4):1102–1106
Brown MA (2008) Imaging acute appendicitis. Semin Ultrasound CT MR 29(5):293–307
Rybkin AV, Thoeni RF (2007) Current concepts in imaging of appendicitis. Radiol Clin North Am 45(3):411–422
Marudanayagam R, Williams GT, Rees BI (2006) Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol 41(8):745–749
Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL (1976) Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg 131(2):219–223
Engin O, Calik B, Yildirim M, Coskun A, Coskun GA (2011) Gynecologic pathologies in our appendectomy series and literature review. J Korean Surg Soc 80(4):267–271
Burns RP, Cochran JL, Russell WL, Bard RM (1985) Appendicitis in mature patients. Ann Surg 201(6):695–704
Noudeh YJ, Sadigh N, Ahmadnia AY (2007) Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran. Int J Surg 5(2):95–98
Tobe T (1965) Inapparent virus infection as a trigger of appendicitis. Lancet 1(7400):1343–1346
Baier R, Puppel H, Zelder O, Heiming E, Bauer E, Syring J (1982) Frequency and significance of infections due to Yersinia enterocolitica in “acute appendicitis”. Z Gastroenterol 20(2):78–83
Lamps LW (2004) Appendicitis and infections of the appendix. Semin Diagn Pathol 21(2):86–97
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
Gideon Y. Stein and Lea Rath-Wolfson contributed equally to this work.
Rights and permissions
About this article
Cite this article
Stein, G.Y., Rath-Wolfson, L., Zeidman, A. et al. Sex differences in the epidemiology, seasonal variation, and trends in the management of patients with acute appendicitis. Langenbecks Arch Surg 397, 1087–1092 (2012). https://doi.org/10.1007/s00423-012-0958-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-012-0958-0