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Characteristics of Perforated Appendicitis: Effect of Delay Is Confounded by Age and Gender

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The effect of age and gender on time to perforation in acute appendicitis has not been well characterized. This study examined the relationship between duration of disease and appendiceal perforation in different subgroups of age and gender.

Methods

This study is a retrospective analysis of 380 patients who underwent an appendectomy from January 2000 to June 2005 at a rural teaching hospital.

Results

Factors associated with perforated appendicitis included age, symptom duration, CT scan, and distance from the hospital. Factors associated with increased patient time included age, temperature >101.5 F, and referral from an outside institution. Factors associated with shorter system time included right lower quadrant tenderness, classic or severe presentation, and leading diagnosis of acute appendicitis. Preoperative CT scan increased system time by approximately 3 h. Analyzing symptom duration and time to perforation, males have a higher prevalence of perforated appendicitis compared to females with similar duration of symptoms. In patients older than 55 years of age, 29% had perforated appendicitis at 36 h of symptoms and 67% at 36 to 48 h of symptoms. In a multivariate regression analysis, age greater than 55 years (odds ratio (OR) 3.0, P value 0.007), fever (OR 4.3, P 0.007), and symptom duration more than 24 h (OR 4.1, P 0.001) were significant predictors of perforated appendicitis.

Conclusions

There is an early risk of perforated appendicitis even within the first 36 h of symptoms. This risk appears to be higher in males and patients older than 55 years, a quarter of whom are perforated within the first 36 h of symptom duration. Additionally, perforation in acute appendicitis may be more of a continuous phenomena worsening exponentially with duration of symptoms rather than a threshold phenomenon.

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Acknowledgments

The authors thank Siddharth Bhende MD, Keyur Chavda MD, Anthony Guiffrida, and Catherine Simone for collecting the data for the study.

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Authors and Affiliations

  1. Department of Surgery, Guthrie-Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA

    Toms Augustin, Burt Cagir & Thomas J. VanderMeer

Authors
  1. Toms Augustin
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  2. Burt Cagir
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  3. Thomas J. VanderMeer
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Corresponding author

Correspondence to Toms Augustin.

Additional information

The abstract was presented as an oral presentation at the 5th Annual Academic Surgical Congress of the Association for Academic Surgery held at the Marriott Rivercenter Hotel in San Antonio, TX, USA from February 3–5, 2010.

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Augustin, T., Cagir, B. & VanderMeer, T.J. Characteristics of Perforated Appendicitis: Effect of Delay Is Confounded by Age and Gender. J Gastrointest Surg 15, 1223–1231 (2011). https://doi.org/10.1007/s11605-011-1486-x

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  • DOI: https://doi.org/10.1007/s11605-011-1486-x

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