Jonathan Imran, MD, Tarik Madni, MD, Audra Clark, MD, Madhu Subramanian, MD, Michael Cripps, MD, Ali El Mokdad, MD, Christian T Minshall, MD, PhD. University Of Texas Southwestern Medical Center
Introduction: Intra-abdominal abscess (IAA) following appendectomy results in increased hospital length of stay, readmissions, and drainage procedures. Perforated appendicitis and laparoscopic appendectomy have been associated with increased rates of IAA. The purpose of this study was to identify potential risk factors for IAA development following appendectomy.
Methods: A retrospective review was performed of all patients who underwent appendectomy at our institution from 2011 to 2013. Patient cohorts were divided into those who did and did not develop a postoperative IAA following an appendectomy. A Wilcoxon rank sum test and a chi-square test were used for continuous and categorical variables. A multivariable logistic regression model was used to identify predictors of postoperative IAA.
Results: During a 3-year period, 1148 patients underwent appendectomy. Seventy-six patients (7%) developed an IAA. On univariate analysis, patients who developed an IAA had a higher mean age, body mass index, number of days of pain prior to presentation, were more often male than female, and more likely to have diabetes mellitus type II (DM2; p < .01). Patients with an appendicolith on preoperative CT imaging had a higher incidence of IAA (p < .001). An intraoperative diagnosis of complicated appendicitis was more common in patients who developed an IAA versus those who did not (64% vs. 18%; p < .001). Twenty-two of 107 patients (21%) who underwent open appendectomy developed IAA vs. 5% who underwent laparoscopic appendectomy (p < .001). Overall, 553 of 1148 patients received at least one dose of postoperative antibiotics. Of those, 60 patients developed IAA vs. 16 who did not receive antibiotics. Mean postoperative antibiotic duration was 3.8 days in the IAA cohort. During initial multivariate analysis antibiotic duration was strongly associated with abscess formation. When removing antibiotic duration from the model, multivariate analysis revealed that male gender (OR 2.05; 95% CI, 1.11- 3.78), DM2 (OR 2.31; 95% CI, 1.06- 5.01), presence of an appendicolith on preoperative CT imaging (OR 1.88; 95% CI, 1.05- 3.34), intraoperative diagnosis of complicated appendicitis (OR 6.11; 95% CI, 3.34-11.17) and open appendectomy (OR 2.27; 95% CI, 1.14- 4.52) were associated with postoperative IAA formation.
Conclusion: Male gender, DM2, the presence of an appendicolith on preoperative imaging, intraoperative diagnosis of complicated appendicitis and open appendectomy were associated with IAA formation when antibiotic duration was removed from the analysis. Patients with these risk factors should be monitored more closely after appendectomy for the development of IAA.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77971
Program Number: P071
Presentation Session: Poster (Non CME)
Presentation Type: Poster