Naoki Akishige, MD1, Koetsu Inoue1, Kentaro Shima1, Tatsuya Ueno1, Shinji Goto1, Michinaga Takahashi1, Takanori Morikawa2, Takeshi Naitoh2, Hiroo Naito1. 1Department of Surgery, South Miyagi Medical Center, 2Department of Surgery, Tohoku University graduate school of meicine
Background: Laparoscopic appendectomy (LA) has been widely performed as standard treatment of acute appendicitis (AA). Intra-abdominal abscess (IAA) is one of the refractory postoperative complications requiring antibiotics and/or drainage, resulting in prolonged hospital stay. It is generally recognized that IAA develops following appendectomy in gangrenous appendicitis rather than other type of appendicitis. However, risk factors for IAA after LA in gangrenous appendicitis still remain unclear. The aim of this study is to assess risk factors for IAA after LA.
Methods: 386 patients who underwent LA for AA from April 2008 to August 2017 were retrospectively reviewed. 132 patients who were diagnosed as gangrenous appendicitis by operative findings and/or pathological findings were enrolled in this study. We defined IAA as a patient who had purulent discharge from drains and/or intra-abdominal abscess detected by postoperative CT scan. Patients were divided into two groups according to presence of IAA (Group A: Postoperative intra-abdominal abscess, Group B: Without postoperative intra-abdominal abscess). Perioperative characteristics, intraoperative findings and laboratorial data were analyzed.
Results: Twenty patients (15.1%) were considered to suffer postoperative IAA. In univariate analysis, there was no significant difference between two groups regarding age, sex, BMI, intraoperative findings such as diameter of the appendix and presence of fecal stone. Preoperative white blood cells (16.4±0.98 vs. 13.8±0.41(x103/μL), p=0.016), preoperative value of serum C-reactive protein (11.5±1.7 vs. 6.2±4.8(mg/dL), p=0.006), and value of serum C-reactive protein on first postoperative day (19.8±1.5 vs. 13.8±0.65(mg/dL), p=0.0004) were significantly high in Group A. Multivariate logistic regression analysis showed that value of serum C-reactive protein on first postoperative day higher than 15.48 (OR 14, 95%CI 2.94-66.1, p=0.0009) was an independent risk factor for postoperative IAA in gangrenous appendicitis.
Conclusion: Patients with value of serum C-reactive protein on first postoperative day higher than 15.5 is a likely risk for IAA after LA. Therefore, we should offer careful postoperative management to these patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86820
Program Number: P066
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster