Risk factors for morbidity after appendectomy
H. P. Alizai
C. D. Klink
U. P. Neumann
Received: 22 December 2016 /Accepted: 18 July 2017 /Published online: 27 July 2017
Springer-Verlag GmbH Germany 2017
Introduction The aim of the present study was to evaluate the
risk factors for postoperative complications after an appendec-
tomy with special regard to both the time period from hospital
admission to operation and night time surgery.
Patients and methods Patients who underwent an appendec-
tomy due to acute appendicitis and were admitted to the
University Hospital Aachen between January 2003 and
January 2014 were included in this retrospective analysis.
Regarding the occurrence of postoperative complications, pa-
tients were divided into the following two groups: the group
with complications (group 1) and the group without compli-
cations (group 2).
Results Of the 2136 patients who were included in this study,
165 patients (group 1) exhibited complications, and in 1971
patients (group 2), no complications appeared. After a univar-
iate logistic regression analysis, six predictors for postopera-
tive complications were found and are described as follows:
(1) complicated appendicitis (odds ratio (OR) 4.8 (3.46–6.66),
p < 0.001), (2) operation at night (OR 1.62 (1.17–2.24),
p = 0.004), (3) conversion from laparoscopic to open access
(OR 37.08 (12.95–106.17), p <0.001),(4)anage>70years
(OR 6.00 (3.64–9.89), p < 0.001), (5) elevated CRP (OR 1.01
(1.01–1.01), p < 0.001) and (6) increased WBC count (OR
1.04 (1.01–1.07), p = 0.003). After multivariate logistic re-
gression analysis, a significant association was demonstrated
for complicated appendicitis (1.88 (1.06–3.32), p < 0.031),
conversion to open access (OR 16.33 (4.52–58.98),
p < 0.001), elevated CRP (OR 1.00 (1.00–1.01), p =0.017)
and an age > 70 years (OR 3.91 (2.12–7.21), p < 0.001). The
time interval between hospital admission and operation was
not associated with postoperative complications in the univar-
iate and multivariate logistic regression analyses, respectively.
However, the interaction between complicated appendicitis
and the time interval to operation was significant (OR 1.024
(1.00–1.05), p =0.028).
Conclusion Based on our findings, surgical delay in the case
of appendicitis and operation at night did not increase the risk
for postoperative complications. However, the mean waiting
time was less than 12 h and patients aged 70 years or older
were at a higher risk for postoperative complications.
Furthermore, for the subgroup of patients with complicated
appendicitis, the time interval to surgery had a significant
influence on the occurrence of postoperative complications.
Therefore, the contemporary operation depending on the clin-
ical symptoms and patient age remains our recommendation.
Timing of surgery
The treatment of acute appendicitis is subject to continuous
change. It is one of the most common diseases in children and
adults requiring emergency operation. Previously, the surgical
access for an appendectomy was the object of several studies [1,
2]. Recently, a focus on the appropriate point in time
for operation has been the main focus of investigation.
* Anne Andert
Department of General, Visceral and Transplant Surgery, Uniklinik
RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
Department of Medical Statistics, Uniklinik RWTH Aachen,
Department of General and Visceral Surgery, Sana Hospital
Düsseldorf-Gerresheim, Düsseldorf, Germany
Langenbecks Arch Surg (2017) 402:987–993