Prevalence and Risk Factors of Complicated Appendicitis at Debaratana Nakornratchasima Hospital
Keywords:
Appendicitis, Complications, Risk FactorsAbstract
Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Without prompt treatment, it can lead to complications such as perforation, intra-abdominal abscess, or generalized peritonitis. This study aimed to determine the prevalence and factors associated with the occurrence of complications in patients with acute appendicitis.
Methods: This was a retrospective study utilizing data collection forms to extract information from medical records. A total of 458 patients diagnosed with appendicitis at Debaratana Nakhonratchasima Hospital were included. Data were analyzed using descriptive statistics and inferential statistics, including the independent t-test, chi-square test, and Mann–Whitney U test. Multivariable logistic regression was performed to identify factors associated with complicated appendicitis, with results presented as adjusted odds ratios (Adj. OR) and a significance level set at p < 0.05.
Results: Among 458 patients with acute appendicitis, 65 (14.19%) had complicated appendicitis. Multivariate logistic regression identified five significant preoperative risk factors (p < 0.05): age ≥ 50 years (adjusted odds ratio [aOR] = 2.23; 95% confidence interval [CI]: 1.11–4.45; p = 0.023), rebound tenderness (aOR = 2.67; 95% CI: 1.37–5.20; p = 0.004), neutrophil percentage (per 1% increase) (aOR = 1.09; 95% CI: 1.01–1.19; p = 0.043), symptom duration before admission (per hour) (aOR = 1.10; 95% CI: 1.07–1.13; p < 0.001), and preoperative waiting time (per hour) (aOR = 1.13; 95% CI: 1.05–1.21; p < 0.001). In addition, patients with complicated appendicitis had significantly longer operative time, greater intraoperative blood loss, a of drain insertion, and longer hospital stays (p < 0.001).
Conclusion: Older age (≥50 years), rebound tenderness, elevated neutrophil levels, prolonged symptom duration before hospital admission, and delayed surgical intervention were significantly associated with complicated appendicitis. Early diagnosis and timely surgery are essential to reduce the risk of complications.
References
Kaiser S, Finnbogason T, Jorulf HK, Söderman E, Frenckner B. Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced Helical CT. Radiology. 2004 May;231(2):427–33.
นภาพงษ์ ประดับสุข. ปัจจัยที่สัมพันธ์กับการเกิดภาวะไส้ติ่งแตกเปรียบเทียบกับการเกิดภาวะไส้ติ่งอักเสบธรรมดาในโรงพยาบาลชุมชน. วารสารการแพทย์โรงพยาบาลศรีสะเกษ สุรินทร์ บุรีรัมย์. 2566;38(3):913–22.
Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB. Imaging for Suspected Appendicitis: Negative Appendectomy and Perforation Rates. Radiology. 2002 Oct;225(1):131–6.
Callahan MJ, Rodriguez DP, Taylor GA. CT of Appendicitis in Children. Radiology. 2002 Aug;224(2):325–32.
ธวัชชัย ตรีรัตนวิกรานต์. ปัจจัยที่สัมพันธ์กับการผ่าตัดไส้ติ่งแล้วไม่พบพยาธิสภาพในผู้ป่วยที่ได้รับการวินิจฉัยไส้ติ่งอักเสบ. หัวหินเวชสาร. 2567;4(1):43–57.
Chatbanchai W, Hedley AJ, Ebrahim SB, Areemit S, Hoskyns EW, de Dombal FT. Acute abdominal pain and appendicitis in north east Thailand. Paediatr Perinat Epidemiol. 1989 Oct;3(4):448–59.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278-1287.
Sartelli M, Baiocchi GL, Di Saverio S, et al. Prospective Observational Study on Acute Appendicitis Worldwide (POSAW). World J Emerg Surg. 2018;13:19. doi:10.1186/s13017-018-0179-0
ไพจิตร อธิไภริน. ปัจจัยทำนายทางคลินิกต่อการเกิดภาวะไส้ติ่งแตกในผู้ป่วยไส้ติ่งอักเสบเฉียบพลัน. มหาราชนครศรีธรรมราชเวชสาร. 2565;6(1):92–101.
Zhou Y, Chen Y, Wang Y, Zhang W, Gao H, He G, et al. A prediction nomogram for uncomplicated appendicitis and complicated appendicitis: A retrospective study [Internet]. 2024 [cited 2024 Aug 11]. Available from: https://www.researchsquare.com/article/rs-4117535/v1
Laohawilai S, Sunthornpinij T, Silaruks B. Risk Factors for Perforated Appendicitis in a Tertiary Hospital. TCA [internet]. 2019 Dec. 6 [cited 2025 Jul. 18];43(5):171-8. available from: https://he02.tci-thaijo.org/index.php/theclinicalacademia/article/view/221095
Khongcharoen N, Khiawthuam N, Chouchuen P, Surachat K, Sirichamratsakul K, Sangkhathat S. Epidemiology, Seasonal Variability, and Factors Associated with Increased Mortality in Patients with Acute Appendicitis in Thailand: A Study Using Data from the National Health Security Office. PSU Med J [internet]. 2024 Apr. 23 [cited 2025 Jul. 18];4(1):3-15. available from: https://he01.tcithaijo.org/index.php/PSUMJ/article/view/264804
Davies GM, Behrman SW. Factors affecting the incidence of perforated appendicitis in the United States. J Gastrointest Surg. 2006;10(8):1223–31. doi:10.1016/j.gassur.2006.04.003
García-Amador C, Arteaga Peralta V, de la Plaza Llamas R, Torralba M, Medina Velasco A, Ramia JM. Evaluation of Preoperative Clinical and Serological Determinations in Complicated Acute Appendicitis: A Score for Predicting Complicated Appendicitis. Valoración de parámetros clínicos yanalíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada. Cir Esp (Engl Ed). 2021;99(4):282-288. doi:10.1016/j.ciresp.2020.05.031
Ferris M, Kaplan B, Soon IS, Molodecky N, Dixon E, Benchimol E, et al. The Dynamic Global Incidence of Acute Appendicitis: A Systematic Review of International Temporal Trends: 236. Off J Am Coll Gastroenterol ACG. 2010 Oct;105:S88.
Khattak S, Aslam S, Kamal A. Acute Appendicitis: An Audit of 663 Cases. Gomal J Med Sci [Internet]. 2010 Dec 31 [cited 2025 Sep 11];8(2). Available from:https://www.gjms.com.pk/index.php/journal/article/view/350
Alotaibi AM, Alfawaz M, Felemban L, Moshref L, Moshref R. Complicated appendicitis increases the hospital length of stay. Surg Open Sci. 2022 Jul 1;9:64–8.
Mahattanobon S, Samphao S, Pruekprasert P. Clinical features of complicated acute appendicitis. J Med Assoc Thail Chotmaihet Thangphaet. 2014 Aug;97(8):835–40.
Mori M, Narushima K, Hirano A, Kano Y, Chiba F, Edamoto Y, et al. Preoperative neutrophil-to-lymphocyte ratio may contribute to the prediction of postoperative infectious complications in patients with acute appendicitis: a retrospective study. BMC Surg. 2022 Mar 3;22(1):78.
Moreno-Alfonso JC, Molina Caballero A, Yárnoz Irazábal MC, Pérez Martínez A. Blood cell indices as predictors of complicated appendicitis: A diagnostic study. J Pediatr Surg Open. 2023 Dec 1;4:100072.
Liu M, Tang Z, Gou Y, Yang P. Neutrophil percentage-to-albumin ratio for preoperative risk stratification of complicated appendicitis in children: a retrospective study. BMC Gastroenterol. 2025;25(1).
Gao Z, Li M, Zhou H, Liang Y, Zheng C, Li S, Zhang T, Deng W. Complicated appendicitis are common during the epidemic period of 2019 novel coronavirus (2019-nCoV). Asian J Surg. 2020 Oct;43(10):1002-1005.
Tang G, Zhang L, Xia L, Zhang J, Chen R, Zhou R. Preoperative in-hospital delay increases postoperative morbidity and mortality in patients with acute appendicitis: a meta-analysis. Int J Surg. 2025 Jan 1;111(1):1275-1284.
Alotaibi AM, Alfawaz M, Felemban L, Moshref L, Moshref R. Complicated appendicitis increases the hospital length of stay. Surg Open Sci. 2022 Jul 1;9:64–8.
T P, N PM. Surgical outcome in patients with complicated appendicitis treated at a medical college hospital. Int Surg J. 2019 Jun 29;6(7):2379–85.
