Ulus Travma Acil Cerrahi Derg. 2019; 25(2): 129-136 | DOI: 10.5505/tjtes.2018.80103

Complicated appendicitis: Risk factors and outcomes of laparoscopic appendectomy – Polish laparoscopic appendectomy results from a multicenter, large-cohort study

Michal Pedziwiatr¹, Anna Lasek¹, Michal Wysocki¹, Judene Mavrikis², Piotr Mysliwiec³, Maciej Bobowicz⁴, Wojciech Karcz⁵, Maciej Michalik⁶, Wojciech Makarewicz⁷, Piotr Major¹, Mateusz Rubinkiewicz¹, Tomasz Stefura², Jakub Kenig⁸, Malgorzata Polanska-Plachta⁹, Pol-LA Polish Laparoscopic Appendectomy^10
12nd Department of General Surgery, Jagiellonian University Medical College, Kraków-Poland
²Center for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków-Poland
³1st Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok-Poland
⁴Department of Surgical Oncology, Medical University of Gdansk, Gdansk-Poland
⁵Department of General, Visceral and Transplant Surgery, Ludwig Maximilian University, Munich-Germany
⁶Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury, Olsztyn-Poland
⁷Department of General Surgery and Surgical Oncology, Specialist Hospital in Kościerzyna, Kościerzyna-Poland
⁸Department of General, Oncological and Geriatric Surgery, Jagiellonian University Medical College, Krakow-Poland
⁹2nd Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Second Faculty of Medicine, Warsaw-Poland
¹⁰Polish Laparoscopic Appendectomy Collaborative Study Group

BACKGROUND: Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA.
METHODS: The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni- and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis.
RESULTS: In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were: female sex (Odds ratio [OR]: 1.58), obesity (OR: 1.51), age >50 years (OR: 1.51), symptoms >48 hours (OR: 2.18), high Alvarado score (OR: 1.29 with every point), and C-reactive protein level >100 mg/L (OR: 3.92).
CONCLUSION: Several demographic and clinical risk factors for complicated AA were identified. LA for complicated appendicitis was associated with poorer outcomes.

Keywords: Acute appendicitis, complicated appendicitis; laparoscopic appendectomy.

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Komplike apandisit: Laparoskopik apandektominin risk faktörleri ve sonlanýmlarý – çok merkezli geniþ çaplý Pol-LA kohort çalýþmasýnýn (Polonya Laparoskopik Apandektomi) sonuçlarý

Michal Pedziwiatr¹, Anna Lasek¹, Michal Wysocki¹, Judene Mavrikis², Piotr Mysliwiec³, Maciej Bobowicz⁴, Wojciech Karcz⁵, Maciej Michalik⁶, Wojciech Makarewicz⁷, Piotr Major¹, Mateusz Rubinkiewicz¹, Tomasz Stefura², Jakub Kenig⁸, Malgorzata Polanska-Plachta⁹, Pol-LA Polish Laparoscopic Appendectomy^10
1Jagiellonian Üniversitesi Týp Fakültesi, 2. Genel Cerrahi Kliniði, Kraków, Polonya
²Cerrahi Araþtýrma, Eðitim ve Ýnovasyon Merkezi (CERTAIN Surgery), Kraków, Polonya
³Bialystok Üniversitesi Týp Fakültesi, 1. Genel ve Endokrinolojik Cerrahi Kliniði, Świerkowa, Polonya
⁴Gdansk Üniversitesi Týp Fakültesi, Onkoloji Bölümü, Gdansk, Polonya
⁵Ludwig Maximilian Üniversitesi Týp Fakültesi, Genel, Viseral ve Nakil Cerrahisi Anabilim Dalý, Münih, Almanya
⁶Warmia ve Mazury Üniversitesi Týp Fakültesi, Genel, Minimal Ýnvaziv ve Yaþlý Cerrahi Bölümü, Olsztyn, Polonya
⁷Koscierzyna University, Genel Cerrahi ve Cerrahi Onkoloji Anabilim Dalý, Surgerycierzyna, Polonya
⁸Jagiellonian Üniversitesi Týp Fakültesi, Onkolojik ve Geriyatrik Cerrahi Anabilim Dalý, Krakow, Polonya
⁹Varþova Üniversitesi Týp Fakültesi, 2. Genel Cerrahi Kliniði, Varþova, Polonya
¹⁰Polish Laparoskopik Apendektomi Ortak Çalýþma Grubu

AMAÇ: Komplike olan ve olmayan akut apandisitin (AA) ameliyat öncesi sýnýflandýrýlmasý zordur. Ancak cerrahi sonuçlardaki farklýlýklar komplike AA’nýn geliþimindeki risk faktörlerinin belirlenmesini zorunlu kýlmaktadýr. Laparoskopik apandektomilerin (LA) klinik sonuçlarýný inceledik ve komplike AA’nýn geliþmesine iliþkin ameliyat öncesi risk faktörlerini saptadýk.
GEREÇ VE YÖNTEM: Polonya ve Almanya’da 18 cerrahi birimde LA uygulanan 4618 hastanýn verileri Polonya Videocerrahi Derneði tarafýndan oluþturulan sanal veri tabanýnda toplandý. Komplike olan ve olmayan hastalarýn cerrahi sonuçlarý karþýlaþtýrýldý. Komplike apandisit geliþmesine iliþkin risk faktörlerini belirlemek için tek ve çok deðiþkenli regresyon modelleri kullanýldý.
BULGULAR: Komplike apandisiti olan 1269 (%27.5) (Grup 1) ve olmayan (Grup 2) 3349 (%72.5) hasta LA oldu. Cerrahiye geçiþ oraný, ameliyat sýrasýnda advers etkiler, yeniden giriþim oraný, ameliyat sonrasý komplikasyonlar ve yeniden hastaneye kabul oranlarý Grup 1’de daha yüksekti. Komplike apandisitle iliþkili ameliyat öncesi risk faktörleri kadýnlarda (OR 1.58), obezite (OR 1.51), yaþ >50 yýl (OR 1.51), semptomlar >48 saat içinde (OR 2.18), daha yüksek Alvarado skoru (OR her noktada 1.29) ve CRP >100 mg/l (OR 3.92) idi.
TARTIÞMA: Komplike AA için birkaç demografik ve klinik risk faktörü tanýmlanmýþtýr. Komplike apandisit için uygulanan LA daha kötü sonlanýmlarla iliþkiliydi.

Anahtar Kelimeler: Akut apandisit, komplike apandisit; laparoskopik apandektomi.

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