Analyse von Einflussfaktoren der akuten Appendizitis an 1439 Patienten der chirurgischen Universitätsklinik Ulm

Abstract

Purpose: Our aim was to determine factors predicting for the diagnosis and for post-operative complications of acute appendicitis. Materials and patients: Data sets of 1439 consecutive patients undergoing an appendectomy between 1999 and 2008 were analyzed in adults and children. Results: A mild acute appendicitis was present in 50 % (n = 722) and a severe acute appendicitis in 25 % (n = 355). No signs of any pathology were found in 6 % (n = 82). Gender, white blood count (WBC), C-reactive protein (CRP), and ultrasound (US) examination were important factors to detect a mild acute and severe acute appendicitis in adults and children. Post-operative complications occurred in 16 % (237/1439) mainly consisting of wound infections (8 %, n = 122) and bowl dysfunction (5 %, n = 76). Sixty-two patients (4.3 %) required re-operations. One patient died (1/1439, 0.07 % mortality rate). Age, pathological type, and presence of bacteria in the intra-operative swab were important factors to predict for post-operative complications in adults and children. Time since onset of symptoms and type of operation were associated with post-operative complications in adults, too. From 754 adults receiving open surgery 21 % (n = 155) developed complications, but only 9 % of adults (10/125) undergoing laparoscopic surgery. Conclusions: Besides history and clinical examination WBC, CRP, and US examination are still nowadays important factors for diagnosing acute appendicitis. Complications are related to the pathological type, presence of bacteria, and type of operation. Early diagnosis within 48 h may be important as well as an laparoscopic approach from which especially adult patients may benefit due to a lower frequency of wound infections.