Predicting factors of postoperative complications in appendectomies.

we retrospectively analyzed 1241 patients undergoing open or laparoscopic appendectomy. Patients were allocated to four groups: Group 1, without postoperative complications, and Groups 2, 3, and 4, with postoperative complications defined according to their severity, following Clavien-Dindo classification (I, II, and ≥III, respectively).

Results:

patients aged ≥38.5 years had more severe complications (p<0.0001). Patients in Group 1, without postoperative complications, had, for the most part, a laparoscopic approach. Groups 2, 3, and 4 underwent, predominantly, to an open surgery (p<0.0001). In cases of acute appendicitis, the odds ratio (OR) for complications was 3.09, 3.04, and 12.41 for Groups 2, 3, and 4, respectively (p<0.0001). Anesthetic risk, duration of the procedure, and length of hospital stay were related to a higher risk and severity of complications.

Conclusion:

the main predicting factors of postoperative complications in patients operated for acute appendicitis were: age ≥38.5 years, conventional or open surgical access, complicated appendicitis, ASA≥2, and surgical time >77 minutes.

Keywords:
Appendicitis; Appendectomy; Risk Factors; Postoperative Complications.

Group	Clavien-Dindo classification¹³13 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.	Definition
1	-	Absence of postoperative complication
2	I	Any deviation from the ideal postoperative course without the need of pharmacological treatment or surgical, endoscopic, and radiological interventions.*
3	II	Requires pharmacological treatment with drugs other than those permitted for grade I complications.**
4	III	Requires surgical, endoscopic, or radiological intervention.
	IV	Life-threatening complication. Need for UTI treatment.
	V	Death of the patient.

	Group 1		Group 2		Group 3		Group 4		p
	n	%	n	%	n	%	n	%	p
Gender									0.505
Female	462	77.4	65	10.9	45	7.5	25	4.2
Male	478	51.9	77	54.2	52	53.6	37	59.7
Age									<0.0001
Up to 38.5 years	703	74.8	85	59.9	53	54.6	33	53.2
Above 38.5 years	237	25.2	57	40.1	44	45.4	29	46.8
Type of surgery									<0.0001
Open	442	47.0	93	65.5	66	68.0	39	62.9
Laparoscopic	467	49.7	40	28.2	26	26.8	19	30.6
Converted	31	3.3	9	6.3	5	5.2	4	6.5
Type of appendicitis									<0.0001
Uncomplicated	641	68.2	58	40.8	40	41.2	9	14.5
Complicated	229	31.8	84	59.2	57	58.8	53	85.5
ASA									<0.0001
1	641	68.2	80	56.3	50	51.5	28	45.2
2	265	28.2	54	38.0	36	37.1	25	40.3
≥3	34	3.6	8	5.6	11	11.3	9	14.5

	Group 2		Group 3		Group 4		p
	OR	CI	OR	CI	OR	CI	p
Female	0.873	0.61-1.12	0.895	0.58-1.36	0.7	0.40-1.17	0.505
Appendicitis complicated	3.098	2.16-4.46	3.047	1.99-4.70	12.412	6.33-27.39	<0.0001
Above 38.5 years	1.989	1.37-2.86	2.461	1.60-3.76	2.605	1.53-4.39	<0.0001

	Group 1		Group 2		Group 3		Group 4		p
	Mean	Median	Mean	Median	Mean	Median	Mean	Median	p
Surgical duration	67.77	60	77.43	70	77.68	70	88.47	85	<0.0001
Length of hospital stay	3.33	2.39	4.48	3.97	5.7	3.98	13.06	9.87	<0.0001

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[1] Mailing address: Luis Fernando Moreira E-mail: lufmoreira@hcpa.edu.br / hgarbin@hcpa.edu.br