Risk factors for perforation of appendix among patients of appendicitis with appendicolithiasis?

A recent study examined the predictors of progression to perforated acute appendicitis in patients with appendicolithiasis, a condition where calcified deposits are found in the appendix. The study, which analyzed inpatient data, aimed to identify factors associated with in-hospital perforation of the appendix. The study was published in BMC Surgery by Amir H. Sohail and colleagues.

The study focused on adults with appendicolithiasis-associated non-perforated acute appendicitis who underwent an appendectomy. Appendicolithiasis refers to the presence of appendicoliths, which are calcified structures, in the appendix. The researchers utilized computed tomography (CT) scans to identify these patients and later conducted appendectomies. Perforation status was determined based on histopathology.

The findings revealed that out of the 296 patients with appendicolithiasis-associated non-perforated acute appendicitis, 48 (16.2%) experienced perforation of the appendix during their hospital stay. Perforation often leads to more complex treatment and longer recovery.

The study reported several key factors associated with an increased risk of in-hospital perforation. These include:

• Age Over 65: Patients aged over 65 had a 5.4 times higher risk of perforation.
  
• Obesity (BMI > 30): Patients with a body mass index (BMI) over 30 had a 3.5 times higher risk.
• Hyponatremia: Patients with low sodium levels in the blood had a 3.6 times higher risk.

The researchers also observed that the length of the hospital stay was significantly longer for patients with perforated appendicitis, with an average stay of 3.0 days compared to 1.2 days for non-perforated cases.

Notably, the study did not find a significant association with factors such as age between 25-65 years, gender, race, steroid use, time-to-surgery, neutrophil percentage, or leukocyte count.

These findings underscore the importance of identifying risk factors for appendicolithiasis patients who may progress to perforated appendicitis. By recognizing these predictors, medical professionals can potentially intervene more effectively and provide appropriate care to reduce the risk of perforation.

The study's conclusions suggest that geriatric patients, individuals with obesity, and those with hyponatremia should be carefully monitored and evaluated when presenting with appendicolithiasis-associated non-perforated acute appendicitis. Early identification and intervention may help prevent the progression to perforation, resulting in better outcomes for patients.

This study provides valuable insights into the management and care of patients with appendicolithiasis, offering healthcare providers important tools for risk assessment and patient care decisions.

Reference:

Sohail, A. H., Hakmi, H., Cohen, K., Hurwitz, J. C., Brite, J., Cimaroli, S., Tsou, H., Jr, Khalife, M., Maurer, J., & Symer, M. Predictors of in-hospital appendiceal perforation in patients with non- perforated acute appendicitis with appendicolithiasis at presentation. BMC Surgery,2023;23(1). https://doi.org/10.1186/s12893-023-02210-4