Risk factors associated with perforated acute appendicitis in geriatric emergency patients

Figures & data

Table 1 Baseline characteristics of the patients

Characteristic	Perforated group (n=78)	Non-perforated group (n=145)	Total (N=223)	P-value
Age, years, median (IQR)	70 (64-76.8)	68 (63-74)	68 (64-75)	0.127
Sex				0.097
Male	41 (52.6)	58 (40.0)	99 (44.4)
Female	37 (47.4)	87 (60.0)	124 (55.6)
Underlying disease	61 (78.2)	95 (65.5)	156 (70)	0.069
Hypertension	34 (43.6)	54 (37.2)	88 (39.5)	0.435
Diabetes mellitus	14 (17.9)	17 (11.7)	31 (13.9)	0.281
Heart disease	9 (11.5)	11 (7.6)	20 (9)	0.46
Pulmonary disease	3 (3.8)	7 (4.8)	10 (4.5)	1.00
Cerebrovascular disease	2 (2.6)	8 (5.5)	10 (4.5)	0.50
Cognitive disorder	1 (1.3)	1 (0.7)	2 (0.9)	1.00
Chronic kidney disease	3 (3.8)	0 (0)	3 (1.3)	0.042
Connective tissue disease	1 (1.3)	0 (0)	1 (0.4)	0.35

Note: Data are presented as n (%) unless indicated otherwise.

Abbreviation: IQR, interquartile range.

Table 2 Comparison of clinical presentation, physical examination, and laboratory test

Variable	Perforated group (n=78)	Non-perforated group (n=145)	Total (N=223)	P-value
Time duration from onset of symptoms to ED arrival, hours, median (IQR)	24 (17.2-48)	19 (9.1-24)	24 (11.5-30.6)	<0.01
Time duration from onset of symptoms to ED arrival >24 hours	36 (46.2)	36(24.8)	72 (32.3)	0.02
Fever	25 (32.1)	38 (26.2)	63 (28.3)	0.42
Right lower abdominal pain	55 (70.5)	115 (79.3)	170 (76.2)	0.191
Migratory pain	20 (25.6)	49 (33.8)	69 (30.9)	0.27
Nausea/vomiting	43 (55.1)	73 (50.3)	116 (52)	0.58
Anorexia	17 (21.8)	20 (13.8)	37 (16.6)	0.179
Heart rates ≥90 beats/minute	41 (52.6)	51 (35.2)	92 (41.3)	0.018
Respiratory rates ≥20 breaths/minute	59 (75.6)	75 (51.7)	134 (60.1)	<0.001
SBP ≥90 mmHg	78 (100)	144 (99.3)	222 (99.6)	1
Right lower abdominal tenderness	67 (85.9)	135 (93.1)	202 (90.6)	0.27
Rebound tenderness	55 (70.5)	105 (72.4)	160 (71.7)	0.27
Localized guarding at right lower abdominal quadrant	10 (12.8)	10 (6.9)	20 (9)	0.218
Generalized guarding	8 (10.3)	1 (0.7)	9 (4)	0.001
Leukocytosis (WBc count >10,000/μL)	56 (71.8)	114 (78.6)	170 (76.2)	0.329
Neutrophils >75% median (IQR)	81 (74-87)	81 (75-87)	81 (75-87)	0.914
Band cells >10%	8 (25)	3(10.3)	11 (18)	0.249
Alvarado score (points)				0.37
≤4	17 (21.8)	22 (15.2)	39 (17.5)
5-6	30 (38.5)	54 (37.2)	84 (37.7)
≥7	31 (39.7)	69 (47.6)	100 (44.8)
Presentation
Typical presentation	15 (19.2)	22 (15.2)	37 (16.6)	0.556
Atypical presentation	63 (80.8)	123 (84.8)	186 (83.4)	0.556

Notes: Data are presented as n (%) unless indicated otherwise. Values <0.05 are statistically significant.

Abbreviations: ED, emergency department; IQR, interquartile range; SBP, systolic blood pressure; WBC, white blood cell.

Table 3 Comparison of provisional diagnosis and definitive diagnosis

Provisional diagnosis by EP	Total (N=223)	Definitive diagnosis of acute appendicitis
		Perforated group	Non-perforated group
Acute appendicitis	202	63 (28.25)	139 (62.33)
Gut obstruction	9	9 (4.03)	0
Peritonitis	5	5 (2.24)	0
Acute diverticulitis	6	1 (0.44)	5 (2.24)
Acute gastroenteritis	1	1 (0.44)	0

Note: Data are presented as n (%).

Abbreviation: EP, emergency physician.

Table 4 Multivariate analysis by logistic regression if perforated appendicitis occurred

Variable	Crude OR (95% CI)	Adjusted OR (95% CI)	P-value
Time duration from onset of symptoms to ED arrival >24 hours	2.6 (1.45-4.65)	2.49 (1.33-4.68)	0.004
Heart rates ≥90 beat/minute	2.04 (1.17-3.58)	1.93 (1.04-3.58)	0.035
Respiratory rates ≥20 breaths/minute	2.9 (1.57-5.34)	2.54 (1.33-4.84)	0.004
Presented with generalized guarding	16.46 (2.02-134.17)	12.58 (1.43-110.85)	0.004

Note: Values <0.05 are statistically significant.

Abbreviation: ED, emergency department.

Figure 1 Time from ED arrival to operation between the two groups.

Note: The median values in the non-perforated group and perforated group were 5.72 and 7.27 hours, respectively.
Abbreviation: ED, emergency department.

Table 5 Postoperative complications, hospital LOS, and mortality

Outcome	Perforated group (n=78)	Non-perforated group (n=145)	Total (N=223)	P-value
Surgical wound infection	2 (2.6)	1 (0.7)	3 (1.3)	0.281
Wound dehiscence	4 (5.1)	0 (0)	4 (1.8)	0.014
Abdominal infection/collection	2 (2.6)	0 (0)	2 (0.9)	0.121
Hospital LOs, days, median (IQR)	6.5 (5-7)	3 (3-5)	4 (3-6)	<0.001

Notes: Data are presented as n (%) unless indicated otherwise. Values <0.05 are statistically significant.

Abbreviations: LOS, length of stay; IQR, interquartile range.