Abstract
Purpose
Appendicitis is the most common urgent condition in general surgery, and yet there
is no evidence-based definition for perforation. Therefore, all retrospective data
published on perforated appendicitis are unreliable because of an ill-defined denominator.
For approximately 2 years beginning in April 2005, we performed a prospective randomized
trial investigating 2 different antibiotic regimens for perforated appendicitis. During
this study, we strictly defined perforation as a hole in the appendix or a fecalith in the abdomen. Before this prospective study,
perforation was staff surgeon opinion. We investigated the abscess rates in both the
perforated and nonperforated appendicitis populations before and during the study
to determine if our definition was safe and that there was not an increased risk of
abscess formation in patients treated as nonperforated.
Methods
Records of all patients undergoing laparoscopic appendectomy for appendicitis during
the immediate 2 years before using the definition were compared to those treated in
the 2 years after the definition was implemented. Interval and incidental appendectomies
were ruled out. The postoperative abscess rate (when perforation was not defined)
was compared to the abscess rate of those for whom perforation was strictly defined.
Results
There were 292 patients treated for acute nonperforated appendicitis in the 2 years
before the definition and 388 patients after the definition. There were 131 patients
treated for perforated appendicitis before the definition and 161 after the definition
was implemented. The abscess rate in those with perforated appendicitis increased
from 14% to 18% after the definition was used. However, after the definition began
to be used, the abscess rate for those patients treated as nonperforated decreased
from 1.7% to 0.8%.
Conclusions
Defining perforation as a hole in the appendix or a fecalith in the abdomen is effective
in identifying the patients at risk for postoperative abscess formation. Application
of these criteria would allow substantial reduction in therapy for patients with purulent
or gangrenous appendicitis who do not possess the same abscess risk. These data outline
the first evidence-based definition of perforation.
Key words
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References
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Article info
Publication history
Accepted:
August 29,
2008
Received:
August 27,
2008
Footnotes
Presented at 41st annual meeting of the Pacific Association of Pediatric Surgeons, Jackson Lodge, Grand Teton National Park, Wyoming, June 29-July 3, 2008.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
