Complicated appendicitis increases the hospital length of stay

Abdulrahman Muaod Alotaibi; Mohammed Alfawaz; Lina Felemban; Leena Moshref; Rana Moshref

doi:10.1016/j.sopen.2022.05.006

Complicated appendicitis increases the hospital length of stay

Surg Open Sci. 2022 May 20:9:64-68. doi: 10.1016/j.sopen.2022.05.006. eCollection 2022 Jul.

Authors

Abdulrahman Muaod Alotaibi^{1

2}, Mohammed Alfawaz³, Lina Felemban⁴, Leena Moshref², Rana Moshref²

Affiliations

¹ Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
² Department of Surgery, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.
³ Department of Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
⁴ Department of Surgery, King Abdul-Aziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia.

Abstract

Background: There are insufficient data from Saudi Arabia regarding appendectomy outcomes and hospital length of stay. Further, there is a need to compare the length of stay of Saudi patients and the literature. The purpose is to evaluate the surgical outcomes and hospital length of stay for complicated appendicitis and simple appendicitis.

Method: This is a single-center retrospective review of patients who had undergone an appendectomy between 2016 and 2018. The patients were divided into 2 groups: complicated appendicitis versus simple appendicitis.

Results: Of 449 patients who underwent appendectomy, 60 (13.4%) had complicated appendicitis. The complicated appendicitis was significantly associated with increased age, pain duration, neutrophilia, high C-reactive protein, fecalith presence, and free fluid. The incidence rate of surgical site infection was 5.8% (identified in 26 patients). Compared to simple appendicitis, complicated appendicitis was associated more with wound infection (1.8% vs 10%, respectively, P = .001), postoperative collection (1.2% vs 11.6%, respectively, P = .001), and readmission within 30 days (2.3% vs 13.4%, respectively, P = .001). By multivariate analysis, factors associated more with increased hospitalization were pain duration (hazard ratio = 2.37, 95% confidence interval = 1.09-5.16, P = .029), operative time (hazard ratio = 2.09, 95% confidence interval = 1.04-4.21, P = .038), and complicated appendicitis (hazard ratio = 6.61, 95% confidence interval = 2.67-14.21, P = .001).

Conclusion: Complicated appendicitis correlates with significant morbidity, readmission rate, and 6 times more hospital LOS than simple appendicitis. This review might help in appreciating the burden of complicated appendicitis on hospital length of stay, which needs allocating patients and planning the discharge day for hospitals with limited beds.