Risk factors for the development of complicated appendicitis in adults

Objective: To investigate the patient's history and physical examination information to find out risk factors associated with complicated appendicitis. Material and Methods: Two hundred patients who were admitted with complicated appendicitis (including abscess, phlegmon, and generalized peritonitis) were retrieved from our database. Two hundred patients with non-complicated acute appendicitis were randomly selected from the same period. These two groups were compared in terms of demographic characteristics, past medical history, and presenting symptoms. We made a multivariate analysis model using binary logistic regression and backward stepwise elimination. Results: Based on multivariate analysis, risk factors for complicated appendicitis included presenting with epigastric pain (OR= 3.44), diarrhea (OR= 23.4) or malaise (OR= 49.7), history of RLQ pain within the past 6 months (OR= 4.93), older age (OR= 1.04), being married (OR= 2.52), lack of anorexia (OR= 4.63) and longer interval between onset of symptoms and admission (OR= 1.46). Conversely, higher (academic) education was associated with decreased odds for complicated appendicitis (OR= 0.26). Conclusion: Our findings suggest that a surgeon's clinical assessment is more reliable to make a judgment. "Bedside evaluation" is a useful, cheap, quick and readily available method for identifying those at risk for developing complicated acute appendicitis.