The High Risk Factors Of Recurrent Appendicitis

Objective: The objective of the study is to find the high risk factors of recurrent appendicitis.Method: 373 patients who underwent laparoscopic appendectomy or appendectomy in the affiliated hospital of Qingdao University during 2011-2015 were enrolled in the study.Patients were excluded if one of the following criteria were present: chronic appendicitis;age less than 18 years(no upper age limit);abcess;HIV;hemopathy;autoimmune disease;past history of infl ammatory bowel disease;advanced cancer;underwent other operations at the same time;appendiceal mucoceles or tumors;pregnancy or a positive pregnancy test;interval appendicetomy.According to suspected history of appendicitis,all patients were allocated to recurrent appendicitis group or non-recurrent group,the data is compared between 2 groups including age,sex,BMI,symptom,physical examanation,pathology,laboratory blood tests,operation,operative time,intraoperative bleeding,operation-related complications,hospitalization costs,and length of hospital stay,image,CT-scan data.Result: The Alvarado score in the recurrent group was significantly lower than that in the non-recurrent group(p=0.016).There was no significant difference in the length of hospital stay and operation time between the recurrent group and the non-recurrent group(p>0.05).The incision infection rate was 4.51%(6/133)in the recurrent group and 4.17%(10/240)in the non-recurrent group.There was no statistical difference between two groups(p=0.944).There was no statistical difference in the incidence of postoperative abdominal infection.There was no significant difference in the incidence of postoperative intestinal obstruction(p=0.933).There was no significant difference in the incidence of postoperative intestinal fistula(p=0.446).The white blood cell count of the non-recurrent group were significantly higher than that of the recurrent group(p=0.047),and the percentage of lymphocyte count was lower than that of the recurrent group(p=0.029).There were no significant differences in gender,BMI,smoking or drinking,hypertension,heart disease,cerebrovascular disease,body temperature,and heart disease between the two groups(p>0.05).Age <50 years(p=0.008 OR=1.848[ 95% CI 1.172-2.912])and diabetes(p=0.007 OR=2.733 [95% CI 1.294-5.773]))was statistically different.CT features of complex appendicitis and non-complex appendicitis were compared.Statistically significant signs included cecal wall thickening(p=0.014),periappendiceal fluid collection(p=0.014),extraluminal appendicolith(p=0.004),extraluminal air(p=0.000)and appendiceal wall defect(p=0.004).The sensitivity of cecal wall thickening was 65.7%,and the specificity was 58.5%.The sensitivity of periappendiceal fluid collection was 42.9%,and the specificity was 78.7%.The sensitivity of extraluminal appendicolith was 8.6%,and the specificity was 100%.The sensitivity of extraluminal air was 17.1%,the specificity was 100%.The sensitivity of appendiceal wall defect is 5.7%,and the specificity is 100%.There was no significant difference in appendiceal diameter,periappendiceal fat stranding,cecal wall thickening,lymph node enlargemen,extraluminal air,intestinal obstruction,and appendiceal wall defect between the recurrent group and non-recurrent group(p< 0.05),intraluminal appendicolith was statistically different between the two groups(p=0.027 [OR=2.431 95% CI 1.093-5.328]).Conclusions: Recurrent appendicitis doesn't increase operative time,intraoperative bleeding,operation-related complications,hospitalization costs,and length of hospital stay.Age <50 years(OR=1.848 [95% CI 1.172-2.912]),diabete(OR =2.733 [95% CI 1.294-5.773])and intraluminal appendicolith([OR=2.431 95% CI 1.093-5.328])are risk factors for recurrent appendicitis.