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Abdom Imaging. 2015 Oct;40(7):2263-71. doi: 10.1007/s00261-015-0478-9.

Pre-operative CT predictors associated with 30-day adverse events in patients with appendiceal inflammatory masses who underwent immediate appendectomies.

Author information

1
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 110-746, 108 Pyong dong, Jongro-gu, Seoul, Korea.
2
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 110-746, 108 Pyong dong, Jongro-gu, Seoul, Korea. misung70@gmail.com.
3
Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 110-746, 108 Pyong dong, Jongro-gu, Seoul, Korea.

Abstract

PURPOSE:

To retrospectively evaluate pre-operative CT predictors that are associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses.

METHODS:

This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived. One hundred forty-four consecutive patients who underwent immediate appendectomies and were diagnosed with appendiceal inflammatory masses by pre-operative CT from January 2005 to December 2013 at a tertiary hospital were included. The main outcome measure was 30-day adverse events. Patient demographics and data for inflammatory markers including leukocyte counts, segmented neutrophils, and C-reactive protein levels were collected by a single radiologist. Pre- and post-operative CT findings were evaluated for features of appendiceal inflammatory masses, associated findings, and post-operative adverse events by two radiologists in a blinded fashion with consensus to assess surgical and pathologic results, post-operative outcomes, and original CT interpretations. Appendiceal inflammatory masses were defined as complicated appendicitis with a phlegmon or an abscess that was identified on pre-operative CT exam. Factors associated with 30-day adverse events were assessed using logistic regression analysis.

RESULTS:

A total of 22 (15%) of the 144 patients (mean age [±SD] 44.6 ± 22.0 years, range 3-97 years) experienced 30-day adverse events: ten intra-abdominal abscesses, three wound infections, two cases of peritonitis, two small bowel obstructions, two intra-abdominal abscesses with peritonitis, one intra-abdominal abscess with wound infection, one intra-abdominal abscess with small bowel obstruction, and one case of peritonitis with small bowel obstruction. In univariate analysis, the presence of appendicolith (odds ratio [OR] 2.49, p = 0.048) and high-grade obstruction (OR 3.79; p = 0.01) were associated with adverse events. High-grade obstruction (adjusted OR 3.05; p = 0.04) was the only independent pre-operative predictor associated with 30-day adverse events in patients with appendiceal inflammatory masses.

CONCLUSIONS:

High-grade obstruction was an independent pre-operative CT predictor associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses.

KEYWORDS:

Appendiceal inflammatory mass; Appendicitis; Complication; Computed tomography

PMID:
26054981
DOI:
10.1007/s00261-015-0478-9
[Indexed for MEDLINE]

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