The risk factors for infected and perforated appendicitis

It is believed that the appendix will be perforated if the surgery of an acute appendicitis is delayed. However, some of the recent studies, contested this hypothesis and shown that only a delay in the treatment cannot fully explain perforated appendicitis. This study aimed to examine the prevalence and risk factors for perforated appendicitis in patients with acute appendicitis. A cross-sectional study was conducted in Shahid Beheshti Medical center. Data from 526 patients diagnosed with acute appendicitis were extracted from file related to the patients who undergone appendectomy since 2011 till the end of 2015. Performing an appendectomy after more than 48 hours from the onset of symptoms was defined as a delayed appendectomy. Data related to the patients’ age, gender, type of appendicitis, and the delay in appendectomy were gathered using a checklist. Descriptive statistics (frequency, percentage) were used to describe the data. Chi-square and Fisher's exact tests were used to analyze the data. Among the 526 patients with a diagnosis of acute appendicitis, 24.3% were perforated while 75.7% were non-perforated appendicitis. Of the total patients, 72.2% were referred to the hospital and were operated in less than 48 hours while 27.8% were referred and operated with a delay more than 48 hours. The rate of septic appendicitis was 55.5% and 72.6% in patients without and with delayed appendectomy, respectively but the rate of perforated appendicitis was 28.9% and 12.3% in patients without and with delayed appendectomy, respectively (P value < 0.05). The majority of cases of perforated appendicitis were occurred males (73.4%) and in the age range of 15 to 34 years (33.8%). Physiopathology of perforated appendicitis is very complex and a delay in appendectomy cannot fully justify the physiopathology of perforated appendicitis. The fact that perforation cannot fully explained be a delay in appendectomy may prevent many cases of unnecessary surgeries in patients with acute appendicitis. Further studies are recommended to confirm the findings of the present study.