Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide.

N Lluís, J Parra, C Villodre, P Zapater, A Jalali, M Cantó, L Mena, J M Ramia, F Lluís

Journal: International journal of surgery (London, England) 2022;104():106741

PMID: 35772594

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Abstract

BACKGROUND AND AIMS

In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS).

METHODS

Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-h, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure.

RESULTS

A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis.

CONCLUSIONS

The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.

Address: Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL, USA.; Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.; Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain. Electronic address: [email protected].; Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.; School of Mathematical Sciences, University College Cork, Cork, Ireland.; Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.; Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.; Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain.; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.; Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain.; Hospital Universitario de Badajoz, Badajoz, Spain.; Hospital Universitario de Bellvitge, Barcelona, Spain.; Hospital Marina Baixa, Alicante, Spain.; Hospital Juan Ramón Jiménez /Infanta Elena, Huelva, Spain.; Hospital Infanta Cristina, Parla, Madrid, Spain.; Hospital Universitario de Canarias, Tenerife, Spain.; Hospital Reina Sofía de Córdoba, Córdoba, Spain.; H. Ramón y Cajal, Madrid, Spain.; Hospital Parc Taulí de Sabadell, Barcelona, Spain.; Hospital General Universitario de Alicante, Alicante, Spain.; Complejo Hospitalario Universitario de Vigo / Hospital Pontevedra, Spain.; Hospital Trueta de Girona, Girona, Spain.; Hospital Universitario Rio Hortega, Valladolid, Spain.; Hospital Mutua Terrassa, Barcelona, Spain.; Consorci Hospitalari de Vic, Barcelona, Spain.; POVISA, Pontevedra, Spain.; Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.; Hospital Universitario Basurto, Bizkaia, Spain.; Hospital Universitario Marqués de Valdecilla, Santander, Spain.; Hospital de Viladecans, Barcelona, Spain.; Hospital Clínico de Valencia, Valencia, Spain.; Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain.; Hospital Vírgen de la Macarena, Sevilla, Spain.; Hospital Cabueñes, Gijón, Spain.; Complejo Hospitalario de Jaén, Jaén, Spain.; Hospital Universitari Sant Joan de Reus, Tarragona, Spain.; Hospital Universitario Infanta Sofía, Madrid, Spain.; Complejo Hospitalario Torrecárdenas, Almería, Spain.; Hospital Sant Pau i Santa Tecla, Tarragona, Spain.; Hospital General Rafael Méndez de Lorca, Murcia, Spain.; Hospital Vírgen del Rocío, Sevilla, Spain.; Hospital Morales Meseguer, Murcia, Spain.; Hospital del Vinalopó, Alicante, Spain.; Hospital Universitario del Vinalopó, Alicante, Spain.; Hospital Universitario Virgen de las Nieves, Granada, Spain.

DOI: 10.1016/j.ijsu.2022.106741

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MeSH Terms: Acute Disease, Adult, Appendectomy, Appendicitis, Cohort Studies, Female, Humans, Laparoscopy, Male, Prospective Studies, Suppuration