Predicting outcome after appendicectomy.
OBJECTIVE
To validate an intraoperative appendicitis severity score (IASS) and examine outcome following emergency appendectomy.


METHODS
A prospective study was undertaken, enrolling consecutive patients undergoing emergency appendicectomy. Data were obtained independently on preoperative Alvarado scores, IASS (0-3: 0 no inflammation, 1 engorged appendix/no peritonitis, 2 peritoneal reaction/exudate or 3 evidence of perforation/abscess) and postoperative outcome parameters.


RESULTS
There were 149 patients identified with a mean age of 20.7 years. There was no association between Alvarado score and length of hospital stay, septic complication, patient sex or duration of symptoms (p>0.05). IASS was found to be an independent risk factor for septic complication, wound infection (p<0.05) and length of hospital stay (p<0.001). There was no correlation between preoperative duration of symptoms or time until surgery and intraoperative score.


CONCLUSIONS
This simple scoring system can identify patients more likely to suffer morbidity following emergency appendicectomy. Specifically, this system identifies patients who have a high risk of sepsis and therefore could be of use when comparing healthcare performance.
Kell
M R
MR
Department of Surgery, Cork University Hospital, Ireland. malcolmkell@eircom.net
Power
K
K
Winter
D C
DC
Power
C
C
Shields
C
C
Kirwan
W O
WO
Redmond
H P
HP
D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome