title: Risk factors for gastric distension in patients with acute appendicitis: a retrospective cohort study.
abstract: OBJECTIVE
  There has been no report on risk factors for gastric distension (GD) when inducing general anesthesia in an emergency situation. The aim of this study was to clarify the risk factors for GD in patients with acute appendicitis at their hospital visit.
  
  
  METHODS
  We reviewed medical records of patients from April 2007 to March 2010 who underwent open appendectomy for acute appendicitis and were diagnosed pathologically. GD was defined as a larger anteroposterior diameter and larger lateral diameter of the stomach than those of the left kidney in computed tomography (CT) imaging. The primary outcome was the presence of GD. Candidate variables such as patient characteristics, physical findings, and CT imaging findings associated with GD were assessed. Time after beginning of abdominal pain was categorized and compared. Determinants with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models.
  
  
  RESULTS
  We enrolled 121 patients and divided this cohort into a GD group (44 cases, 36%) and a non-GD group (77 cases, 64%). Results of univariate analysis showed longer duration of time after beginning of abdominal pain (P = 0.016), younger age (P < 0.001), and more frequent distended small bowel (P < 0.001) in the GD group than in the non-GD group. In multivariate analysis, age [odds ratio (OR) = 0.939, P = 0.002] and time after beginning of abdominal pain (OR = 1.807, P = 0.031) were shown to be independent risk factors.
  
  
  CONCLUSIONS
  Younger appendicitis patients with acute abdominal pain for 1 or more days should be treated as patients with high risk for GD.
authors.affiliation: Division of Anesthesia, Asahikawa Redcross Hospital, 1-1-1-1 Akebono, Asahikawa, Hokkaido, 070-8530, Japan. chiro1123@gmail.com
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kimura
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Hikaru
authors.initials: H
authors.lastname: Inoue
authors.forename: Saori
authors.initials: S
authors.lastname: Kimura
authors.forename: Michiaki
authors.initials: M
authors.lastname: Yamakage
authors.forename: Mako
authors.initials: M
authors.lastname: Aimono
authors.forename: Shinzou
authors.initials: S
authors.lastname: Sumita
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000768:Anesthesia, General; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D005260:Female; D013271:Gastric Dilatation / Q000453:epidemiology / Q000209:etiology*; D005748:Gastric Fundus / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D010808:Physical Examination; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult