title: Acute perforated appendicitis: an analysis of risk factors to guide surgical decision making.
abstract: BACKGROUND
  Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity.
  
  
  OBJECTIVE
  To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients.
  
  
  METHODS
  A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2.
  
  
  CONCLUSIONS
  506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20%) patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001). Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05).
  
  
  CONCLUSIONS
  Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.
authors.affiliation: Data Management and Analysis Centre, The University of Adelaide, South Australia, Australia. georgebarreto@yahoo.com
authors.forename: Savio G
authors.initials: SG
authors.lastname: Barreto
authors.forename: Edward
authors.initials: E
authors.lastname: Travers
authors.forename: Tudor
authors.initials: T
authors.lastname: Thomas
authors.forename: Clare
authors.initials: C
authors.lastname: Mackillop
authors.forename: Leong
authors.initials: L
authors.lastname: Tiong
authors.forename: Michelle
authors.initials: M
authors.lastname: Lorimer
authors.forename: Randall
authors.initials: R
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein