title: Factors influencing the course of acute appendicitis in adults and children.
abstract: OBJECTIVE
  Our aim was to determine predictive factors for the diagnosis and postoperative complications of acute appendicitis.
  
  
  METHODS
  Data sets of 1,439 consecutive adults and children who had an appendectomy between 1999 and 2008 were retrospectively analyzed.
  
  
  RESULTS
  A mild acute appendicitis was present in 50 % (n = 722) and a severe acute appendicitis in 25 % (n = 355) of the patients. No signs of any pathology were found in 6 % (n = 82). Gender, white blood count (WBC), C-reactive protein (CRP), and ultrasound (US) examination were important indicators of mild acute and severe acute appendicitis in adults and children. Postoperative complications occurred in 16 % (237/1,439), mainly consisting of wound infections (8 %, n = 122) and bowel dysfunction (5 %, n = 76). Sixty-two patients (4.3 %) required reoperations. One patient died (1/1,439, 0.07 % mortality rate). Age, pathology, and the presence of bacteria in the intraoperative swab were important predictive factors for postoperative complications in adults and children. Time since onset of symptoms and type of operation were also associated with postoperative complications among adults. Complications developed in 21 and 9 % of the adults (155/754 and 10/125) who had open and laparoscopic surgery, respectively.
  
  
  CONCLUSIONS
  Besides history and clinical examination, WBC, CRP, and US examination remain important factors for diagnosing acute appendicitis. Complications are related to the pathology, presence of bacteria, and type of operation. Early diagnosis within 48 h may be important. A laparoscopic procedure in adults may also cause fewer wound infections.
authors.affiliation: Clinic of General and Visceral Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Tsioplis
authors.forename: C
authors.initials: C
authors.lastname: Brockschmidt
authors.forename: S
authors.initials: S
authors.lastname: Sander
authors.forename: D
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: M
authors.initials: M
authors.lastname: Kornmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein