Background: Several factors are considered to be associated with increased postoperative complications after appendectomies, yet whether high-risk patients benefit from a shorter waiting time for surgery remains unclear. This study aimed to propose an appendicitis prognostic score (APS) for predicting surgical outcome and assessing the influence of surgical delay on postoperative complications.
Methods: From 2013 to 2019 patients diagnosed with acute appendicitis requiring an emergent appendectomy were divided into training (2013-2018) and validation groups (2019). The APS was developed from preoperative characteristics related to a perforated appendicitis in the training group, then correlated with postoperative complications (surgical site infection, intra-abdominal abscess and ileus) and verified by the validation group. The effects of surgical delay on postoperative complications was evaluated between high and low APS subgroups.
Results: APS criteria included age >45, body temperature >37.5°C, heart rate >95bpm, breathing rate >20/min, diastolic blood pressure <75mmHg, and abdominal pain duration 24-48h and >48h, with a maximum of 8 points. A high APS (≥4 points) was significantly associated with an increased complication rate in the validation group (p=0.016). Further analysis of the training group showed that patients with ≥4 points had a higher overall complication (21.85% vs. 11.27%, p=0.006) and surgical site infection rate (11.92% vs. 4.69%, p=0.011) if surgical delay exceeded 12 hours.
Conclusion: The APS is a practical metric for predicting postoperative complications. It is recommended that patients with an APS score ≥4 undergo an appendectomy within 12 hours to avoid an increased risk of overall complications and surgical site infection.