ANALYSIS OF RISK-FACTORS OF POSTAPPENDECTOMY INTRAABDOMINAL ABSCESS

BACKGROUND: Postappendectomy intra-abdominal abscesses (PAIAA) complic ate the recovery of a small but significant fraction of patients with advanced appendicitis. STUDY DESIGN: A retrospective review of 1,184 p atients with appendicitis was undertaken to define the clinical charac teristics and risk factors associated with PAIAA. RESULTS: Thirty-thre e patients with 36 PAIAAs were found, an incidence of 2.8 percent. The mean age of patients with PAIAA was less than the overall group (16.9 versus 23.1 years, p=0.002), and the mean core temperature of the PAI AA. group was significantly higher (38.5 versus 38.2 degrees C). The i ncidence of PAIAA increased as the degree of appendiceal pathology wor sened. The incidence of PAIAA was six (3.2 percent) of 190 in patients with gangrenous appendicitis and was 27 (8.7 percent) of 309 among pa tients with perforated appendicitis. Logistic regression analysis show ed that independent predictors for the occurrence of PAIAA were young age and perforation. Although children presented with a higher rate of perforated appendicitis, this did not account for the younger age of the patients with PAIAA. Children (less than ten years of age) with pe rforation had PAIAA in ten (14 percent) of 69 cases compared with the incidence in the older patients with perforation of 17 (7.1 percent) o f 240. CONCLUSIONS: These finding improve the surgeon's ability to ide ntify patients at risk for PAIAA. Alterations in the perioperative man agement of perforated appendicitis, particularly in the pediatric pati ent, may reduce the occurrence of PAIAA.