Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies

A perceived high rate of complicated (gangrenous or perforated) appendiciti s, despite advances in laboratory and radiographic diagnostic modalities, p rompted a review of our experience with appendicitis followed by a prospect ive analysis that examined the time course from presentation to definitive treatment in 218 consecutive patients. In 5755 appendectomies, our overall rate of complicated appendicitis was 32 per cent; higher in males, in the y oung, and in the elderly; and relatively stable over each year reviewed. Pr ospectively, we determined that of the various time intervals, the time fro m the onset of symptoms to first seeking medical attention is the only sign ificant predictor of complicated appendicitis (39.8 vs 16.5 hours for acute appendicitis). On the other hand, the time from surgical evaluation to ope rative intervention was significantly shorter for complicated appendicitis (3.8 vs 4.7 hours for acute appendicitis). The high rate of complicated app endicitis with its subsequent sequelae of increased morbidity and resource expenditure is primarily the direct result of patient delay in seeking medi cal attention and not the result of diagnostic dilemma or surgical delay, P ublic education, specifically targeting those groups at risk, may provide a substantial and significant solution to the complicated appendix.