Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

Pediatric appendicitis may be co-associated with meteorologic factors: A case-crossover study

BACKGROUND

The etiopathogenesis of appendicitis is still not fully understood. Few reports have researched the impact of weather as a cofactor for the development of appendicitis.

METHODS

To investigate the potential association between the development of appendicitis and exposure to ambient meteorological conditions, a retrospective case-crossover study was conducted. Publicly available meteorologic data were matched with those from 1343 patients aged ≤19 years with histologically confirmed acute (AA; n = 996) or perforated appendicitis (PA; n = 347) treated at our pediatric surgical hospital between October 2001 and October 2018.

RESULTS

A time-stratified conditional logistic regression analysis revealed increased odds ratios (ORs) for AA of 4-5% for each 1 hPa increase in vapor pressure during each 3-7 day cumulative moving averages (CMA) lag preceding appendectomy. This effect was stronger on stratification by age class >10 years (OR 1.05-1.08; 3-7-day CMA) and during spring (OR 1.08-1.09; 4-7-day CMA). Moreover, each 1% increase in relative humidity on the day of appendectomy was associated with a 2% decrease in the OR for PA, which was 4% during autumn under seasonal stratification.

CONCLUSION

The role of meteorologic factors in the development of appendicitis remains largely unclear. In accordance with the literature, our results show that seasonal variations together with exposure to altered levels of humidity and vapor pressure may impact patients at different grades of appendiceal inflammation. Thus, transient fluctuations in meteorologic and seasonal variables may constitute cofactors that potentially influence the occurrence and course of pediatric appendicitis.

Effectiveness of different appendiceal stump closure methods in laparoscopic appendectomy a network meta-analysis

PURPOSE

Choosing the best stump closure method for laparoscopic appendectomy has been a debated issue, especially for patients with acute appendicitis. The lack of consensus in the literature and the diverse techniques available have prompted the need for a comprehensive evaluation to guide surgeons in selecting the most optimal appendiceal stump closure method.

METHODS

A comprehensive search was conducted on multiple databases from inception until December 2023 to find relevant studies according to eligibility criteria. The primary outcome was the incidence of total complications.

RESULTS

25 studies with a total of 3308 patients were included in this study, overall complications did not reveal a significant advantage for any intervention (RR = 0.72, 95% CI: 0.53; 1.01), Superficial and deep infection risks were similar across all methods, Operative time was significantly longer with endoloop and Intracorporeal sutures (MD = 7.07, 95% CI: 3.28; 10.85) (MD = 26.1, 95% CI: 20.9; 31.29).

CONCLUSIONS

There are no significant differences in overall complications among closure methods. However, Intracorporeal sutures and endoloop techniques were associated with extended operative durations.

Multicenter validation of an artificial intelligence (AI)-based platform for the diagnosis of acute appendicitis

BACKGROUND

The current scores used to help diagnose acute appendicitis have a "gray" zone in which the diagnosis is usually inconclusive. Furthermore, the universal use of CT scanning is limited because of the radiation hazards and/or limited resources. Hence, it is imperative to have an accurate diagnostic tool to avoid unnecessary, negative appendectomies.

METHODS

This was an international, multicenter, retrospective cohort study. The diagnostic accuracy of the artificial intelligence platform was assessed by sensitivity, specificity, negative predictive value, the area under the receiver curve, precision curve, F1 score, and Matthews correlation coefficient. Moreover, calibration curve, decision curve analysis, and clinical impact curve analysis were used to assess the clinical utility of the artificial intelligence platform. The accuracy of the artificial intelligence platform was also compared to that of CT scanning.

RESULTS

Two data sets were used to assess the artificial intelligence platform: a multicenter real data set (n = 2,579) and a well-qualified synthetic data set (n = 9736). The platform showed a sensitivity of 92.2%, specificity of 97.2%, and negative predictive value of 98.7%. The artificial intelligence had good area under the receiver curve, precision, F1 score, and Matthews correlation coefficient (0.97, 86.7, 0.89, 0.88, respectively). Compared to CT scanning, the artificial intelligence platform had a better area under the receiver curve (0.92 vs 0.76), specificity (90.9 vs 53.3), precision (99.8 vs 98.9), and Matthews correlation coefficient (0.77 vs 0.72), comparable sensitivity (99.2 vs 100), and lower negative predictive value (67.6 vs 99.5). Decision curve analysis and clinical impact curve analysis intuitively revealed that the platform had a substantial net benefit within a realistic probability range from 6% to 96%.

CONCLUSION

The current artificial intelligence platform had excellent sensitivity, specificity, and accuracy exceeding 90% and may help clinicians in decision making on patients with suspected acute appendicitis, particularly when access to CT scanning is limited.

Effect of Temperature and Precipitation on Acute Appendicitis Incidence in Seoul: A Time Series Regression Analysis

PURPOSE

This study aimed to investigate the relationship between meteorological factors, specifically temperature and precipitation, and the incidence of appendicitis in Seoul, South Korea.

METHODS

Using data from the National Health Insurance Service spanning 2010-2020, the study analyzed 165,077 appendicitis cases in Seoul. Time series regression modeling with distributed-lag non-linear models was employed.

RESULTS

Regarding acute appendicitis and daily average temperature, the incidence rate ratio (IRR) showed an increasing trend from approximately - 10 °C to 10 °C. At temperatures above 10 °C, the increase was more gradual. The IRR approached a value close to 1 at temperatures below - 10 °C and above 30 °C. Both total and complicated appendicitis exhibited similar trends. Increased precipitation was negatively associated with the incidence of total acute appendicitis around the 50 mm/day range, but not with complicated appendicitis.

CONCLUSIONS

The findings suggest that environmental factors, especially temperature, may play a role in the occurrence of appendicitis. This research underscores the potential health implications of global climate change and the need for further studies to understand the broader impacts of environmental changes on various diseases.

Hospitalization Costs for Patients with Acute Appendicitis: An Update Using Real-World Data from a Large Province in China

Purpose

The aim of this study is to investigate the factors influencing hospitalization costs for patients diagnosed with acute appendicitis in China.

Methods

We conducted a cross-sectional study using data from Provincial Health Statistics Support System Database from S Province in China. This dataset contained all hospital's electronic medical records from January 1, 2015 to December 31, 2018 including both public and private hospitals. The target population was identified based on the principal diagnosis of appendicitis (ICD-10: K35). To examine the impact of various factors on hospitalization costs, we conducted a multivariate linear regression analysis. Furthermore, we employed the Shapley value decomposition method to gain a more comprehensive understanding of the factors that influenced hospitalization costs and their respective levels of importance.

Results

Our study comprised 317,200 cases. During the period from 2015 to 2018, the average hospitalization expenses for patients with acute appendicitis were estimated at approximately 7014 RMB (1061 USD), which accounts for a considerable 12% of China's per capita GDP. The results of this study demonstrate a significant correlation between various factors, such as the patient's age, gender, marital status, occupation, payment method, number of complications, treatment method, hospital tier, and ownership, and the total hospitalization costs and subcomponents of hospitalization costs. Notably, the treatment method employed had the most substantial impact on hospitalization costs.

Conclusion

To the best of knowledge, this is one of the first studies to investigate the hospitalization costs of acute appendicitis incorporating both patient-level and hospital-level covariates, using a large sample size. To reduce the costs associated with acute appendicitis in China, it is recommended to consider suitable treatment options and explore the option of receiving medical care at lower-tier and privately-owned healthcare facilities.

A Study of Misconceptions About Appendicitis Among the Resident Population of the Aseer Region

BACKGROUND

Appendicitis is a common abdominal emergency requiring swift medical intervention. Misconceptions about this condition can lead to delayed diagnosis and potentially life-threatening complications. In the Aseer region of Saudi Arabia, where healthcare accessibility and awareness levels vary, addressing such misconceptions is of paramount importance. The aim of this study is to investigate and identify the prevalent misconceptions regarding appendicitis among the resident population of the Aseer region. Understanding the prevalent misconceptions and knowledge gaps is essential to develop targeted educational interventions and enhance public awareness.

METHODS

This study utilized a cross-sectional study design to investigate misconceptions about appendicitis among residents in the Aseer region. Over a period of three months, 329 Aseer region resident population were interviewed. The symptoms, causes, diagnosis, treatment, and preventive measures of appendicitis were all covered in a questionnaire that was created to gather information on people's knowledge of appendicitis. Data were collected using an online questionnaire. Descriptive analysis was performed using frequencies and percentages, while inferential analysis employed appropriate statistical tests such as chi-square.

RESULTS

 The study's 329 participants were made up of 56% men and 44% women. 40% of the sample size was between the ages of 18 and 30, 26% were between the ages of 31 and 40, 15% were between the ages of 41 and 50, and 10% were above 50 years, with those under the age of 18 years accounting for the smallest proportion (9%). The majority of the respondents (37%) were college graduates, 25% were college students, 23% were in high school and 15% were in middle school. Chi-square tests were conducted to examine the associations between background knowledge and pain area, as well as between background knowledge and source of information. For the association between background knowledge and pain area, the Chi-square test yielded a significant result (X² = 9.104, p = 0.028); the Chi-square test also revealed a significant result (X² = 8.078, p = 0.044) between background knowledge and the source of information about appendicitis.

CONCLUSION

The analysis suggests a notable knowledge gap among the participants, with a significant portion displaying limited understanding or responding with "I don't know" when queried about appendicitis. It is important to note that this observation includes middle school students, who may be too young to be expected to possess knowledge about medical conditions. Additionally, there appears to be gender-related variation in opinions, misconceptions, and understanding regarding appendicitis.

Accuracy of computed tomography in staging acute appendicitis and its impact on surgical outcome and strategy: a multi-center retrospective case-control study

INTRODUCTION

The aims of this study were to evaluate the concordance between AAST-CT appendicitis grading criteria, first published in 2014, and surgical findings and to assess the impact of CT staging on the choice of surgical approach.

METHODS

This was a multi-center retrospective case-control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared.

RESULTS

An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher's exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher's exact test). All the patients with grade 5 appendicitis were treated by laparotomy.

CONCLUSIONS

AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5.

Impacts of short-term air pollution exposure on appendicitis admissions: Evidence from one of the most polluted cities in mainland China

Background

Emerging evidence indicates that air pollutants contribute to the development and progression of gastrointestinal diseases. However, there is scarce evidence of an association with appendicitis in mainland China.

Methods

In this study, Linfen city, one of the most polluted cities in mainland China, was selected as the study site to explore whether air pollutants could affect appendicitis admissions and to identify susceptible populations. Daily data on appendicitis admissions and three principal air pollutants, including inhalable particulate matter (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) were collected in Linfen, China. The impacts of air pollutants on appendicitis were studied by using a generalized additive model (GAM) combined with the quasi-Poisson function. Stratified analyses were also performed by sex, age, and season.

Results

We observed a positive association between air pollution and appendicitis admissions. For a 10 μg/m3 increase in pollutants at lag01, the corresponding relative risks (RRs) and 95% confidence intervals (95% CIs) were 1.0179 (1.0129–1.0230) for PM10, 1.0236 (1.0184–1.0288) for SO2, and 1.0979 (1.0704–1.1262) for NO2. Males and people aged 21–39 years were more susceptible to air pollutants. Regarding seasons, the effects seemed to be stronger during the cold season, but there was no statistically significant difference between the seasonal groups.

Conclusions

Our findings indicated that short-term air pollution exposure was significantly correlated with appendicitis admissions, and active air pollution interventions should be implemented to reduce appendicitis hospitalizations, especially for males and people aged 21–39 years.

Association of Appendicitis Incidence With Warmer Weather Independent of Season

IMPORTANCE

Acute appendicitis is a common cause of abdominal pain and the most common reason for emergency surgery in several countries. Increased cases during summer months have been reported.

OBJECTIVE

To investigate the incidence of acute appendicitis by considering local temperature patterns in geographic regions with different climate over several years.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used insurance claims data from the MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database from January 1, 2001, to December 31, 2017. The cohort included individuals at risk for appendicitis who were enrolled in US insurance plans that contribute data to the MarketScan databases. Cases of appendicitis in the inpatient, outpatient, and emergency department settings were identified using International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. Local weather data were obtained for individuals living in a metropolitan statistical area (MSA) from the Integrated Surface Database. Associations were characterized using a fixed-effects generalized linear model based on a negative binomial distribution. The model was adjusted for age, sex, and day of week and included fixed effects for year and MSA. The generalized linear model was fit with a piecewise linear model by searching each 0.56 °C in temperature for change points. To further isolate the role of temperature, observed temperature was replaced with the expected temperature and the deviation of the observed temperature from the expected temperature for a given city on a given day of year. Data were analyzed from October 1, 2021, to July 31, 2022.

MAIN OUTCOMES AND MEASURES

The primary outcome was the daily number of appendicitis cases in a given city stratified by age and sex, with mean temperature in the MSA over the previous 7 days as the independent variable.

RESULTS

A total of 450 723 744 person-years at risk and 689 917 patients with appendicitis (mean [SD] age, 35 [18] years; 347 473 male [50.4%] individuals) were included. Every 5.56 °C increase in temperature was associated with a 1.3% increase in the incidence of appendicitis (incidence rate ratio [IRR], 1.01; 95% CI, 1.01-1.02) when temperatures were 10.56 °C or lower and a 2.9% increase in incidence (IRR, 1.03; 95% CI, 1.03-1.03) for temperatures higher than 10.56 °C. In terms of temperature deviations, a higher-than-expected temperature increase greater than 5.56 °C was associated with a 3.3% (95% CI, 1.0%-5.7%) increase in the incidence of appendicitis compared with days with near-0 deviations.

CONCLUSIONS AND RELEVANCE

Results of this cohort study observed seasonality in the incidence of appendicitis and found an association between increased incidence and warmer weather. These results could help elucidate the mechanism of appendicitis.

Endoscopy in the Surgically Altered Bowel

Improved utilization of surgical interventions to improve patient outcomes has led to an increased need to endoscopically evaluate and treat the bowel after surgery. The best outcomes are attained when the endoscopist coordinates with the surgeon, and in some cases the pathologist or radiologist to plan the procedure. Understanding the anatomy and pathology anticipated can allow planning for sedation, bowel cleanse and equipment needed. Surgically altered anatomy can create challenges that with planning can be overcome. This article will review how to prepare and navigate several of the most commonly encountered surgical interventions.

Is higher ambient temperature associated with acute appendicitis hospitalizations? A case-crossover study in Tongling, China

Existing studies suggested that ambient temperature may affect the attack of acute appendicitis. However, the identification of the quantitative effect and vulnerable populations are still unknown. The purposes of this study were to quantify the impact of daily mean temperature on the hospitalization of acute appendicitis and clarify vulnerable groups, further guide targeted prevention of acute appendicitis in Tongling. Daily data of cases and meteorological factors were collected in Tongling, China, during 2015-2019. Time stratified case-crossover design and conditional logistic regression model were used to evaluate the odds ratio (OR) of ambient temperature on hospitalizations for acute appendicitis. Stratified analyses were performed by sex, age, and marital status. The odds ratio (OR) of hospitalizations for acute appendicitis increased by 1.6% for per 1 ℃ rise in mean temperature at lag3[OR = 1.016, 95% confidence interval (CI): 1.004-1.028]. In addition, our results suggest it is in the women that increased ambient temperature is more likely to contribute to acute appendicitis hospitalizations; we also found that the married are more susceptible to acute appendicitis hospitalizations due to increased ambient temperature than the unmarried; people in the 21-40 years old are more sensitive to ambient temperature than other age groups. The significant results of the differences between the subgroups indicate that the differences between the groups are all statistically significant. The elevated ambient temperatures increased the risk of hospitalizations for acute appendicitis. The females, married people, and patients aged 21-40 years old were more susceptible to ambient temperature. These findings suggest that more attention should be paid to the impact of high ambient temperature on acute appendicitis in the future.

Ambulatory Laparoscopic Appendectomy: Does the Conventional Approach Need a Reappraisal?

A Deucalione, acute abdomen remains significant in abdominal pain. The entity of acute abdomen accounts for up to 10% of all emergency admissions. The differences between countries' income and level of prosperity are pertinent, particularly in terms of severity, radiological modalities, and surgical management of the condition. Of note, surgical modalities have been the most widely used treatment modality, and current evidence indicates that the laparoscopic approach, per se, is the most effective surgical therapy with a lower incidence of wound infection, post-intervention morbidity, shorter hospital stay, and better quality of life scores compared to the conventional method. In light of this, the present study aimed to evaluate ambulatory appendectomy in a series of sequential laparoscopic appendectomies (LApp), which included both complicated and uncomplicated cases.

A rare case of appendiceal tip complete attachment to a sigmoid diverticulum: An appendiceal phlegmon case report

INTRODUCTION

Appendiceal phlegmon is defined as an inflammatory mass, consisting of the inflamed appendix, enclosed by adjacent viscera and the greater omentum in 2 % to 10 % of patients with acute appendicitis.

CASE PRESENTATION

A 24-year-old female presented to the hospital with chief complaints of fever, nausea, vomiting, and pain over the right lower quadrant of the abdomen for two days. In the local examination, tenderness and rebound tenderness were detected. Ultrasonography and abdominal CT scan indicated appendiceal phlegmon. After seven weeks of receiving a course of antibiotics with complete resolution of her symptoms, she underwent elective laparoscopic appendectomy. During surgery, the appendiceal tip was completely attached and fused to a sigmoid diverticulum, which has not been reported elsewhere. The appendix was completely removed, and the patient was discharged from the hospital in a good general condition after two days.

DISCUSSION

Acute appendicitis can cause serious complications, such as ruptured appendix, abscess, or phlegmon. In most cases, inflammation and infection resolve by antibiotic administration. In some cases perforation of the inflamed appendix and local abscess or diffuse peritonitis formation, which requires immediate percutaneous drainage or surgery as indicated. Theoretically, the inflamed appendix can cause adhesive damage to the adjacent organs; however, there is no particular report on this type of damage.

CONCLUSION

This rare case suggests that during phlegmon formation and related inflammation, other complications such as fistula formation, are theoretically expected.

Exploring the trends of acute appendicitis following recovery or vaccination from COVID-19

Introduction

The relationship that vaccination against corona virus disease 19 (COVID-19) or recovery from the acute form of the illness may have with the incidence or severity of acute appendicitis (AA) has not been explored. The aim of this study was to evaluate this relationship.

Methods

A single centre retrospective study of all consecutive adult patients presenting with AA in the 6 mo after the initiation of a national vaccination program was performed. The presenting characteristics and pathological data of patients who had either been vaccinated against or recovered from COVID-19 were compared with those who had not. In addition, historical data from the equivalent period 12 and 24 mo beforehand was also extracted. The incidence of AA was compared between each of these time-frames.

Results

Of the 258 patients initially identified, 255 were included in the analysis of which 156 had either been vaccinated and/or recovered from COVID-19 (61.2%) whilst 99 (38.8%) patients had not. When comparing these two groups, there were no significant differences in the presenting characteristics, operative findings or postoperative courses. There was also no significant change in the incidence of AA when comparing the study dates with historical data (median weekly incidence of AA 8.0 versus 8.0 versus 8.0 respectively, P = 0.672).

Conclusions

Based on the data presented here, we failed to find a relationship between a national vaccination program and both the nature and incidence of AA presenting to a busy urban hospital.

Incidence of appendicitis during COVID-19 lockdown: A nationwide population-based study

AIM

To investigate how a nationwide lockdown influences the incidence of appendicitis.

BACKGROUND

Communitive infectious diseases may play a role in the pathogenesis of appendicitis as indicated by a seasonal variation in the incidence rate. The spread of communitive infectious diseases has decreased during the COVID-19 pandemic lockdown; thus, we have an opportunity to study the incidence rate of appendicitis in an environment with less impact from common community infections.

METHODS

The study is a nationwide register-based cohort study of the entire Danish population of 5.8 million. The difference in the incidence of appendicitis in a population subjugated to a controlled lockdown with social distancing (study group) was compared to a population not subjugated to a controlled lockdown and social distancing (reference group).

RESULTS

The relative risk of appendicitis during the lockdown was 0.92 (95% confidence interval (CI): 0.82-1.03, p = 0.131). The relative risk of complicated appendicitis during the lockdown was 0.68 (95% CI: 0.49-0.93, p = 0.02). The incidence of uncomplicated appendicitis was not significantly different during the national lockdown.

CONCLUSIONS

During the national lockdown of Denmark due to the COVID-19 pandemic the incidence of complicated appendicitis was reduced significantly compared to previous years, indicating that infectious disease might be a factor in the pathogenesis of appendicitis with complications.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (NCT04407117).

Incidence of Pediatric Perforated Appendicitis during the COVID-19 Pandemic; a Systematic Review and Meta-Analysis

INTRODUCTION

COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooled event rate of pediatric perforated appendicitis before and during the COVID-19 pandemic.

METHODS

This was a systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, and PubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect and depict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3.

RESULTS

Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforated appendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%. In the COVID era, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a significant difference in the subgroup analysis within the pre-COVID and COVID era (P<0.001), showing a higher perforation rate in the COVID era.

CONCLUSION

Our study showed that during the COVID-19 pandemic, the rate of perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study

BACKGROUND

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, outcomes and management of many diseases have been affected. Acute appendicitis is a common acute abdomen. The incidence rate is 0.05%-0.5%. Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic. People avoided going to the hospital for fear of being infected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The Chinese government also published some temporary measures in order to prevent the outbreak.

AIM

To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.

METHODS

Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed. Cases were grouped according to admission year. The demographic characteristics, present illnesses, medical history, symptoms and signs, comorbidities, blood test results, imaging data, appendix pathology, and treatment details were compared.

RESULTS

Overall, 74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019, whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020. Fever, thick appendix, nonsurgical management, and uncomplicated appendicitis (simple or supportive appendicitis) were more common in group 2020 (P < 0.05). Among the nonsurgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and recurrence rate were higher in group 2020 (P < 0.05). Among surgically managed cases, there were more cases with gastrointestinal symptoms, peritonitis, ascites in the image, and intraoperative adhesion or ascites in group 2020 (P < 0.05). The white blood cell count, time from diagnosis to surgery, surgical time, and intraoperative blood loss were higher in group 2020 (P < 0.05).

CONCLUSION

During the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of postsurgical complications did not change.

Seasonal Variation and Severity of Acute Abdomen in Japan: A Nine-Year Retrospective Analysis

The seasonal incidence of acute abdomens, such as appendicitis, is reportedly more common in summer but is reported less frequently in Asia. Additionally, seasonal variations in the severity of acute abdomens have been evaluated insufficiently. This study evaluated the seasonal variations in the incidence and severity of acute abdomens in Japan. This retrospective observational study used a multicenter database containing data from 42 acute hospitals in Japan. We included all patients diagnosed with acute appendicitis, diverticulitis, cholecystitis, and cholangitis between January 2011 and December 2019. Baseline patient data included admission date, sequential organ failure assessment score, presence of sepsis, and disseminated intravascular coagulation. We enrolled 24,708 patients with acute abdomen. Seasonal admissions for all four acute abdominal diseases were the highest in summer [acute appendicitis, (OR = 1.35; 95% CI = 1.28-1.43); diverticulitis, (OR = 1.23; 95% CI = 1.16-1.31; cholecystitis (OR = 1.23; 95% CI = 1.11-1.36); and cholangitis (OR = 1.23; 95% CI = 1.12-1.36)]. The proportion of patients with sepsis and disseminated intravascular coagulation as well as the total SOFA score for each disease, did not differ significantly across seasons. Seasonal variations in disease severity were not observed.

The effect of climate and air pollution on the development of complicated appendicitis

<b>Aim:</b> The aim of this study was to examine whether there is a relationship between complicated appendicitis and seasons, weekends, and air pollution. </br></br> <b> Materials and methods:</b> Patients who had undergone appendectomy in the last three years due to acute appendicitis were filtered from the database. Patients’ demographic features, date of the surgery, pathology reports, data on atmospheric temperatures, atmospheric pressure, relative humidity, and air pollution on the date of the surgery were collected and compared between complicated and non-complicated appendicitis groups. </br></br> <b>Results:</b> Out of 360 patients, 238 were men. The median age was 39 years for women and 29 years for men. Complicated appendicitis was seen in 78 (21.7%) patients, and the incidence rates were similar between the sexes (p = 0.69); this rate increased with increasing age (p = 0.001). The day of the week in which the surgery was performed (p = 0.55) and weekdays versus weekends (p = 0.16) did not change the complicated appendicitis incidence rate. This rate was similar among seasons (p = 0.44), temperature (p = 0.81), humidity (p = 0.62), and atmospheric pressure (p = 0.95). There was no difference between the groups for all noxious gases or PM2.5 levels, but for PM10 levels there was a significant difference (p = 0.045). In multivariate analysis, age (p = 0.001) and PM10 air pollution (p = 0.045) significantly affected the development of complicated appendicitis. </br></br> <b>Conclusions:</b> Air pollution of PM10 may have a real effect on the incidence of complicated appendicitis.

Seasonal variation of acute appendicitis: An Armed Forces experience of high altitude

Background

Lifetime prevalence of Acute Appendicitis is about 6-7%.The seasonal variation is nearly an established fact with most of the studies suggesting that cases are more in summer and during the rainy season. There are few studies globally for evaluating the impact of altitude and temperature on the incidence of acute appendicitis. In India no such study has been reported. With this in view, a study was conducted on the incidence of acute appendicitis to evaluate the effect of absolute temperature in high altitudes >10000 ft.

Methods

Retrospective data collected for a period of five years from 2015 to 2019 for the three centres of Armed Forces, located at high altitude 10,500, 11,500 and 12,000 ft respectively and the three temperature categories viz.< 0 °C, 0-20 °C and >20 °C were made to infer if there is any correlation between these parameters.

Results

A total of 317 cases were operated in a period of 05 yrs at the three centres. In the three categories of temperature viz < 0 °C, 0-20 °C and >20 °C the total number of cases were 84,124 and 109 respectively over period of 5 yrs. The proportion of cases were maximum at altitude of 12000 ft. On evaluation of the effect of altitude and absolute temperature positive correlation is found.

Conclusion

The analysis of the maiden study that was conducted for high altitude and extreme cold climate in India indicated a positive correlation of the altitude and the effect of absolute temperature on the occurrence of cases of Acute Appendicitis.

Seasonal Variation in Generic and Disease-Specific Health-Related Quality of Life in Rhinologic Patients in Southern Finland

Background: Seasonal variation in exacerbations, hospitalisations, and mortality statistics has been reported for some diseases. To our knowledge, however, no published studies exist on the seasonality of health-related quality of life (HRQoL) amongst rhinologic patients. Aims/Objectives: This study, therefore, aimed to investigate the possible seasonal variation in rhinologic patients’ HRQoL using the rhinologic disease-specific Sino-Nasal Outcome Test-22 (SNOT-22) and the generic 15D HRQoL instrument. Material and Methods: We enrolled unselected adult rhinologic patients requiring specialist care at the Helsinki University Hospital in this cross-sectional, questionnaire-based prospective study during four seasons: February (winter), May (spring), August (summer), and November (autumn). Patients received SNOT-22 and 15D questionnaires via post. The Finnish Meteorological Institute supplied climate data from these months. Results: SNOT-22 and 15D data were available for 301 and 298 patients, respectively. We found no statistically significant differences (p = 0.948) between the mean monthly 15D scores or mean SNOT-22 scales. Furthermore, the mean SNOT-22 subscales did not differ between the monthly study periods. Conclusions and Significance: Our study shows that seasonality did not impact rhinologic patients’ SNOT-22 or 15D HRQoL scores. Thus, these questionnaires can be used for follow-up amongst rhinologic patients regardless of season.

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care. Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group. Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018-2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018-2019 (p = 0.0165, Fisher's exact test). Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.

Seasonal Variation in Cases of Acute Appendicitis

Objectives

To investigate whether the incidence of acute appendicitis increases in summer and whether complicated cases present more in summer.

Methods

A single-center cross-sectional, retrospective study on 697 cases of appendicitis admitted in the year 2018. Inclusion criteria: patients admitted with acute appendicitis who underwent appendectomy of all ages. Exclusion criteria: conservative management. Analysis was performed using Microsoft Excel. Pearson correlation coefficient was calculated to assess the correlation between monthly incidence of appendicitis and mean temperature in that month.

Results

Fifty-one patients who were managed conservatively were excluded. Accordingly, 646 patients were included. Ages ranged from three to 77 years. Males comprised the majority (500, 77.4%). Gangrenous, perforated, and purulent appendices were regarded as complicated appendicitis. The highest number of cases were admitted in summer (234), comprising 36.2% of cases. Complicated cases were equal to 65, of which 23 (35.4%) were admitted in summer and 30 (46.2%) in winter. The highest number of cases was during the month of July (68), while the lowest (40) was during February. This corresponded to the highest recorded mean temperature (36.2°C) and second lowest (19.8°C), respectively. Moderate positive correlation (Pearson's R 0.5183) between the monthly incidence of appendicitis and the mean temperature is noted.

Conclusion

More cases of appendicitis were noted during summer. Monthly incidence correlated positively with the temperature. Larger numbers over several years are needed to draw better conclusions and reach the possible causes behind such variation.

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

BACKGROUND AND AIMS

Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy.

METHODS

This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients.

CONCLUSIONS

The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study

BACKGROUND

Our aim is to compare the management approaches and clinical outcomes of acute appendicitis according to annual Gross National Income per Capita (GNI/Capita) of countries.

METHODS

Consecutive patients who were diagnosed to have acute appendicitis from 116 centers of 44 countries were prospectively studied over a 6-month period (April-September 2016). Studied variables included demography, Alvarado score, comorbidities, radiological and surgical management, histopathology, and clinical outcome. Data were divided into three groups depending on the GNI/Capita.

RESULTS

A total of 4271 patients having a mean (SD) age of 33.4 (17.3) years were studied. Fifty-five percent were males. Two hundred and eighty patients were from lower-middle-income (LMI) countries, 1756 were from upper-middle-income (UMI) countries, and 2235 were from high-income (HI) countries. Patients in LMI countries were significantly younger (p < 0.0001) and included more males (p < 0.0001). CT scan was done in less than 8% of cases in LMI countries, 23% in UMI countries, and 38% in HI countries. Laparoscopy was performed in 73% of the cases in the HI countries, while open appendectomy was done in more than 60% of cases in both LMI and UMI countries (p < 0.0001). The longest mean hospital stay was in the UMI group (4.84 days). There was no significant difference in the complication or death rates between the three groups. The overall death rate was 3 per 1000 patients.

CONCLUSIONS

There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis that is related to country income. A global effort is needed to address this variation. Individual socioeconomic status could be more important than global country socioeconomic status in predicting clinical outcome.

Association of meteorological factors with pediatric acute appendicitis in China: A 7-year retrospective analysis

Acute appendicitis (AA) affects between 7% and 8% of the world population and is one of the most common general surgical emergencies. The concept of seasonal patterns in the incidence of AA remains controversial. Thus, this study aimed to investigate whether meteorological factors are related to variations in the rate of pediatric AA cases at the Children's Hospital in Chongqing, China.In total, in this retrospective survey, 3436 children younger than 18 years who had been hospitalized with AA from January 1, 2008 to December 31, 2013 were enrolled, and the meteorological factors during this period were collected.Patients with AA showed a male/female ratio of 1.81:1; the highest incidence age ranged from 6 to 12 years old (P < .0001). The highest incidences of pediatric AA occurred in summer and autumn, with a peak in September and a trough in February. Pearson correlation analysis showed that the monthly mean temperature (r = 0.357, P = .001), monthly mean relative humidity (r = -0.357, P = .001), and monthly mean sunshine duration (r = 0.235, P = -0.031) were relatively weak correlated with pediatric AA. Multiple linear regression analysis indicated that pediatric AA occurrence was positively affected by monthly mean temperature (P < .0001) and negatively affected by monthly mean humidity (P < .0001) and monthly sum of sunshine (P < .0001), while monthly mean air pressure (P = .092), monthly wind speed (P = .143) and monthly precipitation (P = .297) were marginally associated with pediatric AA.Pediatric AA is associated with climatic factors. Specifically, pediatric AA is more likely related to the following meteorological conditions of: high temperature (20 °C-30 °C), low humidity, and less sunshine.

[Seasonal variation in surgical diseases : Is an economic resource management necessary?]

BACKGROUND

The registration of diagnoses and diagnose-related groups (DRG) allows conclusions to be drawn about the distribution over the course of the year. Seasonal variations can be recognized and used to plan further resource management.

METHODS

From 2006 to 2016 a total of 30,999 main diagnoses and DRGs were registered at the hospital for visceral surgery of the University Medical Hospital in Leipzig. The data were sorted on a monthly and seasonal basis and compared to meteorological data received from the German Meteorological Service. Furthermore, epidemiological information about the patients was recorded.

RESULTS

The most frequently registered main diagnosis was malignant neoplasms of the liver and intrahepatic bile ducts with 1589 cases (C22), followed by acute appendicitis with 1557 cases (K35). There was a significant seasonal and monthly variation for cholelithiasis (K80) with 1013 cases (p = 0.002⁺⁺), inguinal hernia (K40), 887 cases (p = 0.002⁺⁺), ventral hernia (K43), 696 cases (p < 0.001⁺⁺) and varices of the lower limbs (I83), 352 cases (p < 0.001⁺⁺). A similar correlation could be shown for daily sunshine hours and case numbers for patients with the main diagnosis groups I83 (r = -0.12, p = 0.036⁺) and K43 (r = -0.08, p = 0.041⁺). Another significant correlation was observed between patients' epidemiological information and medical data: patient-related clinical severity (PCCL) ~ age (r = 0.27, p < 0.001⁺⁺), length of hospital stay ~ age (r = 0.25, p < 0.001⁺⁺), duration of ventilation ~ age (r = 0.07, p < 0.001⁺⁺) and mortality ~ age (r = 0.09, p < 0.001⁺⁺).

CONCLUSION

A seasonal variation in case numbers for individual main diagnoses could be registered and elective and therefore plannable surgeries were mostly affected. An adequate resource management can reveal economic benefits. Older patients consume a high amount of resources and should be given a higher priority.

Seasonal Variation in the Prevalence of Common Orthopaedic Upper Extremity Conditions

Introduction  Seasonal variation in disease processes and injuries have been reported, but it is unclear if this variation exists in upper extremity disorders. The goal of this study is to characterize seasonal and weather variations in common upper extremity orthopaedic conditions. Methods  This cross-sectional study reviewed 68,943 consecutive, new patient visits from January 2010 to September 2015 for carpal tunnel syndrome (CTS), trigger finger (TF), DeQuervain's tenosynovitis (DeQ), lateral epicondylitis (LE), hand arthritis (OA), and distal radius fractures (DRF). Presentation rates for each condition were compared across month, season, and various weather parameters. Results  DRF, OA, and LE had a higher rate of presentation in the winter compared with all other seasons ( p  < 0.001). TF and DeQ showed no statistically significant seasonal differences. Higher barometric pressures were associated with higher rates of all of the diagnoses. Higher humidity was associated with lower rates of CTS, TF, DeQ, LE, and DRF ( p  < 0.001). There was no significant association between temperature levels or amount of precipitation. Discussion  Although the precise mechanism remains unclear, there does appear to be an impact of winter, increased barometric pressure, and higher humidity on presentation rates. Further studies are needed to determine more conclusively why this occurs. Level of Evidence  Level IV, cross-sectional study.

Occurrence and Treatment of Pediatric Appendicitis in Finland 2004-2014

BACKGROUND

We aimed to investigate the trends in occurrence and the treatment approaches of appendicitis in Finnish children.

MATERIAL AND METHODS

All patients aged <16 y hospitalized for appendicitis in Finland in 2004-2014 were included. Data were retrospectively collected from the Finnish Care Register for Health Care and Statistics Finland.

RESULTS

Altogether 8494 children were hospitalized for appendicitis, with standardized incidence rate of 80.7 (95% confidence interval 79.0-82.0)/100,000 person years. The incidence rate of appendicitis decreased by 3.3% per year during the study period. Appendicitis was more common with increasing age, in boys compared to girls at 8 to 15 y of age, and during the summer compared to the other seasons. Most children (83.2%) were treated with conventional open appendectomy, but laparoscopic appendectomies were slowly increasing during the study period. The length of hospital stay (LOS) was shorter in boys than girls, in those treated laparoscopically, and in those with uncomplicated appendicitis. There was no significant seasonal variation in the LOS. However, the LOS decreased during the study period.

CONCLUSIONS

The incidence of pediatric appendicitis is decreasing, and there is a decreasing trend in LOS. While still relatively rare in the Finnish pediatric surgical centers, the use of laparoscopic appendectomy is increasing.

Seasonal variation of acute appendicitis

Objective:

To determine the seasonal variation of acute appendicitis.

Methods:

A total of 320 patients fulfilling the inclusion criteria were enrolled in the study after getting the written informed consent. Appendectomies were performed by consultant surgeons and residents. After surgery histopathological examination of specimens was performed by consultant Histopathologists at Armed Forces Institute of Pathology Rawalpindi and CMH Peshawar. The patients presenting in different four seasons September to November as autumn, December to February as winter, March to May as spring, June to August as summer, were compared to determine seasonal variations.

Results:

In our study out of all 320 patients 188 (58.75%) were males and 132 (41.25%) were females. Sixty patients (18.75 %) presented in autumn season (Sep-Nov), 52 patients (16.25%) in winter season (Dec-Feb), 78 (24.25%) patients in Spring season (Mar-May).130 (40.62%) patients presented in Summer season (Jun-Aug). There was almost 24.37% increased incidence in summer as compared to winter season, 21.87% increased incidence as compared to autumn season, 16.37% increased incidence as compared to spring season.

Conclusion:

Acute appendicitis incidence is increased in summer months in Pakistan. Preventive measures can be taken during summer season (June to Aug) to decrease morbidity and mortality associated with this disease.

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.

Lower Abdominal Pain

Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation.

Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study

INTRODUCTION

This paper presents an epidemiologic study of appendicitis in Taiwan over a twelve-year period. An analysis of the incidence in the low-income population (LIP) is included to explore the effects of lower socioeconomic status on appendicitis.

METHODS

We analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database (NHIRD) from 2000 to 2011. All cases diagnosed as appendicitis were enrolled.

RESULTS

The overall incidences of appendicitis, primary appendectomy, and perforated appendicitis were 107.76, 101.58, and 27.20 per 100,000 per year, respectively. The highest incidence of appendicitis was found in persons aged 15 to 29 years; males had higher rates of appendicitis than females at all ages except for 70 years and older. Appendicitis rates were 11.76 % higher in the summer than in the winter months. A multilevel analysis with hierarchical linear modeling (HLM) revealed that male patients, younger patients (aged ≤14 years), and elderly patients (aged ≥60 years) had a higher risk of perforated appendicitis; among adults, the incidence increased with age. Moreover, the risk of perforation was higher in patients with one or more comorbidities. LIP patients comprised 1.25 % of the total number of patients with appendicitis from 2000 to 2011. The overall incidence of appendicitis was 34.99 % higher in the LIP than in the normal population (NP), and the incidence of perforated appendicitis was 40.40 % higher in the LIP than in the NP. After multivariate adjustment, the adjusted hospital costs and length of hospital stay (LOS) for the LIP patients were higher than those for the NP patients.

CONCLUSIONS

Appendicitis and appendectomy in Taiwan had similar overall incidences, seasonality patterns, and declining trends compared to numerous previous studies. Compared to NP patients, LIP patients had a higher risk of appendicitis, longer LOS and higher hospital costs as a result of appendectomy.

Epidemiology of appendicitis and appendectomy for the low-income population in Taiwan, 2003-2011

Background

Although numerous epidemiological studies on appendicitis have been conducted worldwide, only a few studies have paid attention to the effect of socioeconomic status on appendicitis, particularly studies focusing on the low-income population (LIP).

Methods

We analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database from 2003 to 2011. All cases diagnosed as appendicitis were enrolled.

Results

Between 2003 and 2011, 2,916 patients from the LIP and 209,206 patients from the normal population (NP) were diagnosed with appendicitis. Our finding revealed that the ratios of comorbidities, complicated appendicitis, and readmissions in LIP patients were slightly higher than those of NP patients. LIP patients were more likely to live in suburban and rural areas, and hence a higher proportion of them were hospitalized in a district or regional hospital compared with NP patients. The crucially finding was that the overall incidence ratios of appendicitis, acute appendicitis, and perforated appendicitis in the LIP were substantially higher than those in the NP (36.25%, 35.33%, and 37.28%, respectively). The mean LOS in LIP patients was longer than that of NP patients. The overall case-fatality ratio of appendectomy in the LIP was higher when compared with the NP (0.41% versus 0.12%, p < 0.05). We also observed that appendicitis was occurred frequently in male patients, with a higher incidence for those aged 15–29 years in both the LIP and NP. The incidences of incidental appendectomy showed a decreasing trend in both the LIP and NP. Finally, a valuable discovery was that the total hospital cost was comparable between the laparoscopic appendectomy (LA) and open appendectomy (OA) (1,178 ± 13 USD versus 1,191 ± 19 USD, p < 0.05) in LIP patients because they saved more hospitalization costs than NP patients when the previous one chose the LA.

Conclusion

This study confirmed that a lower socioeconomic status has significantly negative impact on the occurrence and treatment of appendicitis and appendectomy. In terms of hospital costs and LOS, LIP patients benefit more from the LA approach than they do from the OA approach in the treatment of appendicitis.