Original Article

Complications after appendectomy in patients with treated

appendicitis: results from a retrospective study
Tie Wu1, Yinxi Yang2, Yifeng Wu2, Lijun Lu2, Sheng Dong1
1
Department of Emergency Surgery, Wuxi No. 9 People’s Hospital Affiliated to Soochow University, Wuxi, China; 2Department of General Surgery,
Wuxi No. 9 People’s Hospital Affiliated to Soochow University, Wuxi, China
Contributions: (I) Conception and design: S Dong; (II) Administrative support: T Wu; (III) Provision of study materials or patients: Y Yang, Y Wu;
(IV) Collection and assembly of data: L Lu; (V) Data analysis and interpretation: T Wu; (VI) Manuscript writing: All authors; (VII) Final approval of
manuscript: All authors.
Correspondence to: Sheng Dong, MD. Department of Emergency Surgery, Wuxi No.9 People’s Hospital Affiliated to Soochow University, 999 Liangxi
Road, Wuxi, China. Email: [email protected].

Background: This study was designed to provide additional insights into the incidence of appendectomy
complications in patients with appendicitis.
Methods: A total of 619 patients who underwent appendectomy for appendicitis between 2014 and
2020 were recruited. Preoperative patient data and details of postoperative complications were collected.
Comparisons between simple and complex appendicitis were obtained via univariate and multivariate
analyses of the outcomes.
Results: Simple and complex appendicitis was diagnosed in 192 and 427 patients, respectively. Twenty-
eight patients with simple appendicitis developed complications, and 14 of these were infectious
complications. In patients with complex appendicitis, 65 patients developed complications, and 55 of
these were infectious complications. Infectious complications were identified as the largest proportion of
complications. The significant risk factor for infectious complications in simple appendicitis was American
Society of Anesthesiologists (ASA) grade [odds ratio (OR) =7.843, 95% confidence interval (CI): 1.987–
30.955, P=0.003]. ASA grade (OR =1.992, P=0.032) and positive bacterial culture (OR =4.019, 95% CI:
1.809–8.933, P=0.001) were significantly related to infectious complication in complex appendicitis.
Conclusions: This study showed that appendectomy is not always a routine operation with few
complications. There was a relatively high rate of complications in patients with appendicitis, which were
mostly infectious complications. A higher ASA grade correlated with infectious complication. In some cases
of complex appendicitis, patients with positive bacterial culture may have had a greater risk of infectious
complications.

Keywords: Appendectomy; appendicitis; complications; infectious complications

Submitted Oct 21, 2021. Accepted for publication Nov 25, 2021.
doi: 10.21037/apm-21-3295
View this article at: https://dx.doi.org/10.21037/apm-21-3295

Introduction Many studies have shown that, in patients with

appendicitis, the presence of complications is an important
Appendicitis, which has an estimated lifetime risk
of morbidity of 7–8%, is one of the most common risk factor can influence the prognosis of patients
gastrointestinal diseases worldwide (1). As a result, following after appendectomy (3,4). Currently, the
appendectomy has become one of the most frequently diagnosis-related group (DRG)-based payment system for
performed operations, causing a significant burden on the appendicitis, including complex cases, is widely used to cost
modern health system (2). containment (5). In order to both optimize and

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
Annals of Palliative Medicine, Vol 10, No 12 December 2021 12547

reduce the cost of treatment for appendicitis, more Perioperative management

information about the incidence of complications after
Both open and laparoscopic surgical approaches for
appendectomy is needed. In recent years, the classification
appendectomy were performed. Open abdominal
of acute appendicitis into two types has become well
appendectomy was performed using a McBurney incision,
established: simple appendicitis (uncomplicated/non-
and the conventional three-port method was used for
perforating) and complex appendicitis (perforating or
laparoscopic appendectomy. We considered the conversion
necrotizing) (6). However, existing studies show uneven
from laparoscopic to open abdominal appendectomy as a
quality and high variance in two types of appendicitis,
laparoscopic appendectomy. Routine standardized bacterial
with reported complication rates ranging from 5–20% and
cultures were taken: (I) following surgery, the contents of
even up to 31.4% (7-9). Complications were defined as
the appendix cavity were wiped; and (II) bacterial culture
any deviation from the stable postoperative course during
specimens were taken from abscess fluid in patients with
hospitalization. The most common complications after
periappendicular abscess (10). Empirical antibiotics were
appendectomy included: surgical site infection (SSI), ileus,
administered to every patient preoperatively. When
and intra-abdominal abscess (IAA). Other complications
a patient was suspected of appendicitis by physical
included fever, urethral infection, urine retention, and
examination and abdominal computed tomography (CT)
other rare circumstances. While the results of an ongoing
scan, third-generation cephalosporins (cephamycins) with
randomized-controlled trial are not yet available, we are
or without ornidazole (metronidazole, morinidazole) were
now able to benefit from the appendicitis data that have
given intravenously. For patients who were suspected of
been generated thus far.
having more severe infection, wide-spectrum antibiotics
Therefore, the aim of this retrospective study was
were selected, including quinolones, aminoglycosides, or
to provide additional insight into complications after
meropenem.
appendectomy in order to improve treatment and care
in patients with appendicitis. We present the following
article in accordance with the STROBE reporting checklist Outcomes
(available at https://dx.doi.org/10.21037/apm-21-3295).
Patients were divided into 2 groups based on perioperative
diagnosis and postoperative histopathological examination
Methods in accordance with the classification system devised by
Bhangu et al. (6). The first group comprised patients
Patients
with simple, non-perforated appendicitis, and the second
Patients who underwent appendectomy at our surgical group included patients with complex appendicitis,
center for appendicitis between 2014 and 2020 were either gangrenous, perforated, or IAA. The mainstay
enrolled in the study. We collected perioperative of this study was complications after appendectomy.
data and details of postoperative complications from Complications were defined as any deviation from the
electronic patient files. Non-surgical treatment of patients stable postoperative course during hospitalization.
with suspected appendicitis were excluded. Clinical Complication severity was graded in accordance with the
features, including sex, age, and American Society Clavien-Dindo classification system (11). Complications
of Anesthesiologists (ASA) score were collected, and were also categorized as less severe (Clavien-Dindo I–II)
postoperative complications and perioperative files were or severe (Clavien-Dindo III–IV) (12). The most common
retrospectively reviewed. Ethical approval was waived by complications after appendectomy included: surgical
the local Ethics Committee as the observational nature site infection (SSI), which was divided into superficial
of the study and all the procedures being performed (inflammation in the skin or the subcutaneous tissue) or
were part of the routine care. Individual consent for this deep (inflammation in deep soft tissues of the incision, such
retrospective analysis was waived. This study was conducted as the muscles, fascia and tissue around it); ileus, which
in accordance with the ethical standards of our hospital was defined as not resuming bowel movements within
academic committee and with the Declaration of Helsinki (as 5 days of the intervention; and IAA confirmed by CT scan
revised in 2013). or collection of pus in the abdomen. Only complications

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
12548 Wu et al. Complications in patients with appendicitis

that occurred during a patient’s hospital stay were included Table 1.

in this study.

Complications
Statistical analysis
Of the 619 patients, 93 (15.0%) developed postoperative
Descriptive statistics were carried out using IBM SPSS complications. The number of Clavien-Dindo grade
version 24.0 (SPSS Inc., Chicago, IL, USA). We used I, II, III, IV, and V complications were 34 (36.6%), 51
medians with interquartile ranges (IQR) for non-normally (54.8%), 4 (4.3%), 4 (4.3%), and 0 (0%), respectively
distributed continuous data. To discover predictive factors ( F i g u re 1 ) . I n p a t i e n t s w i t h s i m p l e a p p e n d i c i t i s ,
for infectious complications, differences in clinicopathologic complications occurred in 28 out of 192 (14.6%) patients,
characteristics were assessed using the Student’s test, χ2 test, of which 23 were severe (Clavien-Dindo III–IV). In
or Fisher’s exact test. A multivariate logistic regression was patients with complex appendicitis, 65 out of 427 (15.2%)
carried out for all useful variables in the univariate analysis. patients experienced complications, and 36 of those were
The level of statistical significance was P<0.05 (two-tailed) severe (Clavien-Dindo III–IV) (P=0.014). Among patients
for each test. with common postoperative complications, 69 patients
developed infectious complications, which were identified
as the largest proportion of complications, with 14 cases
Results in the simple appendicitis group and 55 in the complex
Patients’ general and perioperative characteristics appendicitis group (P=0.041). Complex appendicitis was
a risk factor for infectious complication. Details of the
A total of 619 patients who primarily presented at our postoperative complications are listed in Table 2.
center with appendicitis and subsequently underwent In total, we identified more than 10 types of different
appendectomy were included in the study. The average age postoperative complications that occurred within 30 days
was 40.7 years (range, 7–93 years). There were 307 (49.6%) of the operation, with infectious complication the most
female and 312 (50.4%) male patients. The ASA grade was common. Statistical analysis conducted after patients were
≥2 in 124 (20.0%) patients. Appendectomy was performed stratified by type of appendicitis (simple and complex) and
laparoscopically in 479 (77.4%) of the patients. Of the 558 type of postoperative complication (infectious complication
(90.1%) patients who had standardized bacterial cultures, and without infectious complication) yielded potentially
274 (44.3%) had positive culture results. The median length important findings. The factors linked to infectious
of hospital stay was 7 days [interquartile range (IQR), 6–9 complications are presented in Tables 3,4. In the simple
days]. There was no 30-day postoperative mortality in this appendicitis group, ASA grade was associated with infectious
study. Simple appendicitis was diagnosed in 192 (31.0%) complications after univariable analysis. In the complex
patients, while complex appendicitis was diagnosed in 427 appendicitis group, ASA grade, age, and positive bacterial
(69.0%) patients. culture were associated with infectious complications
In the simple appendicitis group, the proportion of after univariable analysis. To appraise the variable with
women was significantly higher, with 55.7% (n=107). The the greatest force on the development of an infectious
complex appendicitis group comprised significantly more complication, logistic regression analysis was carried out. All
male patients (53.2%, n=227, P=0.041). There was no useful variables were included (age, gender, ASA grade, type
significant difference in ASA grade between the two groups of surgery, and bacterial culture). In multivariable analysis,
(P=0.902). Type of surgery (P=0.080) and hospital stay ASA grade was also significantly associated with infectious
(P=0.259) were not significantly different in the simple and complications in the simple appendicitis group [odds ratio
complex appendicitis groups. There was also no significant (OR) =7.843, 95% confidence interval (CI): 1.987–30.955,
difference between the simple and complex appendicitis P=0.003]. In the complex appendicitis group, multivariable
groups in the total swabbed rate (P=0.076). Positive analysis revealed that ASA grade (OR =7.042, 95% CI:
bacterial culture rate showed significantly more severe 3.342–14.838, P=0.000) and positive bacterial culture (OR
inflammation in the complex appendicitis group (P=0.026). =4.019, 95% CI: 1.809–8.933, P=0.001) were significantly
General and perioperative characteristics are shown in related to infectious complications.

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
Annals of Palliative Medicine, Vol 10, No 12 December 2021 12549

Table 1 Patient demographic and perioperative data

Characteristics All (n=619) Complex (n=427) Simple (n=192) P

Age, mean [range], years 40.7 [7–93] 41.4 [7–93] 39.0 [8–85] 0.124

Sex, n (%) 0.041

Female 307 (49.6) 200 (46.8) 107 (55.7)

Male 312 (50.4) 227 (53.2) 85 (44.3)

ASA grade, n (%) 0.902

I 495 (80.0) 343 (80.3) 152 (79.2)

II 94 (15.2) 63 (14.8) 31 (16.1)

III 30 (4.8) 21 (4.9) 9 (4.7)

Type of surgery, n (%) 0.080

Laparoscopy 479 (77.4) 322 (75.4) 157 (81.8)

Open 140 (22.6) 105 (24.6) 35 (18.2)

Total swabbed, n (%) 558 (90.1) 391 (91.6) 167 (87.0) 0.076

Positive culture, n (%) 274 (44.3) 204 (47.8) 70 (36.5) 0.026

Hospital stay, median [IQR], days 7 [6–9] 8 [6–9] 7 [6–8] 0.259

Complication present, n (%) 93 (15.0) 65 (15.2) 28 (14.6) 0.837

Severity of complications 0.014

Less severe complications (Clavien-Dindo I–II), n (%) 34 (5.5) 29 (6.8) 5 (2.6)

Severe complications (Clavien-Dindo III–IV), n (%) 59 (9.5) 36 (8.4) 23 (12.0)

Infectious complications, n (%) 69 (11.1) 55 (12.9) 14 (7.3) 0.041

ASA, American Society of Anesthesiologists, IQR, interquartile range.

4.3%
4.3%

85% 15% 54.8% 36.6%

Without complications Complications (Clavien-Dindo classification)

I° II° III° IV°

Figure 1 Details of postoperative complications, including Clavien-Dindo grade I, II, III, IV.

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
12550 Wu et al. Complications in patients with appendicitis

Table 2 Complications in simple appendicitis versus complex appendicitis

Characteristics All (n=619) Complex (n=427) Simple (n=192) P

Complication present, n (%) 93 (15.0) 65 (15.2) 28 (14.6) 0.837

Severity of complications, n (%) 0.014

Less severe complications (Clavien-Dindo I–II) 34 (5.5) 29 (6.8) 5 (2.6)

Severe complications (Clavien-Dindo III–IV) 59 (9.5) 36 (8.4) 23 (12.0)

Infectious complications, n (%) 69 (11.1) 55 (12.9) 14 (7.3) 0.041

Table 3 Predictive factors associated with infectious complications in appendicitis

Simple Complex

Characteristics Patients with Patients without Patients with infectious Patients without
infectious infectious P complications infectious P
complications (n=14) complications (n=178) (n=55) complications (n=372)

Age, mean [range], years 47.1 [21–80] 38.4 [8–85] 0.074 50.9 [11–93] 40.1 [7–87] 0.000

Sex, n (%) 0.654 0.168

Female 7 (50.0) 100 (56.2) 21 (38.2) 179 (48.1)

Male 7 (50.0) 78 (43.8) 34 (61.8) 193 (51.9)

ASA grade, n (%) 0.000 0.000

I 4 (28.6) 148 (83.1) 20 (36.4) 328 (86.8)

II 9 (64.3) 22 (12.4) 24 (43.6) 36 (10.5)

III 1 (7.1) 8 (4.5) 11 (20.0) 8 (2.7)

Type of surgery, n (%) 0.691 0.244

Open 2 (14.3) 33 (18.5) 17 (30.9) 88 (23.7)

Laparoscopy 12 (85.7) 145 (81.5) 38 (69.1) 284 (76.3)

Total swabbed, n (%) 12 (85.7) 155 (87.1) 1.000 50 (90.9) 341 (91.7) 0.850

Positive culture, n (%) 5 (41.7) 65 (41.9) 0.985 38 (69.1) 166 (44.6) 0.000
ASA, American Society of Anesthesiologists.

Table 4 Logistic regression for infectious complications in simple and complex appendicitis
Classification Characteristics Odds ratio 95% CI P

Simple ASA grade 7.843 1.987–30.955 0.003

Complex ASA grade 7.042 3.342–14.838 0.000

Positive culture 4.019 1.809–8.933 0.001

ASA, American Society of Anesthesiologists.

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
Annals of Palliative Medicine, Vol 10, No 12 December 2021 12551

Discussion patient risk assessment protocol in anesthesiology (21).

The ASA classification represents a simple estimate of
Appendicectomy is one of the most common emergency
physiological status without the need for many additional
surgeries (13). Even though surgical techniques and
clinical resources and can be used with every patient prior
asepsis have improved, postoperative complications are
to surgery. Univariate analysis and logistic regression
responsible for a significant morbidity. Complications after
analysis were carried out for infectious complications. In
appendectomy can result in prolonged hospitalization,
the logistic regression analysis, ASA grade was a significant
increased medical expenses, and compromised overall
influencing factor. With each further level in ASA grade,
prognosis. In the current literature, the overall incidence
the risk for an infectious complication increased about 7
of complications after appendectomy vary. Postoperative
times in both appendicitis groups. ASA classification proved
complication events depend on disease severity, specific
to be a predictor of postoperative complications (22). This
degree of complications, detection methods, and
result was expected as ASA evaluated the preoperative
national geographical location. The overall postoperative
condition of the patient and provided a score that predicted
complication rate of 15% in our study was relatively
morbimortality, which is a risk factor for infectious
high compared with the current literature. The higher
complication (23).
incidence of complications in this study compared to the
Subgroup analysis also showed that in some cases of
literature can be explained by the use of strict definitions
complex appendicitis, patients with positive bacterial
for postoperative complications after appendectomy. While
culture may have had a greater risk of an infectious
many other studies have reported only the most common
complication. The bacterial growth in an inflamed
complications (i.e., SSI, IAA, ileus, and postoperative
appendix is formed from a mixture of aerobic and anaerobic
pyrexia) (14,15), we reported complications of any kind that
bacteria, often dominated by E. coli and Bacteroides
required a form of treatment. To evaluate the severity of the
genera (24). Notably, in line with Schlottmann et al., the
complications, we used Clavien-Dindo classification, which
higher the grade of intraperitoneal bacterial contamination,
is the most commonly used system for categorizing the
the higher the risk of infectious complications (25). Complex
severity of complications (16,17). The use of standardized
appendicitis proved to be an important predictor of risk for
reporting for the type of appendicitis (simple or complex)
postoperative complications (26). We hypothesized that
and complications, including explicit definitions for
there was a relationship between infectious complications
these complications and their severity, are key factors in
and bacterial translocation in patients with complex
improving the comparability of future studies.
appendicitis. Based on the physiopathology of appendicitis,
As patients with complex appendicitis had a higher risk
the number of luminal microbes, including E. coli, Klebsiella,
of complications in our study, the reporting of appendicitis
Bacteroides, Streptococcus and Pseudomonas, increases (27).
type and use of subgroup analysis were important for
Bacterial overgrowth aggravates mucosal damage, allowing
explaining the incidence of complications. Existing
microorganisms to easily enter the appendix cavity, the
studies frequently lack a definition of simple and complex
peritoneum, mesenteric lymph nodes, and even parenteral
appendicitis and also the incidence of each appendicitis type.
organs, causing infectious complications. This is easily
We chose to follow the most widely accepted definition of
detected as positive bacterial culture. Further research
complex and simple appendicitis. The results of this study
on the relationship between infectious complications and
suggested that for some patients, appendectomy is not
bacterial translocation in patients with complex appendicitis
always without complications, and more work needs to be
will need to be carried out in the future.
done to minimize complications after appendectomy.
The current study had some limitations. First, as
Infectious complications, at 11.1%, were the most
a retrospective study, it was inherently prone to bias.
common type of complication, and this is comparable to
Second, the study involved a very complex, heterogeneous
results reported by other studies (18-20). Statistical analysis
population of patients, scattered over a considerable period
after stratification of patients by type of appendicitis (simple
of time. Third, as we retrospectively collected the data
and complex) and by type of infectious complication
from the electronic medical record system, not all variables
yielded important findings. Although the ASA classification
of interest could be retrieved, which may have affected
was developed in 1941 by Saklad et al. for statistical
multivariate logistic regression analysis. Lastly, patients
data management, it has become the most widely used
did not undergo longer follow-up once symptoms had

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
12552 Wu et al. Complications in patients with appendicitis

disappeared following medical intervention. Open Access Statement: This is an Open Access article
distributed in accordance with the Creative Commons
Attribution-NonCommercial-NoDerivs 4.0 International
Conclusions
License (CC BY-NC-ND 4.0), which permits the non-
Our study found a relatively high rate of complications commercial replication and distribution of the article with
in patients with appendicitis. The most common were the strict proviso that no changes or edits are made and the
infectious complications. A higher ASA grade correlated original work is properly cited (including links to both the
with infectious complications. In some cases of complex formal publication through the relevant DOI and the license).
appendicitis, patients with positive bacterial culture See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
may have had a greater risk of infectious complications.
Patients at high risk should be carefully followed up for
References
early detection and treatment. An adequate perioperative
care should take immediate action in order to prevent 1. Stewart B, Khanduri P, McCord C, et al. Global disease
complications due to possible comorbidities. burden of conditions requiring emergency surgery. Br J
Surg 2014;101:e9-22.
2. Rickard J, Beilman G, Forrester J, et al. Surgical Infections
Acknowledgments
in Low- and Middle-Income Countries: A Global
Funding: This study was supported by hospital-level funding Assessment of the Burden and Management Needs. Surg
(Wuxi No.9 People’s Hospital) to Tie Wu (JY2021-07-10). Infect (Larchmt) 2020;21:478-94.
3. Fujishiro J, Watanabe E, Hirahara N, et al. Laparoscopic
Versus Open Appendectomy for Acute Appendicitis
Footnote
in Children: a Nationwide Retrospective Study
Reporting Checklist: The authors have completed the on Postoperative Outcomes. J Gastrointest Surg
STROBE reporting checklist. Available at https://dx.doi. 2021;25:1036-44.
org/10.21037/apm-21-3295 4. Siribumrungwong B, Chantip A, Noorit P, et al.
Comparison of Superficial Surgical Site Infection Between
Data Sharing Statement: Available at https://dx.doi. Delayed Primary Versus Primary Wound Closure in
org/10.21037/apm-21-3295 Complicated Appendicitis: A Randomized Controlled
Trial. Ann Surg 2018;267:631-7.
Conflicts of Interest: All authors have completed the ICMJE 5. Zhao C, Wang C, Shen C, et al. Diagnosis-related group
uniform disclosure form (available at https://dx.doi. (DRG)-based case-mix funding system, a promising
org/10.21037/apm-21-3295). Tie Wu reports this study was alternative for fee for service payment in China. Biosci
supported by hospital-level funding (Wuxi No.9 People’s Trends 2018;12:109-15.
Hospital) to Tie Wu (JY2021-07-10). The other authors 6. Bhangu A, Søreide K, Di Saverio S, et al. Acute
have no conflicts of interest to declare. appendicitis: modern understanding of pathogenesis,
diagnosis, and management. Lancet 2015;386:1278-87.
Ethical Statement: The authors are accountable for all 7. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic
aspects of the work in ensuring that questions related versus open surgery for suspected appendicitis. Cochrane
to the accuracy or integrity of any part of the work Database Syst Rev 2010;11:CD001546.
are appropriately investigated and resolved. Ethical 8. National Surgical Research Collaborative. Multicentre
approval was waived by the local Ethics Committee as the observational study of performance variation in provision
observational nature of the study and all the procedures and outcome of emergency appendicectomy. Br J Surg
being performed were part of the routine care. Individual 2013;100:1240-52.
consent for this retrospective analysis was waived. This 9. Andert A, Alizai HP, Klink CD, et al. Risk factors for
study was conducted in accordance with the ethical morbidity after appendectomy. Langenbecks Arch Surg
standards of the hospital research committee and with the 2017;402:987-93.
Declaration of Helsinki (as revised in 2013). 10. Song DW, Park BK, Suh SW, et al. Bacterial culture and

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295
Annals of Palliative Medicine, Vol 10, No 12 December 2021 12553

antibiotic susceptibility in patients with acute appendicitis. Necessary? A Post Hoc Analysis of the EAST Appendicitis
Int J Colorectal Dis 2018;33:441-7. "MUSTANG" Study. J Surg Res 2020;247:508-13.
11. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien- 19. Giesen LJ, van den Boom AL, van Rossem CC, et al.
Dindo classification of surgical complications: five-year Retrospective Multicenter Study on Risk Factors for
experience. Ann Surg 2009;250:187-96. Surgical Site Infections after Appendectomy for Acute
12. Knaapen M, van Amstel P, van Amstel T, et al. Outcomes Appendicitis. Dig Surg 2017;34:103-7.
after appendectomy in children with acute appendicitis 20. Panshin MS, Alnachoukati OK, Schroeppel TJ, et al.
treated at a tertiary paediatric centre: results from a Optimal Duration of Antibiotics Following Appendectomy
retrospective cohort study. Langenbecks Arch Surg for Patients With Complicated Appendicitis. Am Surg
2021;406:163-9. 2021;87:480-5.
13. Tartaglia D, Fatucchi LM, Mazzoni A, et al. Risk factors 21. Saklad M. Grading of patients for surgical procedures.
for intra-abdominal abscess following laparoscopic Anesthesiology 1941;2:281-4.
appendectomy for acute appendicitis: a retrospective cohort 22. Moreira LF, Garbin HI, Da-Natividade GR, et al.
study on 2076 patients. Updates Surg 2020;72:1175-80. Predicting factors of postoperative complications in
14. Werkgartner G, Cerwenka H, El Shabrawi A, et al. appendectomies. Rev Col Bras Cir 2018;45:e19.
Laparoscopic versus open appendectomy for complicated 23. Wolters U, Wolf T, Stützer H, et al. ASA classification
appendicitis in high risk patients. Int J Colorectal Dis and perioperative variables as predictors of postoperative
2015;30:397-401. outcome. Br J Anaesth 1996;77:217-22.
15. Sohn M, Hoffmann M, Hochrein A, et al. Laparoscopic 24. Swidsinski A, Dörffel Y, Loening-Baucke V, et al.
Appendectomy Is Safe: Influence of Appendectomy Acute appendicitis is characterised by local invasion
Technique on Surgical-site Infections and Intra-abdominal with Fusobacterium nucleatum/necrophorum. Gut
Abscesses. Surg Laparosc Endosc Percutan Tech 2011;60:34-40.
2015;25:e90-4. 25. Schlottmann F, Reino R, Sadava EE, et al. Could an
16. Thompson H, Jones C, Pardy C, et al. Application of abdominal drainage be avoided in complicated acute
the Clavien-Dindo classification to a pediatric surgical appendicitis? Lessons learned after 1300 laparoscopic
network. J Pediatr Surg 2020;55:312-5. appendectomies. Int J Surg 2016;36:40-3.
17. Bruno L, Barni L, Pacciani S, et al. Complications 26. Aslan A, Karaveli C, Ogunc D, et al. Does noncomplicated
Following Surgery for Gastric Cancer: Analysis of acute appendicitis cause bacterial translocation? Pediatr
Prospectively Collected Data. Journal of Cancer Therapy Surg Int 2007;23:555-8.
2014:1454-66. 27. Moawad MR, Dasmohapatra S, Justin T, et al. Value of
18. Bou Zein Eddine S, Dodgion CM, Qian S, et al. intraoperative abdominal cavity culture in appendicectomy:
Complicated Appendicitis: Are Extended Antibiotics a retrospective study. Int J Clin Pract 2006;60:1588-90.

Cite this article as: Wu T, Yang Y, Wu Y, Lu L, Dong S.

Complications after appendectomy in patients with treated
appendicitis: results from a retrospective study. Ann Palliat Med
2021;10(12):12546-12553. doi: 10.21037/apm-21-3295

© Annals of Palliative Medicine. All rights reserved. Ann Palliat Med 2021;10(12):12546-12553 | https://dx.doi.org/10.21037/apm-21-3295