Analysis of risk factors of postappendectomy intra-abdominal abscess

BACKGROUND: Postappendectomy intra-abdominal abscesses (PAIAA) complicate the recovery of a small but significant fraction of patients with advanced appendicitis. STUDY DESIGN: A retrospective review of 1,184 patients with appendicitis was undertaken to define the clinical characteristics and risk factors associated with PAIAA. RESULTS: Thirty-three patients with 36 PAIAAs were found, an incidence of 2.8 percent. The mean age of patients with PAIAA was less than the overall group (16.9 versus 23.1 years, p=0.002), and the mean core temperature of the PAIAA group was significantly higher (38.5 versus 38.2 degrees C). The incidence of PAIAA increased as the degree of appendiceal pathology worsened. The incidence of PAIAA was six (3.2 percent) of 190 in patients with gangrenous appendicitis and was 27 (8.7 percent) of 309 among patients with perforated appendicitis. Logistic regression analysis showed that independent predictors for the occurrence of PAIAA were young age and perforation. Although children presented with a higher rate of perforated appendicitis, this did not account for the younger age of the patients with PAIAA. Children (less than ten years of age) with perforation had PAIAA in ten (14 percent) of 69 cases compared with the incidence in the older patients with perforation of 17 (7.1 percent) of 240. CONCLUSIONS: These findings improve the surgeon's ability to identify patients at risk for PAIAA. Alterations in the perioperative management of perforated appendicitis, particularly in the pediatric patient, may reduce the occurrence of PAIAA.