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Surgical outcomes of patients undergone open and laparoscopic appendectomy at qilu hospital: a retrospective study of patients with or without hypertension

Author: 
Salma J. Ali, Sang Xi Guang, Li Pengyu , Zhao Xin, Emmanuel H. Suluba, Hussein Haji, Jaffar S. Pandu and Emmerenceana Mahulu
Subject Area: 
Health Sciences
Abstract: 

Background: Despite the diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of the common causes for acute abdominal pain. Having chronic illness in patients with acute appendicitis may have direct or indirect effect on the outcomes. This is because hypertension and other cardiovascular disease such as CHF have known effects on cardiopulmonary physiology. For that reason we decided to evaluate the surgical outcomes in patients with hypertension in comparison to those without hypertension undergoing appendectomy. Objective: comparison of the outcomes of LA and OA in hypertensive and non-hypertensive patients. Methodology: A hospital-based retrospective study involving adult patients above 18 years who underwent appendectomy 2º appendicitis at Emergency Surgery Department at Qilu Hospital of Shandong University 2014 – 2018. Patient’s data obtained were; age, sex, previous history of abdominal surgery, ASA risk score, pre-operative WBC and neutrophil count, radiological diagnosis, type of appendectomy, intra-operative diagnosis, use of post-operative analgesia, post-operative initiation of oral feeding, LOS, post-operative complication and mortality. Inclusion criteria were adult population above 18 years with a history of peri-umbilical abdominal pain, fever; Pre-operative diagnosis of appendicitis by Ultra-sound or CT scan (inflammatory phlegmon, gangrenous appendicitis, perforated appendicitis and appendiceal abscess) and history of hypertension. Exclusion criteria were patients below 18 years of age, patients who had appendix removed due to other causes and negative appendectomy, appendicitis history for > 7 days, pregnancy of > 3 months, presence of other chronic illness such as DM, IHD and/or CBD. Statistical Package for Social Science (SPSS) version 16 was used to analyse the data. Descriptive data was expressed as mean ±SD. Independent t-test and chi-square test were used to analyse the association of continuous and categorical variables, respectively. Univariate analysis was used to compare the outcomes of LA and OA in hypertensive and non-hypertensive patients. P-value <0.05 was considered statistical significant. Results: The study involved 139 randomly selected patients who underwent appendectomy at Qilu Hospital between 2014 and 2018. The mean age was 42.2±15.657 years with a range of 18-82 years. Majority of the patients 62.6% were between 18-45 years, while only 11.5% aged 65 years and above. 54% were male. 27.3% (n=38) had history of hypertension. 84.2% underwent LA (n=117) whereas, 15.8% underwent OA (n=22). Regarding on the intra-operative diagnosis, 42.4% had acute phlegmon appendicitis (n=59), 15.1% had acute gangrenous appendicitis (n=21), 7.9% had perforated appendicitis (n=11) and 34.5% had appendiceal abscess (n=48). Post-operative complications occurred in 1.4% patients (n=2). One patient had IAA and the other patient had fat liquefaction. Non-hypertensive patients on OA group had the longest duration of operation 117.5±56.679 min. Among hypertensive patients, the duration of operation was longer in LA group 88.92±38.525 min than in OA group 82.08±33.538 min. This was statistically significant with p-value <0.05.The mean duration for analgesia use was 0.48±0.774 days. Hypertensive patients on OA group had longer mean duration of analgesia use 0.75±1.357 days than those who underwent LA 0.5±0.99 days. In non-hypertensive patients, LA group had the shortest duration of analgesia use 0.44±0.618 days than OA group 0.5±0.527 days, with p-value <0.05. Mean LOS was 8.09±4.051 days (4-28) days. Mean LOS was significantly longer in non-hypertensive OA patients 10.4±4.502 days and was found to be shorter in non-hypertensive LA patients 7.26±3.235 days. Among hypertensive patients, the mean LOS was longer in OA group 10.08±4.944 days than in LA group 9.15±5.213 days. P -value < 0.05. Apart from type of appendectomy and hypertensive status, we also found other factors associated with poor surgical outcomes. These include higher ASA risk score (ASA III), higher pre-operative WBC and having gangrenous appendicitis. Conclusion: Despite the fact that pneumo-peritoneum is known to have effects on cardiopulmonary physiology our study showed that LA has protective effect in-terms of post-operative outcomes especially with duration of operation, and LOS in non-hypertensive on OA group whereas, longer duration of analgesia use was seen in hypertensive OA group. This indicates that laparoscopic appendectomy can be safely performed in hypertensive patients as it has better outcomes than OA. A part from hypertension and type of appendectomy we have also seen other factors associated with poor surgical outcomes in appendicitis patients; including higher ASA score, higher WBC and an intra-operative diagnosis of gangrenous appendicitis.

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