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Background <p>The incidence of acute appendicitis in older patients significantly varies from that in younger adults. The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of early post-appendectomy complications (EPAC). This study aimed to investigate the incidence and risk factors associated with EPAC in older patients after appendectomy and to define active COVID-19 infection during surgery as an associated risk factor for EPAC.</p> Methods <p>We conducted a retrospective multicenter analysis of older patients aged ≥ 60 years who underwent appendectomy between April 2020 and December 2024. Logistic regression identified the risk factors associated with EPAC.</p> Results <p>A total of 585 patients aged ≥ 60&#xa0;years were divided into the EPAC (<i>n</i> = 32) and no EPAC (<i>n</i> = 553) groups. The incidences of EPAC was 5.5% (32/585), including superficial incisional surgical site infections (SSI) (9/32, 28.1%), deep incisional SSI (2/32, 6.3%), organ/space infection (2/32, 6.3%), intra-abdominal abscess (9/32, 28.1%), ileus (2/32, 6.3%), pneumonia (3/32, 9.4%), acute myocardial infraction (MI) (2/32, 6.3%), fecal fistula (2/32, 6.3%), and acute adhesive intestinal obstruction (1/32, 3.1%). Multivariable analysis identified that active COVID-19 infection during surgery (odds ratio (OR) = 25.9; 95% confidence interval (CI) 4.8–139.1; <i>p</i> &lt; 0.001), American Society of Anesthesiologists (ASA) score ≥ II (OR = 4.5; 95% CI 1.2–17.07; <i>p</i> = 0.02), open approach (OR = 30.6; 95% CI 8.1–115.3; <i>p</i> &lt; 0.001), and high-grade appendicitis ≥ IV (OR = 63.06; 95% CI 7.5–526.4; <i>p</i> &lt; 0.001) were significant associated risk factors for EPAC.</p> Conclusions <p>The incidence of EPAC in older patients after appendectomy is 5.5%. Active COVID-19 infection during surgery is strongly associated with an increased risk of EPAC. COVID-19 should be considered in perioperative risk assessment of EPAC.</p> Trial registration <p>This study was registered as a clinical trial (NCT06787573). Retrospectively registered.</p> Graphical abstract <p></p>

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COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study

  • 期刊论文

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  • 发表日期：

    2025年11月5日

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  • Tamer A. A. M. Habeeb,
  • A. Hussain,
  • Jose Bueno-Lledó,
  • M. E. Giménez,
  • A. Aiolfi,
  • M. Chiaretti,
  • I. A. Kryvoruchko,
  • M. N. Manangi,
  • Abd Al-Kareem Elias,
  • Abdelmonem A.M Adam,
  • Mohamed A. Gadallah,
  • Saad Mohamed Ali Ahmed,
  • Ahmed Khyrallh,
  • Mohammed H. Alsayed,
  • Esmail Tharwat Kamel Awad,
  • Emad A. Ibrahim,
  • Mohammed Hassan Elshafey,
  • Mohamed fathy Labib,
  • Mahmoud Hassib Morsi Badawy,
  • Sobhy rezk ahmed Teama,
  • Abdelhafez Seleem,
  • Mohamed Ibrahim Abo Alsaad,
  • Abouelatta KH Ali,
  • Hamdi Elbelkasi,
  • Mahmoud Ali abou zaid,
  • Basma Ahmed Mohamed,
  • Alaa Alwadees,
  • Ahmed k. El-Taher,
  • Mohamed Ibrahim Mansour,
  • Mahmoud Abdou Yassin,
  • Ahmed Salah Arafa,
  • Mohamed Lotfy,
  • Baher Atef,
  • Mohamed Elnemr,
  • Mostafa M Khairy,
  • Abdelfatah H. Abdelwanis,
  • ahmed mesbah Abdelaziz,
  • Abdelshafy Mostafa,
  • AbdElwahab M. Hamed,
  • Tamer Wasefy,
  • Ibrahim A. Heggy,
  • Abdelrahman Mohamed Hasanin Nawar

摘要

Background

The incidence of acute appendicitis in older patients significantly varies from that in younger adults. The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of early post-appendectomy complications (EPAC). This study aimed to investigate the incidence and risk factors associated with EPAC in older patients after appendectomy and to define active COVID-19 infection during surgery as an associated risk factor for EPAC.

Methods

We conducted a retrospective multicenter analysis of older patients aged ≥ 60 years who underwent appendectomy between April 2020 and December 2024. Logistic regression identified the risk factors associated with EPAC.

Results

A total of 585 patients aged ≥ 60 years were divided into the EPAC (n = 32) and no EPAC (n = 553) groups. The incidences of EPAC was 5.5% (32/585), including superficial incisional surgical site infections (SSI) (9/32, 28.1%), deep incisional SSI (2/32, 6.3%), organ/space infection (2/32, 6.3%), intra-abdominal abscess (9/32, 28.1%), ileus (2/32, 6.3%), pneumonia (3/32, 9.4%), acute myocardial infraction (MI) (2/32, 6.3%), fecal fistula (2/32, 6.3%), and acute adhesive intestinal obstruction (1/32, 3.1%). Multivariable analysis identified that active COVID-19 infection during surgery (odds ratio (OR) = 25.9; 95% confidence interval (CI) 4.8–139.1; p < 0.001), American Society of Anesthesiologists (ASA) score ≥ II (OR = 4.5; 95% CI 1.2–17.07; p = 0.02), open approach (OR = 30.6; 95% CI 8.1–115.3; p < 0.001), and high-grade appendicitis ≥ IV (OR = 63.06; 95% CI 7.5–526.4; p < 0.001) were significant associated risk factors for EPAC.

Conclusions

The incidence of EPAC in older patients after appendectomy is 5.5%. Active COVID-19 infection during surgery is strongly associated with an increased risk of EPAC. COVID-19 should be considered in perioperative risk assessment of EPAC.

Trial registration

This study was registered as a clinical trial (NCT06787573). Retrospectively registered.

Graphical abstract