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Background <p>Appendicolith has increasingly been recognized as a marker of more severe appendiceal disease, yet its independent association with adverse postoperative outcomes remains uncertain. This study aimed to evaluate whether the presence of appendicolith is associated with baseline clinicopathologic features and postoperative outcomes, and to determine whether appendicolith remains independently associated with postoperative complications, wound infection, and length of hospital stay after appendectomy.</p> Methods <p>A retrospective observational study was conducted at Al-Makassed Islamic Charitable Society Hospital, Palestine, among patients who underwent appendectomy between December 2015 and July 2025. Medical records were reviewed for demographic, clinical, laboratory, operative, histopathologic, and postoperative variables. Patients were categorized according to appendicolith status. Univariable comparisons were performed using Mann–Whitney U, chi-square, or Fisher’s exact tests, as appropriate. Multivariable logistic regression models were used to assess the independent association of appendicolith with any postoperative complication and wound infection, while multivariable linear regression was used to examine its association with log-transformed length of stay.</p> Results <p>A total of 1,262 patients were included, of whom 92 (7.3%) had appendicolith. Patients with appendicolith were more likely to undergo open surgery, had longer operative time, higher neutrophil percentage, and higher rates of perforated appendicitis and more severe histopathologic findings. In multivariable analysis, appendicolith remained associated with postoperative complications after adjustment for age, sex, surgical approach, surgery year, and perforated appendicitis (adjusted odds ratio [aOR] 3.025, 95% confidence interval [CI] 1.452–6.303; p=0.003). Appendicolith was also associated with higher adjusted odds of wound infection (aOR 7.559, 95% CI 2.903–19.679; p&lt;0.001), although this exploratory estimate should be interpreted cautiously because only 21 wound-infection events occurred. However, appendicolith was not associated with log-transformed length of hospital stay after multivariable adjustment (B −0.021, 95% CI −0.108 to 0.067; p=0.645). Laparoscopic surgery was associated with lower odds of postoperative complications. </p> Conclusions <p>Appendicolith was associated with higher odds of recorded postoperative complications after adjustment for the available measured covariates and was not associated with log-transformed length of hospital stay. The wound-infection finding should be interpreted cautiously because of the limited number of events. Prospective multicenter studies are required to confirm these associations and determine their clinical utility.</p>

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Association of appendicolith with postoperative complications, wound infection, and length of stay after appendectomy: a retrospective observational study from Palestine

  • 期刊论文

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  • 发表日期：

    2026年7月29日

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  • Ali Shakhshir,
  • Mahdi Aljamal,
  • Abdallah Alem,
  • Zainah Amjad Issa,
  • Ibrahim Aljamal

摘要

Background

Appendicolith has increasingly been recognized as a marker of more severe appendiceal disease, yet its independent association with adverse postoperative outcomes remains uncertain. This study aimed to evaluate whether the presence of appendicolith is associated with baseline clinicopathologic features and postoperative outcomes, and to determine whether appendicolith remains independently associated with postoperative complications, wound infection, and length of hospital stay after appendectomy.

Methods

A retrospective observational study was conducted at Al-Makassed Islamic Charitable Society Hospital, Palestine, among patients who underwent appendectomy between December 2015 and July 2025. Medical records were reviewed for demographic, clinical, laboratory, operative, histopathologic, and postoperative variables. Patients were categorized according to appendicolith status. Univariable comparisons were performed using Mann–Whitney U, chi-square, or Fisher’s exact tests, as appropriate. Multivariable logistic regression models were used to assess the independent association of appendicolith with any postoperative complication and wound infection, while multivariable linear regression was used to examine its association with log-transformed length of stay.

Results

A total of 1,262 patients were included, of whom 92 (7.3%) had appendicolith. Patients with appendicolith were more likely to undergo open surgery, had longer operative time, higher neutrophil percentage, and higher rates of perforated appendicitis and more severe histopathologic findings. In multivariable analysis, appendicolith remained associated with postoperative complications after adjustment for age, sex, surgical approach, surgery year, and perforated appendicitis (adjusted odds ratio [aOR] 3.025, 95% confidence interval [CI] 1.452–6.303; p=0.003). Appendicolith was also associated with higher adjusted odds of wound infection (aOR 7.559, 95% CI 2.903–19.679; p<0.001), although this exploratory estimate should be interpreted cautiously because only 21 wound-infection events occurred. However, appendicolith was not associated with log-transformed length of hospital stay after multivariable adjustment (B −0.021, 95% CI −0.108 to 0.067; p=0.645). Laparoscopic surgery was associated with lower odds of postoperative complications.

Conclusions

Appendicolith was associated with higher odds of recorded postoperative complications after adjustment for the available measured covariates and was not associated with log-transformed length of hospital stay. The wound-infection finding should be interpreted cautiously because of the limited number of events. Prospective multicenter studies are required to confirm these associations and determine their clinical utility.