Joan Ricard Soler Frías (Seville / ES), Isidro Martínez Casas (Seville / ES), Maximilian Peter Forssten (Örebro / SE), Daniel Aparicio Sánchez (Seville / ES), Gary Alan Bass (Philadelphia / US), Shahin Mohseni (Örebro / SE), Felipe Pareja Ciuró (Seville / ES), Carlos Javier García Sánchez (Seville / ES)
Abstract text (incl. references and figure legends)
Introduction: Appendicitis management is heterogeneus. SnapAppy was an prospective observational international study. Aim of this subgroup analysis is to compare results among countries and analize complications.
Methods: Patients from Spain and Sweden were selected. Main variable was complications. Mann-Whitney U and Pearson Chi2 were performed to compare cohorts of patients and variables association to complications.
Results: 2,198 patients included. 17.5% developed complications (Sp20.7%vs.Sw14.1%;p<0.001). They were mainly Clavien I-II with no differences in severe ones. Most frequent were pelvic abscess (3.7%) and postoperative ileus (3.6%). Complications associated with age, BMI, ASA score, and comorbidities. No differences in demography and major comorbidities were seen. Absence of RIF pain, symptoms>48h or fever associated with complications. All presenting symptoms but guarding were more frequent in Sw, but not time to presentation. Increasing SIRS score related to complications and Sw had more >2 SIRS patients. Preferred imaging was US in Sp and CT in Sw. CT associated to complications. Most patients received antibiotic prophilaxis, not associated to complications. Time to first antibiotic dose related to complications and was shorter in Sp. Time to surgery (Sp<Sw), treatment other than appendectomy, need for percutaneous drainage, longer operative times, purulent fluid, converted/open surgery, other technical aspects associated to complications. Laparoscopic appendectomy was 91%. Sw had less open surgeries but higher conversions. Malignancy rate was similar but more negative appendectomies in Sp. Sw had more ambulatorization. Sp had less readmissions but higher LOS. Complications were significantly higher in hospitals with lower caseload.
Conclusions: Some differences exist in demography, disease process, diagnostic-therapeutic management or centralization. None could individually explain difference in outcomes but help to guide future research.
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