Gerardo GTJA, Hernández OJL

Language: Spanish
References: 10
Page: 21-25
PDF size: 155.97 Kb.

ABSTRACT

Background: Appendiceal rupture is the most severe complication of acute appendicitis, since it has high morbidity and mortality rates. It has been suggested that the risk of appendiceal rupture is related to the time the patient takes to ask for medical help, previous medication, and te patient’s type of insurance.
Objective: To establish the factors related to the appendiceal rupture in patients with acute appendicitis who attended the Centro Hospitalario Nuevo Sanatorio Durango from January 2008 to October 2012.
Material and metodology: Patients who had undergone appendectomy for acute appendicitis were studied and 2 groups were formed: Appendiceal rupture group and Nonappendiceal rupture group. The time of evolution (in hours) until admittance to the hospital, as well as age, sex, type o insurance (personal, company), comorbidity, and if the patient had taken any medication before looking for medical help, were the patient’s features assessed.
Results: From 189 patients who underwent appendectomy for acute appendicitis, 69 (36%) presented appendiceal rupture. These patients had two more hours of evolution (26 vs 24 horas, p‹0.001) on average before receiving medical help; which meant 2% higher risk per hour (IC 95% de 0.2% a 4%, p = 0.03). Other factors associated were previous medication (RM = 23, IC 95% 9 a 57), having company insurance (RM = 3.3, IC 95% 1.6 a 10).
Conclusions: the factors associated with appendiceal perforation were delay in medical attention, previous medication, and the type of insurance owned by the patient.

REFERENCES

1. Aguirre RR. Tratado de Cirugía General, AMCG y CMCGA. 2 ed. Mexico, DF: El Manual Moderno; 2008.

2. Asociación Mexicana de Cirugía General. Manual de procedimientos: apendicitis aguda. Mexico, DF: Comité de educación médica continua; 2007.

3. Bratton S, Haberkern. Acute Appendicitis Risks of Complications: Age and Medicaid Insurance. Pediatrics. 2000; 106:1-9.

4. Von Titte S, Mc Cabe C. Delayed appendectomy for apendicites. Causes and Consequence. Am J Emerg Med. 1996; 4:653-69.

5. Maguiña P. Factores pronóstico de mortalidaden pacientes con peritonitis secundaria a appendicitis aguda. Rev Med Hered. 2001;12(1):3-7.

6. De Barrenechea G. Apendicitis aguda en el policíclico Angamos. Es SALUD 1999. Lima, Perú: 2000, p. 70.

7. Athié GC, Guízar BC. Epidemiología de la patología abdominal aguda en el servicio de urgencias del Hospital General de México. Análisis de 30 años. Cir Gen. 1999;21:99-104.

8. Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination. Am Fam Physician. 2008;77(6):828-30.

9. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91(1):28-37.

10. Pieracci FM. Insurance status, but not race, predicts perforation in adult patients with acute appendicitis. J Am Coll Surg. 2007;205(3):445-52.