Difficult Appendectomy, Analytic Study of Pre-Operative and Operative Factors in Tikrit Emergency Hospital

Abstract

Background: Acute appendicitis is one of the most common general surgical emergencies. Complicated acute appendicitis, including perforation, peri- appendiceal abscess, or peritonitis, may require more extensive operative management and is associated with increased morbidity. Aim: To identify risk factors and diagnostic indicators associated with complicated acute appendicitis and evaluate the operative management required. Methods: This retrospective cohort study included 612 patients who underwent surgery for acute appendicitis at Tikrit Emergency Hospital between January 2022 and February 2023. Based on a validated scoring system, patients were classified into complicated and uncomplicated acute appendicitis groups. Demographic, clinical, laboratory, operative, and postoperative characteristics were compared. Results: Complicated acute appendicitis occurred in 30.4% of patients. It was significantly associated with female sex (p=0.031), older age (p=0.006), and previous surgical history (p=0.008). Clinical manifestations were more prominent in the complicated group, and elevated C-reactive protein was significantly more frequent (p<0.001). Patients with complicated appendicitis required more extensive surgical approaches (p<0.001), experienced higher postoperative complication rates (p<0.001), and had longer operative times and hospital stays (both p<0.001). Conclusion: Older age, female sex, previous surgery, and elevated inflammatory markers, particularly C-reactive protein, were associated with complicated acute appendicitis. Complicated cases required more extensive operative management and were associated with greater postoperative morbidity.