Complicated acute appendicitis in diabetic patients

• Published in: The American journal of surgery 2008-07, Vol.196 (1), p.34-39
• Main Authors: Tsai, Shih-Hung, M.D, Hsu, Chin-Wang, M.D, Chen, Shin-Chieh, M.D, Lin, Yen-Yue, M.D, Chu, Shi-Jye, M.D
• Format: Article
• Language: English
• Subjects: Abdomen; Acute Disease; Adult; Aged; Aged, 80 and over; Appendicitis; Appendicitis - complications; Appendicitis - pathology; Biological and medical sciences; Comorbidity; Complications; Diabetes; Diabetes Complications - complications; Diabetes mellitus; Diabetic nephropathy; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Male; Medical sciences; Middle Aged; Mortality; Other diseases. Semiology; Perforation; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.05.042

Abstract Background Diabetes mellitus (DM) is associated with adverse events or complications in various gastrointestinal diseases. In this study, we examined whether diabetic patients had higher risk for the development of complicated acute appendicitis than nondiabetic patients. The relevant risk factors also were determined. Methods A retrospective study enrolling diabetic and nondiabetic patients who acquired acute appendicitis was conducted at a single institution over a 5-year period. Results We identified 1,184 patients with a primary discharge diagnosis of acute appendicitis. Seventy-one patients were found to have DM. Diabetic patients were older, had a higher risk of developing complicated acute appendicitis (CAA), and had a more prolonged hospital stay compared with nondiabetic patients. On further examination by multivariate logistic regression analysis, DM was an independent risk factor for CAA after adjusting for age and sex. Of the 71 diabetic patients, 46 patients (64.8%) were found to have CAA. The mean age of diabetic patients with uncomplicated acute appendicitis (DM/UAA) and CAA (DM/CAA) had no significant difference. The duration from the onset of symptoms to diagnosis was significantly longer in the DM/CAA than in the DM/UAA group. The mean length of hospital stay also was significantly longer in the DM/CAA than in the DM/UAA group. DM/CAA patients were found to have a higher rate of history of diabetic nephropathy as well as a higher serum creatinine level and a lower estimated glomerular filtration rate than DM/UAA patients. There was no statistical significance regarding patients older or younger than 60 years. Conclusions Our study showed that diabetic patients had a higher risk for the development of CAA and a subsequently longer hospital stay than nondiabetic patients. Age was not an independent risk factor for the development of CAA in diabetic patients in our study. Delayed diagnosis, and probably a history of diabetic nephropathy, as well as poorer renal function were risk factors for the development of CAA in diabetic patients. The single most important risk factor was the duration from the onset of symptoms to diagnosis. Once CAA developed, the length of hospital stay was prolonged significantly.