Mohammad Naderan, Amir Eslami Shahr Babaki, Saeed Shoar, Hossein Mahmoodzadeh, Shirzad Nasiri, Zhamak Khorgami

Department of Surgery, Tehran University of Medical Sciencest, Shariati Hospital, Tehran , Iran


Objective: To investigate the patient’s history and physical examination information to find out risk factors associated with complicated appendicitis.

Material and Methods: Two hundred patients who were admitted with complicated appendicitis (including abscess, phlegmon, and generalized peritonitis) were retrieved from our database. Two hundred patients with non-complicated acute appendicitis were randomly selected from the same period. These two groups were compared in terms of demographic characteristics, past medical history, and presenting symptoms. We made a multivariate analysis model using binary logistic regression and backward stepwise elimination.

Results: Based on multivariate analysis, risk factors for complicated appendicitis included presenting with epigastric pain (OR=3.44), diarrhea (OR=23.4) or malaise (OR=49.7), history of RLQ pain within the past 6 months (OR=4.93), older age (OR=1.04), being married (OR=2.52), lack of anorexia (OR=4.63) and longer interval between onset of symptoms and admission (OR=1.46). Conversely, higher (academic) education was associated with decreased odds for complicated appendicitis (OR=0.26).

Conclusion: Our findings suggest that a surgeon’s clinical assessment is more reliable to make a judgment. “Bedside evaluation” is a useful, cheap, quick and readily available method for identifying those at risk for developing complicated acute appendicitis.

Keywords: Acute appendicitis, complicated appendicitis, risk factors, adults


Ethics Committee Approval

The ethics committee of the Shariati Hospital, Tehran University of Medical Science approved the study.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - Z.K.; Design - Z.K., M.N.; Supervision - Z.K., M.N., S.N., H.M.; Resources - Z.K., M.N.; Materials - S.N., H.M.; Data Collection and/or Processing - M.N., S.S.; Analysis and/or Interpretation - Z.K., M.N., A.E.S.B., S.S.; Literature Search - Z.K., A.E.S.B., S.S.; Writing Manuscript - Z.K., M.N., A.E.S.B., S.S.; Critical Review - Z.K., M.N., S.N., H.M.; Other - S.N., H.M.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.