Background: The incidence of acute appendicitis in older patients significantly varies from that in younger adults. The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of early post-appendectomy complications (EPAC). This study aimed to investigate the incidence and risk factors associated with EPAC in older patients after appendectomy and to define active COVID-19 infection during surgery as an associated risk factor for EPAC. Methods: We conducted a retrospective multicenter analysis of older patients aged ≥ 60 years who underwent appendectomy between April 2020 and December 2024. Logistic regression identified the risk factors associated with EPAC. Results: A total of 585 patients aged ≥ 60 years were divided into the EPAC (n = 32) and no EPAC (n = 553) groups. The incidences of EPAC was 5.5% (32/585), including superficial incisional surgical site infections (SSI) (9/32, 28.1%), deep incisional SSI (2/32, 6.3%), organ/space infection (2/32, 6.3%), intra-abdominal abscess (9/32, 28.1%), ileus (2/32, 6.3%), pneumonia (3/32, 9.4%), acute myocardial infraction (MI) (2/32, 6.3%), fecal fistula (2/32, 6.3%), and acute adhesive intestinal obstruction (1/32, 3.1%). Multivariable analysis identified that active COVID-19 infection during surgery (odds ratio (OR) = 25.9; 95% confidence interval (CI) 4.8–139.1; p < 0.001), American Society of Anesthesiologists (ASA) score ≥ II (OR = 4.5; 95% CI 1.2–17.07; p = 0.02), open approach (OR = 30.6; 95% CI 8.1–115.3; p < 0.001), and high-grade appendicitis ≥ IV (OR = 63.06; 95% CI 7.5–526.4; p < 0.001) were significant associated risk factors for EPAC. Conclusions: The incidence of EPAC in older patients after appendectomy is 5.5%. Active COVID-19 infection during surgery is strongly associated with an increased risk of EPAC. COVID-19 should be considered in perioperative risk assessment of EPAC. Trial registration: This study was registered as a clinical trial (NCT06787573). Retrospectively registered.
COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study / Habeeb, Tamer A A M; Hussain, A; Bueno-Lledó, Jose; Giménez, M E; Aiolfi, A; Chiaretti, M; Kryvoruchko, I A; Manangi, M N; Elias, Abd Al-Kareem; Adam, Abdelmonem A M; Gadallah, Mohamed A; Ahmed, Saad Mohamed Ali; Khyrallh, Ahmed; Alsayed, Mohammed H; Awad, Esmail Tharwat Kamel; Ibrahim, Emad A; Elshafey, Mohammed Hassan; Labib, Mohamed Fathy; Badawy, Mahmoud Hassib Morsi; Teama, Sobhy Rezk Ahmed; Seleem, Abdelhafez; Abo Alsaad, Mohamed Ibrahim; Ali, Abouelatta Kh; Elbelkasi, Hamdi; Abou Zaid, Mahmoud Ali; Mohamed, Basma Ahmed; Alwadees, Alaa; El-Taher, Ahmed K; Mansour, Mohamed Ibrahim; Yassin, Mahmoud Abdou; Arafa, Ahmed Salah; Lotfy, Mohamed; Atef, Baher; Elnemr, Mohamed; Khairy, Mostafa M; Abdelwanis, Abdelfatah H; Abdelaziz, Ahmed Mesbah; Mostafa, Abdelshafy; Hamed, Abdelwahab M; Wasefy, Tamer; Heggy, Ibrahim A; Nawar, Abdelrahman Mohamed Hasanin. - In: TECHNIQUES IN COLOPROCTOLOGY. - ISSN 1128-045X. - 29:1(2025). [10.1007/s10151-025-03232-1]
COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study
Hussain, ASecondo
Conceptualization
;
2025
Abstract
Background: The incidence of acute appendicitis in older patients significantly varies from that in younger adults. The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of early post-appendectomy complications (EPAC). This study aimed to investigate the incidence and risk factors associated with EPAC in older patients after appendectomy and to define active COVID-19 infection during surgery as an associated risk factor for EPAC. Methods: We conducted a retrospective multicenter analysis of older patients aged ≥ 60 years who underwent appendectomy between April 2020 and December 2024. Logistic regression identified the risk factors associated with EPAC. Results: A total of 585 patients aged ≥ 60 years were divided into the EPAC (n = 32) and no EPAC (n = 553) groups. The incidences of EPAC was 5.5% (32/585), including superficial incisional surgical site infections (SSI) (9/32, 28.1%), deep incisional SSI (2/32, 6.3%), organ/space infection (2/32, 6.3%), intra-abdominal abscess (9/32, 28.1%), ileus (2/32, 6.3%), pneumonia (3/32, 9.4%), acute myocardial infraction (MI) (2/32, 6.3%), fecal fistula (2/32, 6.3%), and acute adhesive intestinal obstruction (1/32, 3.1%). Multivariable analysis identified that active COVID-19 infection during surgery (odds ratio (OR) = 25.9; 95% confidence interval (CI) 4.8–139.1; p < 0.001), American Society of Anesthesiologists (ASA) score ≥ II (OR = 4.5; 95% CI 1.2–17.07; p = 0.02), open approach (OR = 30.6; 95% CI 8.1–115.3; p < 0.001), and high-grade appendicitis ≥ IV (OR = 63.06; 95% CI 7.5–526.4; p < 0.001) were significant associated risk factors for EPAC. Conclusions: The incidence of EPAC in older patients after appendectomy is 5.5%. Active COVID-19 infection during surgery is strongly associated with an increased risk of EPAC. COVID-19 should be considered in perioperative risk assessment of EPAC. Trial registration: This study was registered as a clinical trial (NCT06787573). Retrospectively registered.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
