Factors Associated with Perforated Appendicitis in Kasetwisai Hospital : A single-center, retrospective, observational study

Abstract

Purpose:  To analyze factors associated with perforated appendicitis among patients admitted to Kaset Wisai Hospital, Roi Et Province. 

Study design: A retrospective descriptive study and an unmatched case-control study design using retrospective chart review.

Materials and Methods: The study population comprised patients diagnosed with acute appendicitis (ICD-10: K35) and admitted to Kasetwisai Hospital, Roi Et Province, between January 1, 2020, and December 31, 2025. A total sample of 162 patients was selected, consisting of 54 cases (patients with perforated appendicitis confirmed by operative findings or histopathology) and 108 controls (patients with non-perforated acute appendicitis) at a 1:2 ratio. Data collection instruments were evaluated for content validity, yielding an Index of Item-Objective Congruence (IOC) ranging from 0.67 to 1.00. Data analysis was performed using STATA software, version 17.0. Descriptive statistics were used to describe demographic characteristics. Simple logistic regression (univariate analysis) and multiple logistic regression using the backward elimination method were employed to identify independent predictor variables. Results are presented as adjusted odds ratios (Adj. OR) with 95% confidence intervals (95% CI), with statistical significance set at p < .05. 

Main findings:  Among the 162 study participants, the perforated appendicitis group consisted of 36.80% males and 29.30% females, with a mean age of 46.57 ± 22.36 years. The complication rate in the perforated group was significantly higher than that in the non-perforated group (50.70% vs. 21.30%, p < .001). Regarding the duration before admission, 84.40% of patients in the perforated group experienced a delay of ≥24 hours from symptom onset to hospital admission, compared to 64.10% in the non-perforated group (p = .003).  Multivariate logistic regression analysis identified three independent predictors significantly associated with perforated appendicitis:  Time from symptom onset to hospital admission ≥24 hours: Patients presenting ≥24 hours after symptom onset had a 3.78-fold increased risk of perforated appendicitis compared to those presenting within 24 hours (Adj. OR = 3.78, 95%CI: 1.46–9.77, p = .006). Respiratory Rate: Each 1 breath/min increase in respiratory rate was associated with a 1.26-fold increase in risk (Adj. OR = 1.26, 95%CI: 1.03–1.55, p = .023).  Age: Each 1-year increase in age was associated with a 1.03-fold increase in risk (Adj. OR = 1.03, 95%CI: 1.00–1.04, p = .003). 

Conclusion and Recommendations: A delay in seeking care of ≥24 hours from symptom onset represents the most critical time-dependent risk factor associated with perforated appendicitis in a community hospital setting, alongside older age and elevated respiratory rate. It is recommended to strengthen proactive screening and early diagnostic systems (such as implementing the Alvarado Score alongside clinical practice guidelines), enhance referral efficiency, and promote health education regarding early warning signs to encourage patients to seek medical care within 24 hours. These measures aim to achieve the public health strategic goal of reducing the appendiceal perforation rate to below 5%.