FREQUENCY AND PREDICTORS OF POSITIVE AND NEGATIVE APPENDECTOMIES INCLUDING HISTOPATHOLOGICAL VARIANTS OF POSITIVE CASES: A CROSS-SECTIONAL STUDY IN A LOW-MIDDLE-INCOME COUNTRY. Muhammadhamzadawood86@gmail.com

PW03-10

FREQUENCY AND PREDICTORS OF POSITIVE AND NEGATIVE APPENDECTOMIES INCLUDING HISTOPATHOLOGICAL VARIANTS OF POSITIVE CASES: A CROSS-SECTIONAL STUDY IN A LOW-MIDDLE-INCOME COUNTRY.

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Pakistan

Oral or Poster

Appendicitis is a common surgical emergency with diagnostic challenges in low- and middle-income countries. This study evaluated the frequency and predictors of positive and negative appendectomies and the histopathological variants of positive cases.

This multicenter retrospective cross-sectional study was conducted at five tertiary care hospitals in Karachi, Pakistan, analyzing appendectomy cases performed between 2021-2024. A total of 1256 patients aged 7–50yrs who underwent appendectomy with available histopathological reports were included using convenience sampling. Data were extracted from medical records, operative notes, pathology reports, and analyzed using descriptive statistics and Chi-square/Fisher’s exact tests to compare predictors of positive and negative appendectomies.

Out of 1256 patients, 83.7% (n=1052) had positive appendectomies while 16.3% (n=204) had negative appendectomies. (P-value=0.000) Positive appendectomies were associated with male sex (61.1%), age group 21–30 years (41.6%), elevated white blood cell counts (79.6%) and neutrophil counts (76.2%), Alvarado scores ≥7 (83.4%), typical migratory right lower quadrant pain (87.6%), fever (74.6%), anorexia (76.2%), nausea/vomiting (80.0%), and inflamed appendix visualized on ultrasound (65.3%); while negative appendectomies were more frequent among females (48.5%), younger patients aged 7–20 years (41.7%), those with one or more of the following: lower inflammatory markers, atypical or absent symptoms, and normal or inconclusive ultrasound findings, while having one or more in favor of appendicitis. (P-value <0.001) Acute suppurative appendicitis was the most common histopathological variant among positive cases (48.3%).

Clinical, lab, and imaging factors predict appendectomy outcomes, yet negative appendectomies remain common, underscoring the need for better diagnostic strategies to reduce unnecessary surgeries in resource-limited settings.