SP 10.02 Identifying Pre-Operative Predictors of Appendicitis Severity
Cameron Mullin, Alice Luesley, Adam Peckham-CooperAbstract
Introduction
Appendicitis is a common acute surgical presentation. Whilst numerous data-supported scoring systems for the diagnosis of appendicitis exist, they remain poorly used. Increasingly, cross-sectional imaging is becoming standard, with clinicians relying on this and clinical acumen to triage cases. This study aims to identify common pre-operative variables that may help not diagnose but predict appendicitis severity.
Method
A single-centre retrospective cohort of 100 appendicectomies (n=96 after excluding four normal appendixes) from July-September 2025 was reviewed. Candidate variables included demographic factors, biomarkers (CRP, WCC, Neutrophils, Platelets, Bilirubin, ALT, AST, Albumin), history and examination findings, and imaging. Univariate analyses explored trends, then multivariate logistic regression examined independent predictors of complicated (defined as appendiceal perforation) vs. uncomplicated operative findings.
Results
Univariate analysis identified CRP, neutrophils, low albumin, older age, presence of faecolith, and pre-operative pyrexia were associated with complicated disease. On multivariate regression, CRP, age and faecolith remained independently predictive (p<0.05). Imaging had high specificity (96.4%) and PPV (89.5%) but lower sensitivity (48.6%), missing 18 of 35 complicated cases. Pre-operative pyrexia, elevated bilirubin, low albumin, and guarding/rebound tenderness were not statistically significant (p>0.05) but demonstrated trends suggestive of predictive value and remain of interest for further study.
Conclusions
Nearly half of intra-operative complicated cases were under-reported as uncomplicated on imaging, therefore additional measures must be used to predict disease severity. Statistically significant variables and those with biologically plausible, large effect sizes should be considered for future risk modelling using larger cohorts to optimise theatre prioritisation and inform peri-operative planning.