Risk factors for gastric distension in patients with acute appendicitis: a retrospective cohort study

Abstract

Purpose: There has been no report on risk factors for gastric distension (GD) when inducing general anesthesia in an emergency situation. The aim of this study was to clarify the risk factors for GD in patients with acute appendicitis at their hospital visit.

Methods: We reviewed medical records of patients from April 2007 to March 2010 who underwent open appendectomy for acute appendicitis and were diagnosed pathologically. GD was defined as a larger anteroposterior diameter and larger lateral diameter of the stomach than those of the left kidney in computed tomography (CT) imaging. The primary outcome was the presence of GD. Candidate variables such as patient characteristics, physical findings, and CT imaging findings associated with GD were assessed. Time after beginning of abdominal pain was categorized and compared. Determinants with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models.

Results: We enrolled 121 patients and divided this cohort into a GD group (44 cases, 36%) and a non-GD group (77 cases, 64%). Results of univariate analysis showed longer duration of time after beginning of abdominal pain (P = 0.016), younger age (P < 0.001), and more frequent distended small bowel (P < 0.001) in the GD group than in the non-GD group. In multivariate analysis, age [odds ratio (OR) = 0.939, P = 0.002] and time after beginning of abdominal pain (OR = 1.807, P = 0.031) were shown to be independent risk factors.

Conclusion: Younger appendicitis patients with acute abdominal pain for 1 or more days should be treated as patients with high risk for GD.