L. K. Keeney1, B. S. Hendriksen1, D. J. Morrell1, X. Candela2, T. E. Arkorful5, P. Ssentongo4, J. S. Oh1, C. S. Hollenbeak4, F. Amponsah5 1Penn State Health Hershey Medical Center,Hershey, PA, USA 2Penn State University College Of Medicine,Hershey, PA, USA 4Pennsylvania State University,State College, PA, USA 5Eastern Regional Hospital,Koforidua, Ghana
Introduction:
Appendicitis is a burdensome surgical disease for patients in low-middle income countries which have limited surgeons, infrastructure, and financial health coverage. Laparoscopy is often not feasible, so patients typically undergo exploratory laparotomy. This study aims to better understand common presentations and outcomes of appendicitis in rural Ghana to identify areas for future interventions.
Methods:
Data on laparotomies performed at a public surgical referral center in rural Ghana between July 2017 and June 2018 was obtained. Surgical log books and corresponding patient electronic medical records were reviewed to extract demographic data, clinical findings, and outcomes. All exploratory laparotomy operations were included if the record was complete. Appendicitis was identified as the indication for surgery retrospectively through the medical record diagnosis, operative note, or recorded surgical findings.
Results:
Appendicitis was the post-operative diagnosis in 107 out of 346 (31%) exploratory laparotomy operations reviewed. Of appendicitis cases, males accounted for 68%. The average age was 32, with 60% of cases occurring in adults ages 18 to 60. Nearly 40% of these patients did not have insurance. Laboratory values were obtained in 70% of cases of appendicitis. Of those with lab values, 37% were found to be anemic and 48% had a leukocytosis. Perforations of the appendix were identified in 59% of cases and were more common in married patients (p=0.0055). Length of stay for patients with perforations was significantly longer than those without perforations (5.2 vs 3.5 days, p=0.0003). Readmission within 30 days was also more frequent in cases of perforation (7.9% vs 6.8%, p=0.0468). Overall mortality (0.9%) and the rate of surgical site infections (10.3%) did not differ between perforated and non-perforated appendicitis.
Conclusion:
Appendicitis represents a significant surgical burden in Ghana and many patients requiring appendectomy are uninsured. Presentation with perforation is common and results in worse outcomes. Future studies identifying modifiable risk factors of perforation and interventions for earlier diagnosis of appendicitis are warranted.