R. Pitesa1, C. Paterson1, M. Flaherty1, J. Eteuati1, A.G. Hill1 1Middlemore Hospital, University Of Auckland, Surgery, Auckland, Auckland, New Zealand
Introduction: Acute appendicitis is a common surgical emergency worldwide, with variations in prevalence, presentation, and outcomes, particularly in low- and middle-income countries (LMICs). Complicated appendicitis has significant implications in LMICs due to limited healthcare resources and infrastructure. This systematic review aimed to compare incidence of complicated appendicitis in LMICs.
Methods: A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42024526007). Observational studies and randomized controlled trials (RCTs) published in PubMed, MEDLINE, Embase, and Scopus from 1990 to 2024 were retrieved. The primary outcome investigated was incidence of complicated appendicitis. Meta-analysis was performed using Review Manager version 5.4.1.
Results: Two hundred and twenty articles with 277,872 participants were included. Meta-analysis identified an increased odds of complicated appendicitis in low-income countries (OR 0.44 [95% CI 0.2 – 0.97]) compared to middle income countries (OR 0.24 [95% CI 0.18 – 0.32]) p<0.001.
Conclusion: Appendicitis continues to be a morbid disease in LMICs. This is evident between LMICs and has significant implications for management.