For a study, researchers suggested a supplementary strategy that chooses an endpoint determined by the intraoperative discovery of peritoneal soiling (PS) to help with the preoperative prediction of complex appendicitis.

Over the course of 6 months, 38 institutions (5% of all public hospitals) that provided emergency general surgical care to patients around-the-clock, 7 days a week, recruited a steady stream of adult patients in need of appendectomy. Patients were divided into groups based on whether PS was discovered during surgery or not.

There were 2,645 patients in total; the median age (IQR) was 35 (22–51) years, and 44.3% of the patients were female. About 70.8% of appendectomies were performed using a laparoscopic technique. PS with pus surrounding the appendix, intestinal contents, free pus, or blood in the peritoneal cavity occurred in 31.7% of patients. A total of 1,764 patients were randomly chosen for the derivation cohort, and 881 patients were allocated to the validation cohort in order to create the prediction model. Three laboratory variables (serum urea, serum sodium, and white blood cell count) and 2 clinical variables (age and pulse) were individually associated (P<.05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P=.99; C-statistic, 0.7) on multivariable logistic regression analysis of all patients. Static and dynamic nomograms were created based on the multivariable regression model to predict PS in patients with acute appendicitis.

In areas with limited resources, including basic clinical and laboratory information in the dynamic nomogram may be helpful in directing the initial therapy of patients with acute appendicitis.