Is language disability a risk factor for complicated appendicitis? A retrospective cohort study

Abstract

Aim: Acute appendicitis is the most common emergent surgical disease and complicated appendicitis is an indicator of disrupted access to healthcare. Language disability has become more important in the healthcare sector with increasing migration in the last decade. We aimed to evaluate language disability as a risk factor for complicated appendicitis. Methods: From January 2014 to December 2018, patients who were operated for acute appendicitis were evaluated retrospectively. Patients’ age, gender, language disability (LD) (no (C) or yes (F)), whether surgical drainage was required, pathological findings (appendix diameter, severity as uncomplicated (UCA) or complicated (CA), and presence of local peritonitis), levels of C-Reactive Protein (CRP), White Blood Cells (Wbc), Neutrophil% (Neu%), and ultrasonography (USG) and computed tomography (CT) results were noted and compared. Results: Six hundered twenty-eight patients were included in the study, among which 15.1% (n=95) were considered F, and 12% (n=74) were CA. Age and gender did not significantly differ in terms of LD and severity (P=0.15, P=0.24 and P=0.2, P=0.21, respectively). Drainage requirement, local peritonitis, levels of CRP, Wbc, and Neu% were significantly higher in the CA group (P<0.001, P<0.001, P<0.001, P=0.009, and P<0.001, respectively). Drainage, appendix diameter, levels of CRP, and Neu% were significantly higher in the F group (P=0.01, P=0.04, P=0.007, and P=0.046, respectively). CA rate was insignificantly higher in the F group (17% vs 11%) (P=0.72). The false-negative ratio of USG and CT was higher in F patients with CA (56.2% vs. 37.5%). Conclusion: This study showed that language disability could be a risk factor for complicated appendicitis with higher drainage ratio, appendix diameter, levels of CRP, and Neu%.

Keywords

• Appendicitis
• Severity
• Language Disability

Dil engeli, komplike apandisit için bir risk faktörü müdür? Geriye dönük kohort çalışma

Öz

Amaç: Akut apandisit en sık acil cerrahi hastalık ve komplike apandisit sağlık kuruluşlarına erişebilme göstergesidir. Son on yılda göçlerin artması ile dil engeli sağlık için önemli hale gelmiştir. Dil engelinin komplike apandisit için risk faktörü olarak değerlendirmeyi amaçladık. Yöntemler: Ocak 2014’den Aralık 2018 tarihleri arasında akut apandisit nedeni ile opere edilen hastalar geriye dönük değerlendirildi. Hastaların yaş, cinsiyet, dil engeli (DE) (var (Y) yok (V)), drenaj uygulanması, patolojisi (apandiks çapı, şiddeti komplike olan (KA), komplike olmayan (KOA), ve lokal peritonit varlığı), C-Reaktif Proteini (CRP), beyaz küre (BK), nötrofil yüzdesi (Nöt%), ultrasonografi (US) ve bilgisayarlı tomografi (BT) sonuçları istatistiksel olarak değerlendirildi. Bulgular: Altı yüz yirmi sekiz hasta çalışmaya dahil edildi. %15,1’i (n=95) Y, ve %12’si (n=74) KA idi. DE ve şiddet açısından yaş ve cinsiyet farkı istatistiksel olarak anlamlı saptanmadı (sırasıyla P=0,15, P=0,24 ve P=0,2, P=0,21). Drenaj, lokal peritonit, CRP, BK ve Nöt% KA grubunda anlamlı olarak yüksek saptandı (sırasıyla P<0,001, P<0,001, P<0,001, P=0,009, ve P<0,001). Drenaj, apandiks çapı, CRP ve Nöt% seviyesi Y gurunda anlamlı olarak yüksek saptandı (sırasıyla P=0,01, P=0,04, P=0,007 ve P=0,046). KA oranı Y grubunda daha fazla olmasına rağmen (%17 karşı %11) istatistiksel olarak anlamlı (P=0,72). US ve BT’nin yalancı negatiflik oranı KA’lı Y grubunda daha yüksek saptandı (%56,2 karşı %37,5). Sonuç: Bu çalışma dil engelinin; yüksek drenaj oranı, apandiks çapı, CRP ve Nöt% seviyeleri ile komplike apandisit için bir risk faktörü olabileceğini göstermiştir.

Anahtar Kelimeler

• Apandisit
• Şiddet
• Dil engeli

Kaynakça

1. 1. Health of Refuges and Migrants. Regional situation analysis, practices, experiences, lessons learned and ways forward. WHO European Region 2018. available at https://www.who.int/migrants/publications/EURO-report.pdf
2. 2. Republic of Turkey Ministry of Interior Directorate General of Migration Managment, Migration Statistics 2018. available at http://www.goc.gov.tr/icerik/migration-statistics_915_1024
3. 3. Ponce NA, Hays RD, Cunningham WE. Linguistic disparities in health care access and health status among older adults. J Gen Intern Med. 2006;21:786e91.
4. 4. Braveman P, Schaaf VM, Egerter S, Bennett T, Schecter W. Insurance-related differences in the risk of ruptured appendix. N Engl J Med. 1994;331:444e9.
5. 5. Gans SL, Pols MA, Stoker J, Boermeester MA. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Dig Surg. 2015;32:23–31.
6. 6. Viniol A, Keunecke C, Biroga T, Stadje R, Dornieden K, Bösner S, et al. Studies of the symptom abdominal pain--a systematic review and meta-analysis. Fam Pract. 2014;31(5):517-29.
7. 7. Graff L, Russell J, Seashore J, Tate J, Elwell A, Prete M, et al. False-negative and false-positive errors in abdominal pain evaluation failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med. 2000;7(11):1244-55.
8. 8. Gadomski A, Jenkins P. Ruptured appendicitis among children as an indicator of access to care. Health Serv Res. 2001;36(1 Pt 1):129-42.

9. 9. Liu TL, Tsay JH, Chou YJ, Huang N. Comparison of the perforation rate for acute appendicitis between nationals and migrants in Taiwan, 1996-2001. Public Health. 2010;124(10):565-72. doi: 10.1016/j.puhe.2010.05.009.
10. 10. Tatsioni A, Charchanti A, Kitsiou E, Ioannidis JP. Appendicectomies in Albanians in Greece: outcomes in a highly mobile immigrant patient population. BMC Health Serv Res. 2001;1:5.
11. 11. Yeşiltaş M, Karakaş DÖ, Gökçek B, Hot S, Eğin S. Can Alvarado and Appendicitis Inflammatory Response scores evaluate the severity of acute appendicitis? Ulus Travma Acil Cerrahi Derg. 2018;24:557-62.
12. 12. Shindoh J, Niwa H, Kawai K, Ohata K, Ishihara Y, Takayabashi N, et al. Diagnostic power of inflammatory markers in predicting severity of appendicitis. Hepatogastroenterology. 2011;58(112):2003-6. doi: 10.5754/hge10329.
13. 13. Avanesov M, Wiese NJ, Karul M, Guerreiro H, Keller S, Busch P, et al. Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI). Eur Radiol. 2018;28(9):3601-10. doi: 10.1007/s00330-018-5339-9.
14. 14. Sanz-Peláez O, Angel-Moreno A, Tapia-Martín M, Conde-Martel A, Carranza-Rodríguez C, Carballo-Rastrilla S, et al. [Reference values in the usual laboratory data for sub-Saharan F. Importance in the management of infectious diseases]. Rev Clin Esp. 2008;208(8):386-92.
15. 15. D'Souza N, Nugent K. Appendicitis. Am Fam Physician. 2016;15;93(2):142-3.
16. 16. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies. Ann Surg. 2017;266(2):237-41. doi: 10.1097/SLA.0000000000002188.
17. 17. Jaeger FN, Pellaud N, Laville B, Klauser P. The migration-related language barrier and professional interpreter use in primary health care in Switzerland. BMC Health Serv Res. 2019; 27;19(1):429. doi: 10.1186/s12913-019-4164-4.
18. 18. Torun P, Mücaz Karaaslan M, Sandıklı B, Acar C, Shurtleff E, Dhrolia S, et al. Health and health care access for Syrian refugees living in İstanbul. Int J Public Health. 2018;63(5):601-8. doi: 10.1007/s00038-018-1096-4.
19. 19. Affronti M, Affronti A, Pagano S, Soresi M, Giannitrapani L, Valenti M, et al. The health of irregular and illegal F: analysis of day-hospital admissions in a department of migration medicine. Intern Emerg Med. 2013;8(7):561-6. doi: 10.1007/s11739-011-0635-2.
20. 20. Eddama M, Fragkos KC, Renshaw S, Aldridge M, Bough G, Bonthala L, et al. Logistic regression model to predict acute uncomplicated and complicated appendicitis. Ann R Coll Surg Engl. 2019;101(2):107-18. doi: 10.1308/rcsann.2018.0152.
21. 21. Li Z, Zhao L, Cheng Y, Cheng N, Deng Y. Abdominal drainage to prevent intraperitoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database of Systematic Reviews. 2018, Issue 5. Art. No.: CD010168. doi: 10.1002/14651858.CD010168.pub3.
22. 22. Van den Worm L, Georgiou E, De Klerk M. C-reactive protein as a predictor of severity of appendicitis. S Afr J Surg. 2017 Jun;55(2):14-7.
23. 23. Şahbaz NA, Bat O, Kaya B, Ulukent SC, İlkgül Ö, Yiğit M, et al. The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(6):423-6.
24. 24. McGowan DR, Sims HM, Zia K, Uheba M, Shaikh IA. The value of biochemical markers in predicting a perforation in acute appendicitis. ANZ J Surg. 2013;83(1-2):79-83. doi: 10.1111/ans.12032.
25. 25. Virmani S, Prabhu PS, Sundeep PT, Kumar V. Role of laboratory markers in predicting severity of acute appendicitis. Afr J Paediatr Surg. 2018;15(1):1–4. doi:10.4103/ajps.AJPS_47_16
26. 26. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012;10(3):115-9. doi: 10.1016/j.ijsu.2012.02.006.
27. 27. Lembcke B. Ultrasonography for acute appendicitis - the way it looks today. Z Gastroenterol. 2016;54(10):1151-65. doi: 10.1055/s-0042-116949.