The effect of environmental factors on the incidence of perforated appendicitis


COD: 2801_23_07_2018_AOP Categorie: ,

Haifa Aroui, H. Kalboussi, A. El Ghali, I. Kacem, M. Maoua, J. Maatoug, D. Taieb,
F. Hamila, N. Mrizak

Ann Ital Chir, Digital Edition 2018; 7
Epub Ahead of Print – July 23

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BACKGROUND: Acute appendicitis is the most common abdominal emergency. Its etiopathogenesis appears to be multifactorial.
Several studies suggested a relationship between the development of acute appendicitis and some environmental
factors. Air pollution predisposes some people to develop perforated appendicitis. However, data are relatively scarce and
the results still controversial.
AIM: Determine the seasonal variation of acute appendicitis and study the association between perforated appendicitis
and short-term exposure to climatic factors and to air pollutants.
METHODS: A cross-sectional study was conducted including patients hospitalized in the general surgery department of
Farhat Hached University Hospital in Sousse for acute appendicitis between January 1st and December 31st, 2014.
Climatic conditions were collected from the National Institute of Meteorology. Data on air pollution were given by the
National Agency for the Protection of the Environment and obtained by the modeling of the atmospheric pollution. For
statistical analysis, we used mean concentrations of each environmental factor corresponding to the day of hospital admission
and lagged by the 7 previous days. These factors were compared between the group of patients with perforated
appendicitis and patients with nonperforated appendicitis.
RESULTS: We collected 246 cases of acute appendicitis. Perforated appendicitis was reported in 15.2% of the cases. The
incidence of acute appendicitis was higher during summer. Compared to nonperforated appendicitis, perforated appendicitis
was significantly associated with the mean relative humidity of the 5 day lag (p = 0.046), rainfall of the
7 day lag (p = 0.043), and consultation delay (p <10-3). Furthermore, perforated appendicitis was significantly associated with the daily mean concentration of carbon dioxide (p = 0.042), the 2- day lag mean concentration of particulate matter less than 10 μ (PM10 ) (p = 0.016), and the 2-day lag mean concentration of ozone (p = 0.048). After multivariate statistical analysis, predictive factors for perforated appendicitis were the consultation delay (OR: 1.621, 95% CI [1.288 - 2.039]; p<10-3) and the 2 day lag mean concentration of PM10 (OR: 1.066, 95% CI [1.007- 1.130]; p = 0.029). CONCLUSION: Short-term exposure to particulate matter was associated with perforated appendicitis. Further large-scale studies are needed to support this conclusion.