{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:27:37Z","timestamp":1788172057400,"version":"build-2803163510"},"reference-count":60,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T00:00:00Z","timestamp":1659398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MHB publication fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p &lt; 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.<\/jats:p>","DOI":"10.3390\/jcm11154495","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T21:41:37Z","timestamp":1659476497000},"page":"4495","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Claus W.","family":"Schildberg","sequence":"first","affiliation":[{"name":"Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg\/Havel, 14770 Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Reissig","sequence":"additional","affiliation":[{"name":"Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg\/Havel, 14770 Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hunger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg\/Havel, 14770 Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Paasch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg\/Havel, 14770 Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosi","family":"Stillger","sequence":"additional","affiliation":[{"name":"CLINOTEL Hospital Association Gemeinnuetzige GmbH von- der- Wettern-Str.27, 51149 K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Mantke","sequence":"additional","affiliation":[{"name":"Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg\/Havel, 14770 Brandenburg, Germany"},{"name":"Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg\/Havel, 14770 Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,2]]},"reference":[{"key":"ref_1","first-page":"218","article-title":"Versorgungstrends, regionale Variation und Qualit\u00e4t der Versorgung bei Appendektomien","volume":"10","author":"Rolle","year":"2016","journal-title":"Versorg. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Jaschinski, T., Christoph, G., Mosch, M., Eikermann, M., Edmund, N.A.M., Sauerland, S., and Cochrane Colorectal Cancer Group (2018). Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst. Rev., 11.","DOI":"10.1002\/14651858.CD001546.pub4"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1007\/s00268-011-1101-z","article-title":"In-hospital delay increases the risk of perforation in adults with appendicitis","volume":"35","author":"Busch","year":"2011","journal-title":"World J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1097\/SLA.0000000000002039","article-title":"Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015: CRD42015016882)","volume":"265","author":"Harnoss","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_5","first-page":"17","article-title":"Akute Appendizitis: Moderne Diagnostik und Therapie","volume":"1","author":"Braun","year":"2016","journal-title":"HEABL"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s00423-017-1608-3","article-title":"Risk factors for morbidity after appendectomy","volume":"402","author":"Andert","year":"2017","journal-title":"Langenbecks Arch Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12876-015-0277-3","article-title":"Laparoscopic versus open appendectomy in patients with suspected appendicitis: A systematic review of meta-analyses of randomised controlled trials","volume":"15","author":"Jaschinski","year":"2015","journal-title":"BMC Gastroenterol."},{"key":"ref_8","unstructured":"(2022, April 14). Available online: https:\/\/www.dimdi.de\/static\/de\/klassifikationen\/icd\/icd-10-gm\/kode-suche\/htmlgm2013\/."},{"key":"ref_9","unstructured":"(2022, April 14). Available online: https:\/\/www.dimdi.de\/static\/de\/klassifikationen\/ops\/kode-suche\/opshtml2019\/."},{"key":"ref_10","first-page":"106","article-title":"STROCSS 2021 Guideline: Strengthening the reporting of cohort studies in surgery","volume":"96","author":"Agha","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_11","first-page":"764","article-title":"Acute Appendicitis in Childhood and Adulthood","volume":"117","author":"Laffolie","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1007\/s00384-021-03940-8","article-title":"Classification of acute appendicitis (CAA): Treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology","volume":"36","author":"Hoffmann","year":"2021","journal-title":"Int. J. Colorectal. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/SLA.0000000000001115","article-title":"Clinical Health Service Research on the Surgical Therapy of Acute Appendicitis: Comparison of Outcomes Based on 3 German Multicenter Quality Assurance Studies Over 21 Years","volume":"262","author":"Sahm","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s00268-016-3688-6","article-title":"Mortality Related to Appendectomy; a Population Based Analysis over Two Decades in Finland","volume":"41","author":"Kotaluoto","year":"2017","journal-title":"World J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/S0895-4356(98)00065-1","article-title":"Appendectomy in Sweden 1989-1993 assessed by the Inpatient Registry","volume":"51","author":"Blomqvist","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_16","first-page":"13","article-title":"Prospective Observational Study on acute Appendicitis Worldwide (POSAW)","volume":"16","author":"Sartelli","year":"2018","journal-title":"World J. Emerg. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1007\/s00268-012-1856-x","article-title":"Short and long-term mortality after appendectomy in Sweden 1987 to 2006, Influence of appendectomy diagnosis, sex, age, co-morbidity, surgical method, hospital volume, and time period. A national population-based cohort study","volume":"37","author":"Andersson","year":"2013","journal-title":"World J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4103\/1596-3519.70956","article-title":"Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria","volume":"9","author":"Oguntola","year":"2010","journal-title":"Ann. Afr. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ijsu.2006.03.009","article-title":"Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran","volume":"5","author":"Noudeh","year":"2007","journal-title":"Int. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4668","DOI":"10.1007\/s00464-016-5245-7","article-title":"Diagnosis and management of acute appendicitis. EAES consensus development conference 2015","volume":"30","author":"Gorter","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"198","DOI":"10.2214\/AJR.16.17274","article-title":"Comparison of Low- and Standard-Dose CT for the Diagnosis of Acute Appendicitis: A Meta-Analysis","volume":"208","author":"Yun","year":"2017","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.amjsurg.2012.07.038","article-title":"Examining the relevance of the physician\u2019s clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis","volume":"205","author":"Nelson","year":"2013","journal-title":"Am. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/2156-7514.104306","article-title":"Computed tomography mimics of acute appendicitis: Predictors of appendiceal disease confirmed at pathology","volume":"2","author":"Duda","year":"2012","journal-title":"J. Clin. Imaging. Sci."},{"key":"ref_24","first-page":"19","article-title":"Diagnostic accuracy of computed tomography for appendicitis in adults","volume":"7","author":"Rud","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"406","DOI":"10.2214\/ajr.185.2.01850406","article-title":"CT evaluation of appendicitis and its complications: Imaging techniques and key diagnostic findings","volume":"185","author":"Leite","year":"2005","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/S2468-1253(17)30247-9","article-title":"Low-dose CT for the diagnosis of appendicitis in adolescents and young adults (LOCAT): A pragmatic, multicenter, randomized controlled non-inferiority trial","volume":"2","author":"Kim","year":"2017","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1067\/j.cpradiol.2016.12.002","article-title":"Use of computed tomography to determine perforation in patients with acute appendicitis","volume":"47","author":"Gaskill","year":"2018","journal-title":"Curr. Prob. Diagnostic Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jacr.2018.09.033","article-title":"ACR Appropriateness Criteria\u00ae Right Lower Quadrant Pain-Suspected Appendicitis","volume":"15","author":"Garcia","year":"2018","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_29","first-page":"66","article-title":"Negative appendectomy: Evaluation of ultrasonography and Alvarado score","volume":"61","author":"Kundiona","year":"2015","journal-title":"Cent Afr. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jchir.2009.08.002","article-title":"Ultrasound and CT imaging in the diagnosis of acute appendicitis","volume":"1","author":"Bretagnol","year":"2009","journal-title":"J. Chir."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s00104-010-1938-y","article-title":"Rational diagnostics of acute abdomen","volume":"81","author":"Schildberg","year":"2010","journal-title":"Chirurg"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00104-018-0755-6","article-title":"Rational diagnostics of acute appendicitis","volume":"90","author":"Hoffmann","year":"2019","journal-title":"Chirurg"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1055\/s-0030-1247477","article-title":"Acute appendicitis-changes in epidemiology, diagnosis and therapy","volume":"36","author":"Sahm","year":"2011","journal-title":"Zentralbl. Chir."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/2452-2473.276384","article-title":"Point-of-care ultrasound for the acute abdomen in the primary health care","volume":"20","author":"Khan","year":"2020","journal-title":"Turk J. Emerg. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1007\/s00104-020-01237-0","article-title":"Recommendations on treatment of acute appendicitis: Recommendations of an expert group based on the current literature","volume":"9","author":"Andric","year":"2020","journal-title":"Chirurg"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Lapsa, S., Ozolins, A., Strumfa, I., and Gardovskis, J. (2021). Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics, 6.","DOI":"10.3390\/geriatrics6030093"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1097\/SLA.0000000000003661","article-title":"EAST Appendicitis Study Group. Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG), an EAST Multicenter Study","volume":"273","author":"Yeh","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1308\/rcsann.2020.7128","article-title":"Where have all the appendectomies gone?","volume":"103","author":"Mowbray","year":"2021","journal-title":"Ann. R Coll. Surg. Engl."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ijsu.2017.03.013","article-title":"How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence","volume":"40","author":"Kabir","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem Guidelines","volume":"15","author":"Podda","year":"2020","journal-title":"World J. Emerg. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Park, J.H., Salminen, P., Tannaphai, P., and Lee, K.H. Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence, Korean J. Radiol., 2022, ahead of print.","DOI":"10.3348\/kjr.2021.0596"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"D\u2019Souza, N., Hicks, G., Beable, R., Higginson, A., and Rud, B. (2021). Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database Syst. Rev., 12.","DOI":"10.1002\/14651858.CD012028.pub2"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"MERCY Study Collaborating Group (2022). Predictors of surgical outcomes of minimally invasive right colectomy: The MERCY study. Int. J. Colorectal. Dis., 37, 907\u2013918.","DOI":"10.1007\/s00384-022-04095-w"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1080\/0284186X.2021.2016949","article-title":"Dutch Pancreatic Cancer Group. Age and prognosis in patients with pancreatic cancer: A population-based study","volume":"61","author":"Besselink","year":"2022","journal-title":"Acta Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1177\/000313481808400674","article-title":"Laparoscopic Appendectomy: A Report on 1164 Operations at a Single-Institution, Safety-Net Hospital","volume":"84","author":"Dumas","year":"2018","journal-title":"Am. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Minutolo, V., Licciardello, A., Di Stefano, B., Arena, M., Arena, G., and Antonacci, V. (2014). Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years\u2019 experience in a district hospital. BMC Surg., 14.","DOI":"10.1186\/1471-2482-14-14"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4103\/aam.aam_11_18","article-title":"Acute perforated appendicitis in adults: Management and complications in Lagos, Nigeria","volume":"18","author":"Balogun","year":"2019","journal-title":"Ann. Afr. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s00464-010-1344-z","article-title":"Laparoscopic versus open appendectomy for acute appendicitis: A metaanalysis","volume":"25","author":"Wei","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1007\/s11605-012-1972-9","article-title":"Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis","volume":"16","author":"Ohtani","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1007\/s00464-012-2233-4","article-title":"Evidence to support the use of laparoscopic over open appendectomy for obese individuals: A meta-analysis","volume":"26","author":"Woodham","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/SLE.0b013e3182006f40","article-title":"Laparoscopy or not: A meta-analysis of the surgical effects of laparoscopic versus open appendectomy","volume":"20","author":"Liu","year":"2010","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/SLE.0b013e318058a117","article-title":"Choice of approach for appendectomy: A meta-analysis of open versus laparoscopic appendectomy","volume":"17","author":"Bennet","year":"2007","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Li, X., Zhang, J., Sang, L., Zhang, W., Chu, Z., Li, X., and Liu, Y. (2010). Laparoscopic versus conventional appendectomy\u2014A meta-analysis of randomized controlled trials. BMC Gastroenterol., 3.","DOI":"10.1186\/1471-230X-10-129"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/SLA.0000000000002188","article-title":"The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies","volume":"266","author":"Ferris","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/bjs.9964","article-title":"Snapshot Appendicitis Collaborative Study Group. Prospective nationwide outcome audit of surgery for suspected acute appendicitis","volume":"103","author":"Bolmers","year":"2016","journal-title":"Br. J. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1080\/13645700903053840","article-title":"Laparoscopic appendectomies: Experience of a surgical unit","volume":"18","author":"Gurrado","year":"2009","journal-title":"Minim. Invasive Ther. Allied. Techno."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1002\/bjs.9552","article-title":"Short-term complications and long-term morbidity of laparoscopic and open appendectomy in a national cohort","volume":"101","author":"Andersson","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_58","first-page":"875","article-title":"Morbidity and Mortality in Appendicitis in the Elderly","volume":"28","author":"Calis","year":"2018","journal-title":"J. Coll. Phys. Surg. Pak."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e2020","DOI":"10.4293\/JSLS.2020.00046","article-title":"Appendicitis is a Severe Disease in Elderly Patients: A Twenty-Year Audit","volume":"24","author":"Weinandt","year":"2020","journal-title":"JSLS"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1007\/s00268-012-1545-9","article-title":"Does laparoscopic appendectomy impart an advantage over open appendectomy in elderly patients?","volume":"36","author":"Masoomi","year":"2012","journal-title":"World J. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4495\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:01:03Z","timestamp":1760140863000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,2]]},"references-count":60,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11154495"],"URL":"https:\/\/doi.org\/10.3390\/jcm11154495","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,2]]}}}