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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Clinical and Laboratory Prediction of Histopathologically Complicated Acute Appendicitis and Associated Surgical Outcomes: A Retrospective Cohort Study

  • Volkan Gökmen1
  • Eva Kajti2
  • Dursun Alper Yılmaz1,3
  • Adem Aslan4
4 affiliations
  1. 1Department of Nursing, Faculty of Health Sciences, Ağrı İbrahim Çeçen University, Ağrı 04100, Türkiye
  2. 2Department of Nursing, Faculty of Health Sciences, Atlas University, İstanbul 34408, Türkiye
  3. 3Department of Physiology, Faculty of Medicine, Bursa Uludağ University, Bursa 16059, Türkiye
  4. 4Department of General Surgery, Faculty of Medicine, Ağrı İbrahim Çeçen University, Ağrı 04100, Türkiye
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Abstract

Background/Objectives: Preoperative recognition of complicated acute appendicitis remains difficult, although severity influences treatment and perioperative planning. This study examined clinical and laboratory correlates of histopathologically complicated appendicitis and associated short-term outcomes and developed a preoperative prediction model. Methods: This single-center retrospective cohort included 500 adults undergoing appendectomy for suspected acute appendicitis (2021–2025). The primary outcome was gangrenous or perforated appendicitis on histopathology. Fifty preoperative candidate predictors were analyzed using least absolute shrinkage and selection operator (LASSO) logistic regression with nested cross-validation, calibration and predictor-selection reproducibility assessment, comparison with the Appendicitis Inflammatory Response (AIR) and Alvarado scores, and same-center temporal evaluation (2025 cohort). Results: Complicated histopathology was present in 111 patients (22.2%) and was associated with longer symptom duration, physiological disturbance, peritoneal signs, and systemic inflammation. The LASSO model achieved an out-of-fold area under the curve (AUC) of 0.861 (95% confidence interval [CI], 0.828–0.892; Brier score, 0.129; calibration intercept, −0.158; slope, 0.898), compared with 0.841 for AIR (difference, 0.020; 95% CI, −0.011 to 0.054; p = 0.221) and 0.743 for Alvarado (difference, 0.117; 95% CI, 0.067–0.169; p < 0.001). In the 2025 cohort, the AUC was 0.859 (95% CI, 0.783–0.926), but calibration indicated overprediction (intercept, −0.383; slope, 0.895). Thirty-day complications occurred in 15.3% and 8.0% of patients with complicated and non-complicated histopathology, respectively. Conclusions: Routinely available preoperative variables provided good internally validated discrimination, but the LASSO model did not significantly outperform the simpler AIR score. Overprediction in the later same-center cohort indicates that independent multicenter validation and recalibration are required before clinical use.

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Cite

BibTeXRIS
BibTeX
@article{gokmen2026clinical,
  title = {{Clinical and Laboratory Prediction of Histopathologically Complicated Acute Appendicitis and Associated Surgical Outcomes: A Retrospective Cohort Study}},
  author = {Volkan Gökmen and Eva Kajti and Dursun Alper Yılmaz and Adem Aslan},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208063},
  url = {https://www.mdpi.com/2077-0383/15/20/8063},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Clinical and Laboratory Prediction of Histopathologically Complicated Acute Appendicitis and Associated Surgical Outcomes: A Retrospective Cohort Study
AU  - Volkan Gökmen
AU  - Eva Kajti
AU  - Dursun Alper Yılmaz
AU  - Adem Aslan
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208063
UR  - https://www.mdpi.com/2077-0383/15/20/8063
AB  - Background/Objectives: Preoperative recognition of complicated acute appendicitis remains difficult, although severity influences treatment and perioperative planning. This study examined clinical and laboratory correlates of histopathologically complicated appendicitis and associated short-term outcomes and developed a preoperative prediction model. Methods: This single-center retrospective cohort included 500 adults undergoing appendectomy for suspected acute appendicitis (2021–2025). The primary outcome was gangrenous or perforated appendicitis on histopathology. Fifty preoperative candidate predictors were analyzed using least absolute shrinkage and selection operator (LASSO) logistic regression with nested cross-validation, calibration and predictor-selection reproducibility assessment, comparison with the Appendicitis Inflammatory Response (AIR) and Alvarado scores, and same-center temporal evaluation (2025 cohort). Results: Complicated histopathology was present in 111 patients (22.2%) and was associated with longer symptom duration, physiological disturbance, peritoneal signs, and systemic inflammation. The LASSO model achieved an out-of-fold area under the curve (AUC) of 0.861 (95% confidence interval [CI], 0.828–0.892; Brier score, 0.129; calibration intercept, −0.158; slope, 0.898), compared with 0.841 for AIR (difference, 0.020; 95% CI, −0.011 to 0.054; p = 0.221) and 0.743 for Alvarado (difference, 0.117; 95% CI, 0.067–0.169; p < 0.001). In the 2025 cohort, the AUC was 0.859 (95% CI, 0.783–0.926), but calibration indicated overprediction (intercept, −0.383; slope, 0.895). Thirty-day complications occurred in 15.3% and 8.0% of patients with complicated and non-complicated histopathology, respectively. Conclusions: Routinely available preoperative variables provided good internally validated discrimination, but the LASSO model did not significantly outperform the simpler AIR score. Overprediction in the later same-center cohort indicates that independent multicenter validation and recalibration are required before clinical use.
SN  - 2077-0383
ER  -