Abstract

Introduction: Acute appendicitis is a common surgery disease which may affect about 7 of people during their longevity. This disease is one of the most common surgical emergencies and one of the most common abdominal emergency cases in the US. Approximately, 11 persons out of every 10 thousand experience appendicitis in their lifetime. The present research aims to study the epidemiological features of appendicitis including age, gender, and seasonal distribution in Yazd Province in 2014. Material and Methods: The present study was a retrospective analysis. After referring to the HIS system, information on all cases of appendicitis patients admitted to hospitals of Yazd province was extracted based on census sampling and then analyzed is SPSS-18 and shown in frequency tables and charts. In this study, Yazd Province’s population in 2014 was estimated based on the 2011 census conducted by the Statistics Center of Iran and those who were not from Yazd Province were excluded from the study. Results: the prevalence of appendectomy was studied in health-medical centers of Yazd province. Out of 24 hospitals in this province, 18 hospitals were selected and studied. According to the hospital record systems, 3743 cases of appendectomy have been done in 2014, 1898 of which were related to men and the rest of them was related to women. In addition, using chi-square, no significant relationship was found between season and gender of patients (p=0.362). Conclusion: In this study we learn that there were no relation between gender and prevalence of appendicitis. Key words: appendicitis, prevalence, surgery Introduction: Acute appendicitis is a common surgery disease which may affect about 7 of people during their longevity. This disease is one of the most common surgical emergencies and one of the most common abdominal emergency cases in the US. Approximately, 11 persons out of every 10 thousand experience appendicitis in their lifetime 1. Appendicitis mostly occurs at ages 15-25. This disease affects all age groups and both genders and its epidemiological prevalence in men and women is 8.6% and 6.7%, respectively. It is often difficult to get an accurate diagnosis of appendicitis. In France, 75,000 cases of normal or fibrotic appendectomy are annually done which is indicative of poor preoperative diagnosis as a major problem in diagnosis of acute appendicitis. On the other hand, two important complications of appendicitis, that are gangrene and perforation, are caused due to late diagnosis in most cases 2. The classical signs and symptoms of appendicitis are not always the same and different symptoms can make difficult the diagnosis of acute appendicitis. Clinical diagnosis is a common misdiagnosis problem and the rate of negative laparotomy is approximately 20-40% 3. Delay in diagnosis of appendicitis is associated with increased morbidity and mortality. Laboratory, ultrasound, and CT scan findings can be helpful in clinical diagnosis of patients. However, clinical method is the best diagnosis procedure for this disease and considered part of the art of clinical surgery. This ongoing inflammatory process requires the immediate removal of the appendix and prevention of life-threatening complications such as ruptured appendix and peritonitis. The results of appendicitis surgery have been satisfactory so far. On the other hand, if simple appendicitis is progressed to complicated appendicitis, it increases morbidity and mortality and also imposes high cost on patients and health systems 4. In the US, about 250,000 cases ofImperial Journal of Interdisciplinary Research (IJIR) Vol-2, Issue-11, 2016 ISSN: 2454-1362, http://www.onlinejournal.in Imperial Journal of Interdisciplinary Research (IJIR) Page 778 appendectomy are done annually done in the whole population and this figure in the population aged under 18 is 4 cases in every 1000 people 5. Rate of appendectomy has declined in most countries since 1950. For example, it reached the lowest rate in the US (15 cases in every 1000 people) in the US in 1990. In recent years, a few studies have specifically conducted on clinical aspects and problems of diagnosis and prognosis of acute appendicitis. In addition, some studies have been carried out on age, gender, and seasonal distribution of this disease but the reason for these changes is not yet known. The present research aims to study the epidemiological features of appendicitis including age, gender, and seasonal distribution in Yazd Province in 2014. Methodology: The present study was a retrospective analysis. After referring to the HIS system, information on all cases of appendicitis patients admitted to hospitals of Yazd province was extracted based on census sampling and then analyzed is SPSS-18 and shown in frequency tables and charts. In this study, Yazd Province’s population in 2014 was estimated based on the 2011 census conducted by the Statistics Center of Iran and those who were not from Yazd Province were excluded from the study. Results: In the present research, the prevalence of appendectomy was studied in health-medical centers of Yazd province. Out of 24 hospitals in this province, 18 hospitals were selected and studied. According to the hospital record systems, 3743 cases of appendectomy have been done in 2014, 1898 of which were related to men and the rest of them was related to women (Table 1). These patients were in the age group of below 1 to 80 with a mean of 24.97 (Table 2). The minimum and maximum days of hospitalization were 2 and 8, respectively, with a mean of 3.66 days (Table 2 and Table 3). In terms of seasonal distribution, 23.4%, 46.9%, 8.7%, and 21% of surgeries were performed in spring, summer, fall, and winter, respectively (Table 4). Based on the study of distribution among the seasons using chi-square analysis, no significant relationship was found between seasons and frequency of appendectomy (p=0.365) (Table 5). According to Table 6, patients were divided into 18 age groups in order to obtain the annual prevalence of appendicitis. According to the results, the highest and the lowest prevalence of appendicitis were related to the age groups 15-19 (4.39 cases in every 1000 people during the year) and 70-79 (0 case in every 1000 people during the year), respectively. Accordingly, an analytic comparison was made between age group and gender of patients using the chi-square and the results showed that there is no significant relationship between age and gender of patients (Table 7). Comparison of hospitalization days with age of patients suggested a significant relationship between them. This means that the length of hospitalization in younger and older patients is higher than the middle-aged ones (p=0.03). In addition, using chi-square, no significant relationship was found between season and gender of patients (p=0.362) (Table 7). In this research, the relationship of seasons with hospitalizations days and gender of patients was also studied but no significant relationship was observed between them (Table 8). Discussion: Acute appendicitis is the most common emergency general surgery that its standard treatment is appendectomy. In the case of no treatment, inflamed appendix may be ruptured or perforated and its infectious materials spread into the abdominal cavity. This can cause a condition called peritonitis, a serious inflammation of the abdominal cavity. If it is not immediately treated by taking strong antibiotics, it may be followed by fatal consequences. Peritonitis is just one of the hazards of bursting appendix. This represents an inflammation of the tissue that makes up the abdominal wall. Other organs may get inflamed after a ruptured appendix. In this case, the affected areas may include intestine, urinary bladder, and splenic flexure colon. If the damaged appendix is perforated instead of rupture, it can cause an abscess. In this case, infection would be limited to one area. However, the abscess can also be dangerous to health 1-2. Hence, the epidemiological features of patients with appendicitis were studied in this research. The present study was a retrospective analysis. After referring to the HIS system, information on all cases of appendicitis patients admitted to hospitals of Yazd province was extracted based on census sampling and then analyzed is SPSS-18 and shown in frequency tables and charts. In a study conducted by Mohammed Al-Omran et al. (2003), epidemiological features of acute appendicitis were studied in all acute care hospitals in Ontario. The results showed that appendicitis is more prevalent among people in the age group 10- 19 10. Jahangiri et al. (2007) studied the epidemiological features of acute appendicitis in Ray, Tehran and reported that appendicitis is more common in those aged 20-29 2. Michelle T. Buckius et al. (2012) conducted a study on the changing epidemiology of acute appendicitis in the United States in the years 1993- 2008 and reported that acute appendicitis is more prevalent among people aged 10-19 5.Imperial Journal of Interdisciplinary Research (IJIR) Vol-2, Issue-11, 2016 ISSN: 2454-1362, http://www.onlinejournal.in Imperial Journal of Interdisciplinary Research (IJIR) Page 779 In the study of David G. Addiss et al. (1990) on the epidemiology of appendicitis and appendectomy in national hospitals of the US in the years 1979- 1984, it was reported that the highest incidence of early positive appendectomy (appendicitis) (23.3 in every 10,000 people) belong to the age group 10-19 5. In the present study, patients were in the age group of below 1 to 80 with a mean of 24.97. According to the results, the highest and the lowest prevalence of appendicitis were related to the age groups 15- 19 (4.39 cases in every 1000 people during the year) and 70-79 (0 case in every 1000 people during the year), respectively. Mohammed Al-Omran et al. (2003) reported that the prevalence of appendicitis in men is higher than women 6. Jahangiri et al. (2007) and David G. Addiss et al. (1990) also reported the same result. Epidemiologically, the prevalence of appendicitis in men and women is 8.6% and 6.7%, respectively. In addition, the risk of appendectomy is 12.0% for men and 23.1% for women 7. In the present study, 1898 men and 1845 women were diagnosed with appendicitis which suggests higher prevalence of appendicitis among men. Mohammed Al-Omran et al. (2003) reported that the prevalence of appendicitis during summer months is higher than other seasons 8. Jahangiri et al. (2007) also obtained the same result 9. In terms of seasonal distribution, 23.4%, 46.9%, 8.7%, and 21% of surgeries studied in this present research were performed in spring, summer, fall, and winter, respectively. This indicates higher prevalence of appendicitis in summer compared to other seasons. Conclusion: In this study we found the References: 1. Al-Omran M, Mamdani MM, McLeod RS. Epidemiologic features of acute appendicitis in Ontario, Canada. Canadian journal of surgery. 2003;46(4):263. 2. Noudeh YJ, Sadigh N, Ahmadnia AY. Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran. International journal of surgery. 2007;5(2):95-8. 3. Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. Journal of Surgical Research. 2012;175(2):185-90. 4. Andersen S, Paerregaard A, Larsen K. Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996-2004. 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