Risk Factors for Intra-Abdominal Abscess Formation After Appendectomy: A Multicenter Study from Africa

Risk Factors for Intra-Abdominal Abscess Formation After Appendectomy: A Multicenter Study from Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk Factors for Intra-Abdominal Abscess Formation After Appendectomy: A Multicenter Study from Africa Ali Mohamed Arif, Muhammet Ali Aydemir, Tugrul Ozdemir, Abdiwahab Dahir Alasow, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8562776/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Postoperative intra-abdominal abscess (IAA) remains a significant cause of morbidity after appendectomy, particularly in low-resource settings where delayed presentation and advanced disease are common. This study aimed to identify factors associated with postoperative IAA formation after appendectomy in an African setting and to evaluate management strategies and outcomes. Methods A multicenter retrospective cohort study was conducted at three tertiary hospitals in Mogadishu, Somalia. All patients who underwent appendectomy between January 2024 and July 2025 were included. Demographic, clinical, intraoperative, and postoperative variables were collected from medical records. The primary outcome was the development of an intra-abdominal abscess within 30 days after appendectomy. Patients with and without IAAs were compared. Results Ninety-two patients were included, of whom 19 (20.7%) developed postoperative IAAs. Delayed presentation beyond 48 hours was significantly more frequent in the abscess group (94.7% vs. 30.1%, p < 0.001). Perforated appendicitis and appendicolith presence were strongly associated with IAA formation. Operative times longer than 60 minutes and drain placement were also more common among patients with IAAs. These patients experienced longer hospital stays and higher rates of wound infection and sepsis. Most abscesses were successfully managed with antibiotics alone. Conclusion Postoperative IAA formation after appendectomy in this low-resource setting is primarily driven by delayed presentation and advanced disease severity. Improving early access to surgical care and optimizing perioperative management may reduce postoperative morbidity. Appendectomy intra-abdominal abscess risk factors INTRODUCTION Post-appendectomy intra-abdominal abscess (IAA) is a well-recognized postoperative complication that substantially increases morbidity, prolongs hospital stay, and leads to higher healthcare utilization compared with uncomplicated appendectomy ( 1 – 3 ). Although advances in surgical techniques and perioperative care have reduced overall complication rates, IAA remains a clinically relevant problem, particularly in patients undergoing appendectomy for complicated appendicitis. The development of IAA after appendectomy is considered a multifactorial process. Disease-related factors play a central role, with perforated and gangrenous appendicitis consistently reported as the strongest predictors of postoperative abscess formation ( 1 , 4 , 5 ). Patients presenting with these advanced forms of appendicitis have significantly higher rates of postoperative IAAs than those with simple or uncomplicated disease. In addition to the severity of appendicitis, several patient- and surgery-related variables have been implicated, including obesity, elevated preoperative inflammatory markers, biochemical indicators such as hyperbilirubinemia, prolonged operative time, and the presence of free appendicoliths ( 2 , 6 , 7 ). From a pathophysiological perspective, the extent of intra-abdominal contamination during appendectomy is a key determinant of postoperative infectious complications. Residual purulent or feculent peritoneal fluid has been shown to correlate strongly with subsequent organ/space infections, including IAAs, highlighting the importance of adequate source control during surgery ( 3 ). Operative strategies such as the choice of surgical approach and the use of peritoneal irrigation or drainage have been investigated as potential modifiers of IAA risk; however, evidence regarding routine drainage remains inconsistent, and no universal consensus has been established ( 1 , 8 ). While most data on post-appendectomy IAAs originate from high-income countries, the burden of this complication may be disproportionately higher in low-resource settings. In many African countries, access to timely surgical care is limited by geographical, economic, and systemic barriers, resulting in delayed presentation and a higher prevalence of complicated appendicitis at the time of surgery ( 9 ). Late presentation, combined with constraints in sterilization infrastructure, perioperative antibiotic availability, and postoperative monitoring, may further increase the risk of postoperative infectious complications, including IAAs ( 10 ). Despite these challenges, data focusing specifically on post-appendectomy IAA risk factors in African populations remain scarce. Management of IAAs following appendectomy typically includes conservative treatment with antibiotics alone, image-guided percutaneous drainage, or surgical re-intervention ( 3 , 11 ). The choice of management strategy depends on abscess size, clinical stability, and available resources. Antibiotic therapy alone has been shown to be effective in selected patients, whereas percutaneous drainage remains a cornerstone for larger or persistent collections, with reported success rates exceeding 70–90% in multiple series ( 11 , 12 ). Understanding how these management strategies are applied and perform in resource-limited settings is essential for optimizing patient outcomes. The primary aim of this study is to identify factors associated with the development of intra-abdominal abscesses after appendectomy in an African, low-resource setting. The secondary aim is to evaluate the management approaches used for post-appendectomy IAAs and to assess their outcomes, with the goal of informing evidence-based strategies applicable to similar healthcare environments. MATERIALS AND METHODS This study was conducted using a retrospective cohort design to evaluate factors associated with the development of IAA following appendectomy. The study was conducted in Mogadishu, Somalia, at three tertiary-level hospitals providing general surgical services: Royal Hospital, a private tertiary-care referral center; Alami Specialist Hospital, a high-volume tertiary hospital managing both elective and emergency general surgery; and Samadeeq Hospital, a tertiary multidisciplinary hospital with a substantial emergency surgery workload. These institutions represent major appendectomy-performing centers in the city and serve diverse patient populations. The study population consisted of patients who underwent appendectomy at the participating hospitals during the study period between January 1, 2024, and July 31, 2025. Patients were eligible for inclusion if they had undergone appendectomy within the defined study period, regardless of age or sex, and if their medical records contained sufficient clinical, intraoperative, and postoperative data to allow reliable assessment of risk factors and outcomes. Patients were excluded if they had been referred from another hospital after undergoing appendectomy elsewhere, in order to avoid misclassification of perioperative variables and postoperative outcomes, or if their medical records were incomplete or missing key information, particularly regarding operative findings or postoperative follow-up. A census sampling approach was used, whereby all patients meeting the inclusion criteria during the study period were included. After application of the inclusion and exclusion criteria, a total of 92 patients were included in the final analysis. Of these, 73 patients did not develop postoperative IAAs, while 19 patients were diagnosed with intra-abdominal abscesses within 30 days following appendectomy. Case identification and data retrieval were performed retrospectively using surgical logs and medical record archives at each participating hospital. Data collection was performed through detailed review of hospital records, including admission notes, operative and anesthesia reports, laboratory findings, imaging results, and discharge summaries. A standardized data extraction form was used to ensure consistency across the three study sites. Collected variables included patient-related factors such as age, sex, and documented comorbidities including diabetes mellitus and hypertension, as well as indicators of immune or nutritional status when available. Clinical and intraoperative variables included duration of symptoms prior to surgery, type and severity of appendicitis as documented intraoperatively (classified as simple/uncomplicated, perforated, or gangrenous), duration of surgery, presence of intraoperative spillage or contamination, and the level of surgical experience of the operating surgeon (resident or specialist/consultant). Postoperative variables included antibiotic use and timing, length of hospital stay, and postoperative complications. The primary outcome variable was the development of an intra-abdominal abscess within 30 days after appendectomy, defined as a postoperative intra-abdominal collection confirmed by imaging modalities such as ultrasonography or computed tomography, or identified during reoperation. All collected data were entered into Stata version 18 (StataCorp LLC, College Station, TX, USA) for statistical analysis. Descriptive statistics were used to summarize baseline characteristics, with continuous variables expressed as means and standard deviations or medians with interquartile ranges, and categorical variables reported as frequencies and percentages. Bivariate analyses were performed to assess associations between independent variables and IAA formation using the chi-square or Fisher exact test for categorical variables and the independent-samples t test or Mann–Whitney U test for continuous variables, as appropriate. P value of less than 0.05 was considered statistically significant. Ethical approval was obtained from the Research and Ethical Committee of the School of Postgraduate Studies and Research Centre, Benadir University, Mogadishu, Somalia (IRB number: BU/PSG/53/73). Due to the retrospective nature of the study, informed consent was waived, and all data were anonymized prior to analysis. RESULTS A total of 92 patients who underwent appendectomy during the study period were included in the final analysis. Postoperative intra-abdominal abscess (IAA) developed in 20.7% (19/92) of patients, while 79.3% (73/92) had no evidence of abscess formation within the 30-day postoperative follow-up period (Table 1 ). Table 1 Factors associated with postoperative intra-abdominal abscess following appendectomy Categorical variables were compared using Chi-square or Fisher’s exact test, as appropriate Variables Intra-abdominal abscess Total p No (n = 73) Yes (n = 19) Sex 0.501 Female n (%) 21 (28.77) 4 (21.05) 25 (27.17) Male n (%) 52 (71.23) 15 (78.95) 67 (72.83) Age 0.741 <14 n (%) 14 (19.18) 6 (31.58) 20 (21.74) 15–24 n (%) 18 (24.66) 5 (26.32) 23 (25.00) 25–34 n (%) 25 (34.25) 4 (21.05) 29 (31.52) 35–44 n (%) 7 (9.59) 2 (10.53) 9 (9.78) 45 above n (%) 9 (12.33) 2 (10.53) 11 (11.96) Nutritional Status 0.094 Normal n (%) 57 (78.08) 13 (68.42) 70 (76.09) Overweight/Obese n (%) 12 (16.44) 2 (10.53) 14 (15.22) Underweight n (%) 4 (5.48) 4 (21.05) 8 (8.70) Comorbidities 0.425 Yes n (%) 18 (24.66) 7 (36.84) 25 (27.17) No n (%) 55 (75.34) 12 (63.16) 67 (72.83) Time from Symptom Onset 48 hours n (%) 22 (30.14) 18 (94.74) 40 (43.48) Appendicolith < 0.001 Yes n (%) 15 (20.55) 12 (63.16) 27 (29.35) No n (%) 58 (79.45) 7 (36.84) 65 (70.65) Types of Appendicitis < 0.001 Simple/Uncomplicated n (%) 44 (60.27) 1 (5.26) 45 (48.91) Gangrenous n (%) 7 (9.59) 1 (5.26) 8 (8.70) Perforated n (%) 22 (30.14) 17 (89.47) 39 (42.39) Surgical Approach 0.313 Laparoscopic n (%) 10 (13.70) 1 (5.26) 11 (11.96) Open n (%) 63 (86.30) 18 (94.74) 81 (88.04) Operative Time 0.032 30–60 minutes n (%) 20 (27.40) 5 (26.32) 25 (27.17) 60–120 minutes n (%) 39 (53.42) 13 (68.42) 52 (56.52) >120 minutes n (%) 14 (19.18) 1 (5.26) 15 (16.30) Surgeon Level 0.466 Resident n (%) 2 (2.74) 0 (0.00) 2 (2.17) Consultant n (%) 71 (97.26) 19 (100) 90 (97.83) Drain placement < 0.001 Yes n (%) 34 (46.58) 17 (89.47) 51 (55.43) No n (%) 39 (53.42) 2 (10.53) 41 (44.57) Timing of drain removal 0.494 Within 24 hours post-surgery n (%) 3 (7.89) 0 (0.00) 3 (5.26) 1 to 3 days post-surgery n (%) 11 (28.95) 4 (21.05) 15 (26.32) 3 to 5 days post-surgery n (%) 18 (47.37) 12 (63.16) 30 (52.63) More than 5 days post-surgery n (%) 6 (15.79) 3 (15.79) 9 (15.79) Duration of Antibiotic Therapy 0.123 10 days n (%) 7 (9.59) 3 (15.79) 10 (10.87) Length of Hospital Stay < 0.001 7 days n (%) 3 (4.11) 3 (15.79) 6 (6.52) Postoperative Complications < 0.001 Wound infection n (%) 3 (4.11) 6 (31.58) 9 (9.78) Sepsis n (%) - 2 (10.53) 2 (2.17) Ileus n (%) 1 (1.37) 0 (0.00) 1 (1.09) None n (%) 69 (94.52) 11 (57.89) 80 (86.96) Sex distribution was comparable between the two groups. Male patients constituted 78.9% (15/19) of the abscess group and 71.2% (52/73) of the non-abscess group (p = 0.501). Age distribution did not differ significantly between patients with and without postoperative IAA (p = 0.741), and no specific age category was disproportionately represented in the abscess group. Although not statistically significant, a higher proportion of underweight patients was observed among those who developed IAAs (21.1% [4/19]) compared with patients without abscess formation (5.5% [4/73]) (p = 0.094). Similarly, comorbid conditions were more frequent in the abscess group (36.8% [7/19]) than in the non-abscess group (24.7% [18/73]), but this difference did not reach statistical significance (p = 0.425). Delayed presentation was strongly associated with postoperative IAA formation. Presentation more than 48 hours after symptom onset occurred in 94.7% (18/19) of patients in the abscess group compared with 30.1% (22/73) in the non-abscess group (p < 0.001). In contrast, early presentation within the first 24 hours was observed exclusively among patients who did not develop postoperative abscesses (Table 1 ). The presence of an appendicolith was significantly more common in patients who developed IAAs (63.2% [12/19]) than in those without abscess formation (20.5% [15/73]) (p < 0.001). Disease severity differed markedly between groups. Perforated appendicitis was identified in 89.5% (17/19) of patients with postoperative IAAs, whereas uncomplicated appendicitis predominated in the non-abscess group (60.3% [44/73]) (p < 0.001). Gangrenous appendicitis was infrequent and similarly distributed between the two groups. Operative time was significantly longer in patients who developed IAAs (p = 0.032). Procedures lasting more than 60 minutes were observed in 68.4% (13/19) of the abscess group compared with 53.4% (39/73) of the non-abscess group. Drain placement was significantly more frequent among patients with postoperative IAAs (89.5% [17/19]) than among those without abscess formation (46.6% [34/73]) (p < 0.001). Length of hospital stay was also significantly prolonged in the abscess group (p < 0.001), with hospital stays of 5–7 days occurring in 78.9% (15/19) of abscess patients compared with 47.9% (35/73) of non-abscess patients, and stays longer than 7 days observed in 15.8% (3/19) versus 4.1% (3/73), respectively. Postoperative complications other than IAAs were significantly more frequent among patients who developed abscesses (p < 0.001). Wound infection occurred in 31.6% (6/19) of patients in the abscess group compared with 4.1% (3/73) in the non-abscess group, while sepsis was observed only among patients with IAAs (10.5% [2/19]). Among patients who developed postoperative IAAs, abscess diagnosis was most commonly confirmed by ultrasonography (73.7% [14/19]), with computed tomography used in the remaining cases. Symptom onset occurred more than 10 days after appendectomy in 63.2% (12/19) of patients. Conservative management with antibiotics alone was the most frequently employed treatment strategy (68.4% [13/19]), followed by percutaneous drainage (21.1% [4/19]), while reoperation was required in 10.5% (2/19) of cases. Microbiological cultures were obtained in 68.4% (13/19) of patients, with positive growth identified in 76.9% (10/13) of cultures; Escherichia coli was the most commonly isolated organism (70.0% [7/10]). Overall outcomes were favorable, with 89.5% (17/19) of patients discharged in improved condition, although 10.5% (2/19) required readmission (Table 2 ). Table 2 Clinical management and outcomes of postoperative intra-abdominal abscess Variables n (%) * Method of abscess diagnosis CT scan 5 (26.32) Ultrasound 14 (73.68) Time to onset of symptoms post-appendectomy 10 days 12 (63.16) Abscess management Antibiotics only 13 (68.42) Percutaneous drainage 4 (21.05) Reoperation 2 (10.53) Microbial culture obtained No 6 (31.58) Yes 13 (68.42) Organism isolated (among cultures obtained) No growth 3 (23.08) Growth detected 10 (76.92) Type of organism isolated † Escherichia coli 7 (70.00) Bacteroides species 2 (20.00) Pseudomonas aeruginosa 1 (10.00) Antibiotic susceptibility patterns Meropenem + Gentamicin + Piperacillin 3 (25.00) Meropenem + Piperacillin + Tazobactam 3 (25.00) Ciprofloxacin + Meropenem + Gentamicin 4 (33.33) Other combinations 2 (16.67) Outcome Discharged improved 17 (89.47) Readmission required 2 (10.53) *All variables are reported among patients who developed postoperative intra-abdominal abscess (n = 19) †Percentages for organism type are calculated among patients with positive cultures (n = 10). DISCUSSION This multicenter retrospective study highlights several clinically and systemically relevant factors associated with the development and management of IAA following appendectomy in a low-resource African setting. The findings underscore the critical interplay between delayed presentation, disease severity, operative factors, and postoperative management in shaping outcomes after appendectomy. Delayed diagnosis and late surgical intervention are well-established determinants of complicated appendicitis and postoperative IAA formation in low- and middle-income countries (LMICs). Recent African multicenter studies report that 60–80% of patients with complicated appendicitis present more than 48 hours after symptom onset, with postoperative abscess rates commonly ranging from 15% to 30% among delayed presenters ( 13 , 14 ). In our cohort, delayed presentation beyond 48 hours was observed in 94.7% of patients who developed IAAs compared with 30.1% of those without abscess formation (p < 0.001), indicating a substantially higher burden of delayed access to care than that reported in most contemporary LMIC series. High-risk pathological features, particularly perforated appendicitis and appendicolith presence, have consistently been associated with increased postoperative abscess risk ( 15 ). Recent evidence suggests that the presence of an appendicolith increases the likelihood of complicated appendicitis by more than threefold (odds ratio 3.52), a condition that is itself associated with higher rates of postoperative intra-abdominal abscess formation ( 16 ). In our study, perforated appendicitis was present in 89.5% of patients who developed IAAs versus 30.1% of those without abscess formation (p < 0.001), and appendicoliths were identified in 63.2% versus 20.5%, respectively (p < 0.001). These markedly higher proportions suggest that advanced disease at presentation is the dominant driver of postoperative IAA development in this setting. Operative duration has been proposed as a surrogate marker of both disease severity and intraoperative complexity. In a retrospective cohorts of 839 appendectomy patients, prolonged operative time was found to correlate with an increased risk of postoperative intra-abdominal infection, with multivariate analysis identifying both appendiceal perforation and extended surgery duration as independent predictors of postoperative abscess formation ( 17 ). In our cohort, procedures lasting longer than 60 minutes were more frequent among patients who developed IAAs (68.4%) compared with those without abscess formation (53.4%) (p = 0.032), supporting the association between prolonged surgery and infection risk in resource-constrained environments. The role of postoperative drainage in preventing postoperative IAAs remains controversial. Recent meta-analyses indicate that routine abdominal drain placement does not significantly reduce the incidence of postoperative IAAs after appendectomy ( 18 ). In addition, contemporary systematic reviews and comparative meta-analyses suggest that drain use may be associated with increased postoperative morbidity, including prolonged hospital stay, without providing a clear protective effect against abscess formation ( 19 ). In our study, drains were placed in 89.5% of patients who developed IAAs compared with 46.6% of those without abscess formation (p < 0.001). This finding likely reflects selective drain use in cases with severe intra-abdominal contamination rather than a protective effect, supporting an indication-based rather than routine drainage strategy. Limited access to diagnostic and therapeutic resources is a defining challenge in many African healthcare systems. In sub-Saharan Africa, ultrasonography is widely used as a primary imaging modality for suspected intra-abdominal collections due to limited access to CT and interventional radiology (IR) services, which remain under-developed in many tertiary centres. Recent analyses underscore the critical need to expand IR capacity in the region to improve abscess management outcomes ( 20 , 21 ). Our findings closely mirror this pattern, with ultrasonography used in 73.7% of abscess diagnoses and percutaneous drainage performed in only 21.1% of cases, underscoring persistent constraints in advanced imaging and minimally invasive treatment options. Surgeon experience and trainee involvement in appendectomies have been variably associated with operative performance and postoperative outcomes. Comparisons of laparoscopic appendectomies performed by residents versus senior registrars or consultants have shown no significant differences in postoperative complication rates, including intra-abdominal infections, despite longer operative times among resident-performed procedures, suggesting that resident participation under appropriate supervision does not inherently increase postoperative morbidity ( 22 ). Furthermore, studies evaluating intraoperative performance metrics in emergency appendectomy have demonstrated that surgical experience level may influence technical performance scores and operative duration, indicating that experience can affect procedural efficiency even if complication rates remain similar ( 23 ). Consistent with this evidence, surgeon level in our cohort did not emerge as a significant predictor of postoperative intra-abdominal abscess formation, suggesting that delayed presentation and disease severity were more influential determinants of adverse outcomes in our setting. Antibiotic stewardship and antimicrobial resistance are increasingly important considerations in postoperative infection management. Recent African studies report empirical broad-spectrum antibiotic use in more than 80% of complicated appendicitis cases, often in the absence of microbiological guidance ( 24 , 25 ). In our cohort, cultures were obtained in 68.4% of abscess cases, with Escherichia coli accounting for 70% of isolated organisms, emphasizing the need for local resistance surveillance to guide targeted therapy. LMIC settings report wide variability in postoperative intra-abdominal abscess rates after appendectomy, with laparoscopic approaches associated with IAA rates of approximately 5–15% and open surgery with rates of 10–25%, largely influenced by case mix and disease severity rather than operative modality alone ( 26 ). Consistent with recent LMIC-based comparative data showing no statistically significant difference in IAA rates between laparoscopic and open appendectomy after adjustment for perforation and delayed presentation, our findings further support that pathological severity and timing of presentation outweigh operative technique in determining postoperative abscess risk in resource-limited settings, as we similarly found no difference in abscess development according to surgical approach ( 27 ). Management of post-appendectomy intra-abdominal abscess is primarily guided by abscess size, anatomical localization, patient stability, and institutional resources. Evidence indicates that selected clinically stable patients with small, well-circumscribed abscesses can be successfully managed with antibiotic therapy alone, with reported resolution rates of approximately 60–80%. In contrast, image-guided percutaneous drainage is recommended for larger, multiloculated, or non-resolving collections, achieving clinical success rates exceeding 70% and reducing the need for re-operation ( 28 , 29 ). In our cohort, conservative management with antibiotics alone was the most frequently employed strategy (68.4%), followed by percutaneous drainage (21.1%), whereas reoperation was required in a minority of cases (10.5%). Despite limited access to interventional radiology, overall outcomes were favorable, with 89.5% of patients discharged in improved condition, suggesting that stepwise, resource-adapted management strategies can yield acceptable outcomes in low-resource settings. This study has inherent limitations related to its retrospective design, which may introduce selection and information bias due to reliance on the completeness and accuracy of medical records. The relatively small sample size, particularly the limited number of patients who developed postoperative intra-abdominal abscesses, may have reduced the statistical power to detect less pronounced associations and constrained the scope of multivariable analyses. Additionally, as the study was conducted in tertiary-level hospitals within a single urban setting, the findings may not be fully generalizable to rural or lower-level healthcare facilities with more limited resources. CONCLUSION In this multicenter retrospective study conducted in a resource-limited African setting, postoperative intra-abdominal abscess following appendectomy was strongly associated with delayed presentation, advanced disease severity, and prolonged operative course. The findings emphasize that barriers to timely healthcare access remain the primary drivers of postoperative morbidity and underscore the need for early diagnosis, prompt surgical intervention, and targeted management of high-risk patients. Strengthening community awareness, optimizing perioperative strategies, improving access to diagnostic and therapeutic resources, and reinforcing antibiotic stewardship programs are critical steps toward reducing the burden of post-appendectomy intra-abdominal abscesses in similar low-resource environments. Declarations Ethics approval and consent to participate This study is derived from a master’s thesis conducted within the School of Postgraduate Studies and Research at Benadir University. The study was approved by the Institutional Review Board of Benadir University (IRB number: BU/PSG/53/73). As this study was retrospective in nature and based on anonymized patient data, Human Ethics and Consent to Participate declarations: not applicable. Clinical trial number: not applicable. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The corresponding author and all co-authors declare that they have no competing interests. The authors also confirm that this manuscript is not under simultaneous consideration by any other journal and has not been published previously. Funding The authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions Ali Mohamed Arif: Project development, protocol development, literature search, data collection and management, data analysis, manuscript writing and editing, critical revision, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Muhammet Ali Aydemir: Project development, literature search, data collection and management, data analysis, manuscript writing, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Tugrul Ozdemir: Protocol development, literature search, data collection and management, data analysis, manuscript writing, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Abdiwahab Dahir Alasow: Literature search, data analysis, manuscript editing, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Feride İrem Simsek: Literature search, data collection and management, data analysis, manuscript editing, critical revision, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Orhan Alimoglu: Project development, protocol development, data collection and management, critical revision, final approval of the version to be published, and agreement to be accountable for all aspects of the work. References Cho J, Park I, Lee D, Sung K, Baek J, Lee J. Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences. Dig Surg. 2015;32(5):375–81. 10.1159/000438707 . Schlottmann F, Sadava EE, Peña ME, Rotholtz NA. Laparoscopic Appendectomy: Risk Factors for Postoperative Intraabdominal Abscess. World J Surg. 2017;41(5):1254–8. 10.1007/s00268-017-3869-y . Leandri M, Vallicelli C, Santandrea G et al. Postoperative Infections After Appendectomy for Acute Appendicitis: The Surgeon's Checklist. Antibiotics (Basel) . 2025;14(9):954. Published 2025 Sep 20. 10.3390/antibiotics14090954 Reid RI, Dobbs BR, Frizelle FA. Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg. 1999;69(5):373–4. 10.1046/j.1440-1622.1999.01576.x . Tartaglia D, Fatucchi LM, Mazzoni A, et al. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg. 2020;72(4):1175–80. 10.1007/s13304-020-00749-y . Eren T, Tombalak E, Ozemir IA, et al. Hyperbilirubinemia as a predictive factor in acute appendicitis. Eur J Trauma Emerg Surg. 2016;42(4):471–6. 10.1007/s00068-015-0562-4 . Son J, Han JW, Oh C. Risk Factors for Postoperative Intra-Abdominal Abscess in Pediatric Perforated Appendicitis Following Laparoscopic Appendectomy: A Multicenter Analysis. Child (Basel). 2024;11(11):1385. 10.3390/children11111385 . Abu A, Mohamedahmed AY, Alamin A, et al. Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis. Cureus. 2022;14(11):e32018. 10.7759/cureus.32018 . Published 2022 Nov 29. Mao BP, Collins G, Ayeni FE, Vagg DJ. Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study. Langenbecks Arch Surg. 2024;409(1):246. 10.1007/s00423-024-03421-w . Published 2024 Aug 9. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278–87. 10.1016/S0140-6736(15)00275-5 . van Amstel P, The SML, Mulder M. The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature. Front Pediatr. 2022;10:908485. 10.3389/fped.2022.908485 . Published 2022 Jun 20. Rodríguez Piñero JN, Casas MA, Angeramo CA, Baz Gallego JJ, Laxague F, Schlottmann F. Prospective validation of a therapeutic algorithm for postoperative intra-abdominal abscess after laparoscopic appendectomy. Surg Endosc. 2025;39(8):4929–34. 10.1007/s00464-025-11908-w . Feleke MG, Ayalew TL, Ashager K, Beyene HA, Abate MW, Tibebu NS. Unfavorable management outcome and its predictors among appendicitis patients in ethiopia: a systematic review and meta- analysis. BMC Surg. 2025;25(1):354. 10.1186/s12893-025-03108-z . Simelane PB, Kader SS, Madiba TE. Clinicopathological spectrum and outcome of appendicectomy at a South African tertiary hospital: continuing impact of delayed presentation. Afr Health Sci. 2024;24(2):365–74. 10.4314/ahs.v24i2.37 . Russell KW, Skarda DE, Jones TW, Barnhart DC, Short SS. Cessation of Antibiotics for Complicated Appendicitis at Discharge Does Not Increase Risk of Post-operative Infection. J Pediatr Surg. 2024;59(1):91–5. 10.1016/j.jpedsurg.2023.09.023 . Nikkolo C, Muuli M, Kirsimägi Ü, Lepner U. Appendicolith as a Sign of Complicated Appendicitis: A Myth or Reality? A Retrospective Study. Eur Surg Res. 2025;66(1):1–8. 10.1159/000543683 . Liu L, Feng W, Yu K, Cao C, Qiang G. Risk factors of abdominal abscess after laparoscopic appendectomy. BMC Surg . 2025;25(1):482. Published 2025 Oct 15. 10.1186/s12893-025-03241-9 Liao J, Zhou J, Wang J, Xie G, Wei H. Prophylactic abdominal drainage following appendectomy for complicated appendicitis: A meta-analysis. Front Surg. 2023;9:1086877. 10.3389/fsurg.2022.1086877 . Published 2023 Jan 18. Wu H, Liao B, Cao T, et al. Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis. BMC Gastroenterol. 2024;24(1):411. 10.1186/s12876-024-03500-8 . Published 2024 Nov 16. Ukweh ON, Alswang JM, Iya-Benson JN et al. Comparative Analysis of Percutaneous Drainage versus Operative Drainage of Intra-Abdominal Abscesses in a Resource-Limited Setting: The Tanzanian Experience. Ann Glob Health . 2023;89(1):35. Published 2023 Jun 1. 10.5334/aogh.4070 Abbattista T, Meloni MF, Ferraioli G, Pirri C. The urgent need to extend the appropriate use of ultrasound in Africa and worldwide. Overview, experiences and perspectives. Front Public Health. 2024;12:1363134. 10.3389/fpubh.2024.1363134 . Published 2024 Jun 17. Siam B, Al-Kurd A, Simanovsky N, et al. Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents. JAMA Surg. 2017;152(7):679–85. 10.1001/jamasurg.2017.0578 . Skjold-Ødegaard B, Ersdal HL, Assmus J, Søreide K. Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme. Surg Endosc. 2024;38(9):4939–46. 10.1007/s00464-024-11007-2 . Tadesse BT, Ashley EA, Ongarello S, et al. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis. 2017;17(1):616. 10.1186/s12879-017-2713-1 . Sartelli M, Catena F, Coccolini F, Pinna AD. Antimicrobial management of intra-abdominal infections: literature's guidelines. World J Gastroenterol. 2012;18(9):865–71. 10.3748/wjg.v18.i9.865 . Choy I, Kitto S, Adu-Aryee N, Okrainec A. Barriers to the uptake of laparoscopic surgery in a lower-middle-income country. Surg Endosc. 2013;27(11):4009–15. 10.1007/s00464-013-3019-z . Zamaray B, de Boer MFJ, Popal Z, Rijbroek A, Bloemers FW, Oosterling SJ. AbcApp: incidence of intra-abdominal ABsCesses following laparoscopic vs. open APPendectomy in complicated appendicitis. Surg Endosc. 2023;37(3):1694–9. 10.1007/s00464-022-09670-4 . Ben Dhaou M, Ghorbel S, Chouikh T, et al. Conservative management of post-appendicectomy intra-abdominal abscesses. Ital J Pediatr. 2010;36:68. 10.1186/1824-7288-36-68 . Published 2010 Oct 14. Di Saverio S, Podda M, De Simone B et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg . 2020;15(1):27. Published 2020 Apr 15. 10.1186/s13017-020-00306-3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Feb, 2026 Reviews received at journal 05 Feb, 2026 Reviews received at journal 15 Jan, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers invited by journal 13 Jan, 2026 Editor invited by journal 13 Jan, 2026 Editor assigned by journal 12 Jan, 2026 Submission checks completed at journal 12 Jan, 2026 First submitted to journal 09 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8562776","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":575103893,"identity":"ee2f25fe-10df-46d0-b78e-446f5c19d000","order_by":0,"name":"Ali Mohamed Arif","email":"","orcid":"","institution":"Benadir University","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Mohamed","lastName":"Arif","suffix":""},{"id":575103894,"identity":"8070688f-a0b3-482f-9a35-185baf0d3025","order_by":1,"name":"Muhammet Ali Aydemir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYFAC5oYDQAKMDnyokJADiR14gFcLI1wL48EZZ2yMwVoSCGhhAGsBEod529ISQVwGfFp02w82HvjZZi2n2877AKjlcPr8sMMPgbbYyek2YNdidiax4WBvW7qx2WF2g4Nzzh3O3Xg7zQCoJdnY7AAOLQcSGw4ADU/cdpiN4cCbMqCW2QkgLQcSt+HScv5hw8G/bYfrwVp42A6nG85O/4Bfy43EBpAXEsyAWg7ytKUlyEvnELDlxsOGwzLn0g1BtoAC2XCDdE7BgQQDPH45n3z445sya3mz88eYPwCjUl5+dvpmIMNODpcWMGBkQ+IYgFUa4FEOBn+Q2PINhFSPglEwCkbBSAMAcqxxoM2NEEQAAAAASUVORK5CYII=","orcid":"","institution":"Istanbul Medeniyet University","correspondingAuthor":true,"prefix":"","firstName":"Muhammet","middleName":"Ali","lastName":"Aydemir","suffix":""},{"id":575103895,"identity":"3e2b2a2d-3f1e-4f01-afa0-f277b97695f8","order_by":2,"name":"Tugrul Ozdemir","email":"","orcid":"","institution":"Istanbul Medeniyet University","correspondingAuthor":false,"prefix":"","firstName":"Tugrul","middleName":"","lastName":"Ozdemir","suffix":""},{"id":575103896,"identity":"4bf20745-eb23-47be-ad44-57902b0a05b1","order_by":3,"name":"Abdiwahab Dahir Alasow","email":"","orcid":"","institution":"Benadir University","correspondingAuthor":false,"prefix":"","firstName":"Abdiwahab","middleName":"Dahir","lastName":"Alasow","suffix":""},{"id":575103897,"identity":"18e2881d-29a7-42e1-9faf-5ca427cfa572","order_by":4,"name":"Feride İrem Simsek","email":"","orcid":"","institution":"Istanbul University Cerrahpaşa","correspondingAuthor":false,"prefix":"","firstName":"Feride","middleName":"İrem","lastName":"Simsek","suffix":""},{"id":575103898,"identity":"90c9bf7e-1d51-4bf9-a5d3-5418f5b66278","order_by":5,"name":"Orhan Alimoglu","email":"","orcid":"","institution":"Istanbul Medeniyet University","correspondingAuthor":false,"prefix":"","firstName":"Orhan","middleName":"","lastName":"Alimoglu","suffix":""}],"badges":[],"createdAt":"2026-01-09 16:08:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8562776/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8562776/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100512648,"identity":"cee7601f-da9a-45bc-acfd-f7764e66e8bf","added_by":"auto","created_at":"2026-01-18 13:07:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":36446,"visible":true,"origin":"","legend":"","description":"","filename":"Revisedmanuscriptv2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/1f3bc8545bd6786cf613b5ae.docx"},{"id":100512645,"identity":"73a06511-1d19-473a-9bb5-4e9d10232005","added_by":"auto","created_at":"2026-01-18 13:07:56","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22451,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/b17f8c4c6b2a0c4ceed8d19f.docx"},{"id":100512646,"identity":"54f46527-6cf3-455a-8fbe-bcaf0703602b","added_by":"auto","created_at":"2026-01-18 13:07:56","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18358,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/a2c0dfb1b5d5b176a880faef.docx"},{"id":100548365,"identity":"f92fe815-b167-4294-beea-d58ca23a0c4d","added_by":"auto","created_at":"2026-01-19 08:18:24","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9097,"visible":true,"origin":"","legend":"","description":"","filename":"a9e1e57caeb9454d8e3eca137128f18a.json","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/97d66ec9d62907f5b533756b.json"},{"id":100548548,"identity":"4c132aeb-192a-45ce-b318-03ed98c96564","added_by":"auto","created_at":"2026-01-19 08:19:23","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119032,"visible":true,"origin":"","legend":"","description":"","filename":"a9e1e57caeb9454d8e3eca137128f18a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/cd47b238c12442e4b89b29f8.xml"},{"id":100512651,"identity":"cf65dee0-736c-4fff-9bb8-f336161b92a2","added_by":"auto","created_at":"2026-01-18 13:07:56","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115094,"visible":true,"origin":"","legend":"","description":"","filename":"a9e1e57caeb9454d8e3eca137128f18a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/b18f90967b40f799a0719e6c.xml"},{"id":100548909,"identity":"644aef00-8e79-4a5a-b63c-828aadcfab93","added_by":"auto","created_at":"2026-01-19 08:21:28","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128844,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/2bb69aa94cf8792541653c6d.html"},{"id":100554273,"identity":"61490545-36d0-4925-9e06-25562d53267e","added_by":"auto","created_at":"2026-01-19 08:38:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":938562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8562776/v1/9e595a47-e3c7-48b2-ad5d-f1301bddef61.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk Factors for Intra-Abdominal Abscess Formation After Appendectomy: A Multicenter Study from Africa","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePost-appendectomy intra-abdominal abscess (IAA) is a well-recognized postoperative complication that substantially increases morbidity, prolongs hospital stay, and leads to higher healthcare utilization compared with uncomplicated appendectomy (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although advances in surgical techniques and perioperative care have reduced overall complication rates, IAA remains a clinically relevant problem, particularly in patients undergoing appendectomy for complicated appendicitis.\u003c/p\u003e \u003cp\u003eThe development of IAA after appendectomy is considered a multifactorial process. Disease-related factors play a central role, with perforated and gangrenous appendicitis consistently reported as the strongest predictors of postoperative abscess formation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Patients presenting with these advanced forms of appendicitis have significantly higher rates of postoperative IAAs than those with simple or uncomplicated disease. In addition to the severity of appendicitis, several patient- and surgery-related variables have been implicated, including obesity, elevated preoperative inflammatory markers, biochemical indicators such as hyperbilirubinemia, prolonged operative time, and the presence of free appendicoliths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom a pathophysiological perspective, the extent of intra-abdominal contamination during appendectomy is a key determinant of postoperative infectious complications. Residual purulent or feculent peritoneal fluid has been shown to correlate strongly with subsequent organ/space infections, including IAAs, highlighting the importance of adequate source control during surgery (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Operative strategies such as the choice of surgical approach and the use of peritoneal irrigation or drainage have been investigated as potential modifiers of IAA risk; however, evidence regarding routine drainage remains inconsistent, and no universal consensus has been established (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile most data on post-appendectomy IAAs originate from high-income countries, the burden of this complication may be disproportionately higher in low-resource settings. In many African countries, access to timely surgical care is limited by geographical, economic, and systemic barriers, resulting in delayed presentation and a higher prevalence of complicated appendicitis at the time of surgery (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Late presentation, combined with constraints in sterilization infrastructure, perioperative antibiotic availability, and postoperative monitoring, may further increase the risk of postoperative infectious complications, including IAAs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite these challenges, data focusing specifically on post-appendectomy IAA risk factors in African populations remain scarce.\u003c/p\u003e \u003cp\u003eManagement of IAAs following appendectomy typically includes conservative treatment with antibiotics alone, image-guided percutaneous drainage, or surgical re-intervention (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The choice of management strategy depends on abscess size, clinical stability, and available resources. Antibiotic therapy alone has been shown to be effective in selected patients, whereas percutaneous drainage remains a cornerstone for larger or persistent collections, with reported success rates exceeding 70\u0026ndash;90% in multiple series (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Understanding how these management strategies are applied and perform in resource-limited settings is essential for optimizing patient outcomes.\u003c/p\u003e \u003cp\u003eThe primary aim of this study is to identify factors associated with the development of intra-abdominal abscesses after appendectomy in an African, low-resource setting. The secondary aim is to evaluate the management approaches used for post-appendectomy IAAs and to assess their outcomes, with the goal of informing evidence-based strategies applicable to similar healthcare environments.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis study was conducted using a retrospective cohort design to evaluate factors associated with the development of IAA following appendectomy. The study was conducted in Mogadishu, Somalia, at three tertiary-level hospitals providing general surgical services: Royal Hospital, a private tertiary-care referral center; Alami Specialist Hospital, a high-volume tertiary hospital managing both elective and emergency general surgery; and Samadeeq Hospital, a tertiary multidisciplinary hospital with a substantial emergency surgery workload. These institutions represent major appendectomy-performing centers in the city and serve diverse patient populations.\u003c/p\u003e \u003cp\u003eThe study population consisted of patients who underwent appendectomy at the participating hospitals during the study period between January 1, 2024, and July 31, 2025. Patients were eligible for inclusion if they had undergone appendectomy within the defined study period, regardless of age or sex, and if their medical records contained sufficient clinical, intraoperative, and postoperative data to allow reliable assessment of risk factors and outcomes. Patients were excluded if they had been referred from another hospital after undergoing appendectomy elsewhere, in order to avoid misclassification of perioperative variables and postoperative outcomes, or if their medical records were incomplete or missing key information, particularly regarding operative findings or postoperative follow-up.\u003c/p\u003e \u003cp\u003eA census sampling approach was used, whereby all patients meeting the inclusion criteria during the study period were included. After application of the inclusion and exclusion criteria, a total of 92 patients were included in the final analysis. Of these, 73 patients did not develop postoperative IAAs, while 19 patients were diagnosed with intra-abdominal abscesses within 30 days following appendectomy. Case identification and data retrieval were performed retrospectively using surgical logs and medical record archives at each participating hospital.\u003c/p\u003e \u003cp\u003eData collection was performed through detailed review of hospital records, including admission notes, operative and anesthesia reports, laboratory findings, imaging results, and discharge summaries. A standardized data extraction form was used to ensure consistency across the three study sites. Collected variables included patient-related factors such as age, sex, and documented comorbidities including diabetes mellitus and hypertension, as well as indicators of immune or nutritional status when available. Clinical and intraoperative variables included duration of symptoms prior to surgery, type and severity of appendicitis as documented intraoperatively (classified as simple/uncomplicated, perforated, or gangrenous), duration of surgery, presence of intraoperative spillage or contamination, and the level of surgical experience of the operating surgeon (resident or specialist/consultant). Postoperative variables included antibiotic use and timing, length of hospital stay, and postoperative complications. The primary outcome variable was the development of an intra-abdominal abscess within 30 days after appendectomy, defined as a postoperative intra-abdominal collection confirmed by imaging modalities such as ultrasonography or computed tomography, or identified during reoperation.\u003c/p\u003e \u003cp\u003eAll collected data were entered into Stata version 18 (StataCorp LLC, College Station, TX, USA) for statistical analysis. Descriptive statistics were used to summarize baseline characteristics, with continuous variables expressed as means and standard deviations or medians with interquartile ranges, and categorical variables reported as frequencies and percentages. Bivariate analyses were performed to assess associations between independent variables and IAA formation using the chi-square or Fisher exact test for categorical variables and the independent-samples t test or Mann\u0026ndash;Whitney U test for continuous variables, as appropriate. P value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Research and Ethical Committee of the School of Postgraduate Studies and Research Centre, Benadir University, Mogadishu, Somalia (IRB number: BU/PSG/53/73). Due to the retrospective nature of the study, informed consent was waived, and all data were anonymized prior to analysis.\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 92 patients who underwent appendectomy during the study period were included in the final analysis. Postoperative intra-abdominal abscess (IAA) developed in 20.7% (19/92) of patients, while 79.3% (73/92) had no evidence of abscess formation within the 30-day postoperative follow-up period (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with postoperative intra-abdominal abscess following appendectomy \u003cem\u003eCategorical variables were compared using Chi-square or Fisher\u0026rsquo;s exact test, as appropriate\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eIntra-abdominal abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (28.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (21.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (27.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (71.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (78.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (72.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (19.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (31.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (21.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (24.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (26.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (25.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (34.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (21.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (31.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (9.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45 above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (12.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (11.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNutritional Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (78.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (68.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (76.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight/Obese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (16.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (15.22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (21.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (8.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (24.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (36.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (27.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (75.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (63.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (72.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime from Symptom Onset\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;12 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (6.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (27.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (21.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (34.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (28.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (30.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (94.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (43.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAppendicolith\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (20.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (63.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (29.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (79.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (36.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (70.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTypes of Appendicitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple/Uncomplicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (60.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (48.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGangrenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (8.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerforated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (30.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (89.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (42.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical Approach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (13.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (11.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (86.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (94.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81 (88.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperative Time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (27.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (26.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (27.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;120 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (53.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (68.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (56.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;120 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (19.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (16.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgeon Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsultant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (97.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90 (97.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrain placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (46.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (89.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (55.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (53.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (44.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTiming of drain removal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin 24 hours post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (5.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 to 3 days post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (28.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (21.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (26.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 to 5 days post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (47.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (63.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (52.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 5 days post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (15.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Antibiotic Therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (34.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (29.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (56.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (73.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (59.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (10.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of Hospital Stay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (47.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (39.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (47.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (78.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (54.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (6.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (31.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (9.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (94.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (57.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (86.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSex distribution was comparable between the two groups. Male patients constituted 78.9% (15/19) of the abscess group and 71.2% (52/73) of the non-abscess group (p\u0026thinsp;=\u0026thinsp;0.501). Age distribution did not differ significantly between patients with and without postoperative IAA (p\u0026thinsp;=\u0026thinsp;0.741), and no specific age category was disproportionately represented in the abscess group.\u003c/p\u003e \u003cp\u003eAlthough not statistically significant, a higher proportion of underweight patients was observed among those who developed IAAs (21.1% [4/19]) compared with patients without abscess formation (5.5% [4/73]) (p\u0026thinsp;=\u0026thinsp;0.094). Similarly, comorbid conditions were more frequent in the abscess group (36.8% [7/19]) than in the non-abscess group (24.7% [18/73]), but this difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.425).\u003c/p\u003e \u003cp\u003eDelayed presentation was strongly associated with postoperative IAA formation. Presentation more than 48 hours after symptom onset occurred in 94.7% (18/19) of patients in the abscess group compared with 30.1% (22/73) in the non-abscess group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, early presentation within the first 24 hours was observed exclusively among patients who did not develop postoperative abscesses (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe presence of an appendicolith was significantly more common in patients who developed IAAs (63.2% [12/19]) than in those without abscess formation (20.5% [15/73]) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Disease severity differed markedly between groups. Perforated appendicitis was identified in 89.5% (17/19) of patients with postoperative IAAs, whereas uncomplicated appendicitis predominated in the non-abscess group (60.3% [44/73]) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Gangrenous appendicitis was infrequent and similarly distributed between the two groups.\u003c/p\u003e \u003cp\u003eOperative time was significantly longer in patients who developed IAAs (p\u0026thinsp;=\u0026thinsp;0.032). Procedures lasting more than 60 minutes were observed in 68.4% (13/19) of the abscess group compared with 53.4% (39/73) of the non-abscess group. Drain placement was significantly more frequent among patients with postoperative IAAs (89.5% [17/19]) than among those without abscess formation (46.6% [34/73]) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Length of hospital stay was also significantly prolonged in the abscess group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with hospital stays of 5\u0026ndash;7 days occurring in 78.9% (15/19) of abscess patients compared with 47.9% (35/73) of non-abscess patients, and stays longer than 7 days observed in 15.8% (3/19) versus 4.1% (3/73), respectively.\u003c/p\u003e \u003cp\u003ePostoperative complications other than IAAs were significantly more frequent among patients who developed abscesses (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Wound infection occurred in 31.6% (6/19) of patients in the abscess group compared with 4.1% (3/73) in the non-abscess group, while sepsis was observed only among patients with IAAs (10.5% [2/19]).\u003c/p\u003e \u003cp\u003eAmong patients who developed postoperative IAAs, abscess diagnosis was most commonly confirmed by ultrasonography (73.7% [14/19]), with computed tomography used in the remaining cases. Symptom onset occurred more than 10 days after appendectomy in 63.2% (12/19) of patients. Conservative management with antibiotics alone was the most frequently employed treatment strategy (68.4% [13/19]), followed by percutaneous drainage (21.1% [4/19]), while reoperation was required in 10.5% (2/19) of cases. Microbiological cultures were obtained in 68.4% (13/19) of patients, with positive growth identified in 76.9% (10/13) of cultures; \u003cem\u003eEscherichia coli\u003c/em\u003e was the most commonly isolated organism (70.0% [7/10]). Overall outcomes were favorable, with 89.5% (17/19) of patients discharged in improved condition, although 10.5% (2/19) required readmission (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical management and outcomes of postoperative intra-abdominal abscess\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethod of abscess diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT scan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (26.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (73.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime to onset of symptoms post-appendectomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (36.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (63.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbscess management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotics only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (68.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercutaneous drainage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (21.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMicrobial culture obtained\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (31.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (68.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganism isolated (among cultures obtained)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (23.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrowth detected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (76.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of organism isolated\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEscherichia coli\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (70.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacteroides species\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (20.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudomonas aeruginosa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntibiotic susceptibility patterns\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeropenem\u0026thinsp;+\u0026thinsp;Gentamicin\u0026thinsp;+\u0026thinsp;Piperacillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (25.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeropenem\u0026thinsp;+\u0026thinsp;Piperacillin\u0026thinsp;+\u0026thinsp;Tazobactam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (25.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u0026thinsp;+\u0026thinsp;Meropenem\u0026thinsp;+\u0026thinsp;Gentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (33.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther combinations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (16.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDischarged improved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (89.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission required\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (10.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003e*All variables are reported among patients who developed postoperative intra-abdominal abscess (n\u0026thinsp;=\u0026thinsp;19)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003e\u0026dagger;Percentages for organism type are calculated among patients with positive cultures (n\u0026thinsp;=\u0026thinsp;10).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis multicenter retrospective study highlights several clinically and systemically relevant factors associated with the development and management of IAA following appendectomy in a low-resource African setting. The findings underscore the critical interplay between delayed presentation, disease severity, operative factors, and postoperative management in shaping outcomes after appendectomy.\u003c/p\u003e \u003cp\u003eDelayed diagnosis and late surgical intervention are well-established determinants of complicated appendicitis and postoperative IAA formation in low- and middle-income countries (LMICs). Recent African multicenter studies report that 60\u0026ndash;80% of patients with complicated appendicitis present more than 48 hours after symptom onset, with postoperative abscess rates commonly ranging from 15% to 30% among delayed presenters (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In our cohort, delayed presentation beyond 48 hours was observed in 94.7% of patients who developed IAAs compared with 30.1% of those without abscess formation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a substantially higher burden of delayed access to care than that reported in most contemporary LMIC series.\u003c/p\u003e \u003cp\u003eHigh-risk pathological features, particularly perforated appendicitis and appendicolith presence, have consistently been associated with increased postoperative abscess risk (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Recent evidence suggests that the presence of an appendicolith increases the likelihood of complicated appendicitis by more than threefold (odds ratio 3.52), a condition that is itself associated with higher rates of postoperative intra-abdominal abscess formation (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In our study, perforated appendicitis was present in 89.5% of patients who developed IAAs versus 30.1% of those without abscess formation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and appendicoliths were identified in 63.2% versus 20.5%, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These markedly higher proportions suggest that advanced disease at presentation is the dominant driver of postoperative IAA development in this setting.\u003c/p\u003e \u003cp\u003eOperative duration has been proposed as a surrogate marker of both disease severity and intraoperative complexity. In a retrospective cohorts of 839 appendectomy patients, prolonged operative time was found to correlate with an increased risk of postoperative intra-abdominal infection, with multivariate analysis identifying both appendiceal perforation and extended surgery duration as independent predictors of postoperative abscess formation (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In our cohort, procedures lasting longer than 60 minutes were more frequent among patients who developed IAAs (68.4%) compared with those without abscess formation (53.4%) (p\u0026thinsp;=\u0026thinsp;0.032), supporting the association between prolonged surgery and infection risk in resource-constrained environments.\u003c/p\u003e \u003cp\u003eThe role of postoperative drainage in preventing postoperative IAAs remains controversial. Recent meta-analyses indicate that routine abdominal drain placement does not significantly reduce the incidence of postoperative IAAs after appendectomy (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, contemporary systematic reviews and comparative meta-analyses suggest that drain use may be associated with increased postoperative morbidity, including prolonged hospital stay, without providing a clear protective effect against abscess formation (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In our study, drains were placed in 89.5% of patients who developed IAAs compared with 46.6% of those without abscess formation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding likely reflects selective drain use in cases with severe intra-abdominal contamination rather than a protective effect, supporting an indication-based rather than routine drainage strategy.\u003c/p\u003e \u003cp\u003eLimited access to diagnostic and therapeutic resources is a defining challenge in many African healthcare systems. In sub-Saharan Africa, ultrasonography is widely used as a primary imaging modality for suspected intra-abdominal collections due to limited access to CT and interventional radiology (IR) services, which remain under-developed in many tertiary centres. Recent analyses underscore the critical need to expand IR capacity in the region to improve abscess management outcomes (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Our findings closely mirror this pattern, with ultrasonography used in 73.7% of abscess diagnoses and percutaneous drainage performed in only 21.1% of cases, underscoring persistent constraints in advanced imaging and minimally invasive treatment options.\u003c/p\u003e \u003cp\u003eSurgeon experience and trainee involvement in appendectomies have been variably associated with operative performance and postoperative outcomes. Comparisons of laparoscopic appendectomies performed by residents versus senior registrars or consultants have shown no significant differences in postoperative complication rates, including intra-abdominal infections, despite longer operative times among resident-performed procedures, suggesting that resident participation under appropriate supervision does not inherently increase postoperative morbidity (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Furthermore, studies evaluating intraoperative performance metrics in emergency appendectomy have demonstrated that surgical experience level may influence technical performance scores and operative duration, indicating that experience can affect procedural efficiency even if complication rates remain similar (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Consistent with this evidence, surgeon level in our cohort did not emerge as a significant predictor of postoperative intra-abdominal abscess formation, suggesting that delayed presentation and disease severity were more influential determinants of adverse outcomes in our setting.\u003c/p\u003e \u003cp\u003eAntibiotic stewardship and antimicrobial resistance are increasingly important considerations in postoperative infection management. Recent African studies report empirical broad-spectrum antibiotic use in more than 80% of complicated appendicitis cases, often in the absence of microbiological guidance (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In our cohort, cultures were obtained in 68.4% of abscess cases, with \u003cem\u003eEscherichia coli\u003c/em\u003e accounting for 70% of isolated organisms, emphasizing the need for local resistance surveillance to guide targeted therapy.\u003c/p\u003e \u003cp\u003eLMIC settings report wide variability in postoperative intra-abdominal abscess rates after appendectomy, with laparoscopic approaches associated with IAA rates of approximately 5\u0026ndash;15% and open surgery with rates of 10\u0026ndash;25%, largely influenced by case mix and disease severity rather than operative modality alone (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Consistent with recent LMIC-based comparative data showing no statistically significant difference in IAA rates between laparoscopic and open appendectomy after adjustment for perforation and delayed presentation, our findings further support that pathological severity and timing of presentation outweigh operative technique in determining postoperative abscess risk in resource-limited settings, as we similarly found no difference in abscess development according to surgical approach (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eManagement of post-appendectomy intra-abdominal abscess is primarily guided by abscess size, anatomical localization, patient stability, and institutional resources. Evidence indicates that selected clinically stable patients with small, well-circumscribed abscesses can be successfully managed with antibiotic therapy alone, with reported resolution rates of approximately 60\u0026ndash;80%. In contrast, image-guided percutaneous drainage is recommended for larger, multiloculated, or non-resolving collections, achieving clinical success rates exceeding 70% and reducing the need for re-operation (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In our cohort, conservative management with antibiotics alone was the most frequently employed strategy (68.4%), followed by percutaneous drainage (21.1%), whereas reoperation was required in a minority of cases (10.5%). Despite limited access to interventional radiology, overall outcomes were favorable, with 89.5% of patients discharged in improved condition, suggesting that stepwise, resource-adapted management strategies can yield acceptable outcomes in low-resource settings.\u003c/p\u003e \u003cp\u003eThis study has inherent limitations related to its retrospective design, which may introduce selection and information bias due to reliance on the completeness and accuracy of medical records. The relatively small sample size, particularly the limited number of patients who developed postoperative intra-abdominal abscesses, may have reduced the statistical power to detect less pronounced associations and constrained the scope of multivariable analyses. Additionally, as the study was conducted in tertiary-level hospitals within a single urban setting, the findings may not be fully generalizable to rural or lower-level healthcare facilities with more limited resources.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this multicenter retrospective study conducted in a resource-limited African setting, postoperative intra-abdominal abscess following appendectomy was strongly associated with delayed presentation, advanced disease severity, and prolonged operative course. The findings emphasize that barriers to timely healthcare access remain the primary drivers of postoperative morbidity and underscore the need for early diagnosis, prompt surgical intervention, and targeted management of high-risk patients. Strengthening community awareness, optimizing perioperative strategies, improving access to diagnostic and therapeutic resources, and reinforcing antibiotic stewardship programs are critical steps toward reducing the burden of post-appendectomy intra-abdominal abscesses in similar low-resource environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is derived from a master\u0026rsquo;s thesis conducted within the School of Postgraduate Studies and Research at Benadir University. The study was approved by the Institutional Review Board of Benadir University (IRB number: BU/PSG/53/73).\u003c/p\u003e\n\u003cp\u003eAs this study was retrospective in nature and based on anonymized patient data, Human Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author and all co-authors declare that they have no competing interests. The authors also confirm that this manuscript is not under simultaneous consideration by any other journal and has not been published previously.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAli Mohamed Arif:\u003c/strong\u003e Project development, protocol development, literature search, data collection and management, data analysis, manuscript writing and editing, critical revision, final approval of the version to be published, and agreement to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMuhammet Ali Aydemir:\u003c/strong\u003e Project development, literature search, data collection and management, data analysis, manuscript writing, final approval of the version to be published, and agreement to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTugrul Ozdemir:\u003c/strong\u003e Protocol development, literature search, data collection and management, data analysis, manuscript writing, final approval of the version to be published, and agreement to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbdiwahab Dahir Alasow:\u003c/strong\u003e Literature search, data analysis, manuscript editing, final approval of the version to be published, and agreement to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeride İrem Simsek:\u003c/strong\u003e Literature search, data collection and management, data analysis, manuscript editing, critical revision, final approval of the version to be published, and agreement to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOrhan Alimoglu:\u003c/strong\u003e Project development, protocol development, data collection and management, critical revision, final approval of the version to be published, and agreement to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCho J, Park I, Lee D, Sung K, Baek J, Lee J. Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences. Dig Surg. 2015;32(5):375\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000438707\u003c/span\u003e\u003cspan address=\"10.1159/000438707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchlottmann F, Sadava EE, Pe\u0026ntilde;a ME, Rotholtz NA. Laparoscopic Appendectomy: Risk Factors for Postoperative Intraabdominal Abscess. World J Surg. 2017;41(5):1254\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-017-3869-y\u003c/span\u003e\u003cspan address=\"10.1007/s00268-017-3869-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeandri M, Vallicelli C, Santandrea G et al. Postoperative Infections After Appendectomy for Acute Appendicitis: The Surgeon's Checklist. \u003cem\u003eAntibiotics (Basel)\u003c/em\u003e. 2025;14(9):954. Published 2025 Sep 20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/antibiotics14090954\u003c/span\u003e\u003cspan address=\"10.3390/antibiotics14090954\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReid RI, Dobbs BR, Frizelle FA. Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg. 1999;69(5):373\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1440-1622.1999.01576.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1440-1622.1999.01576.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTartaglia D, Fatucchi LM, Mazzoni A, et al. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg. 2020;72(4):1175\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13304-020-00749-y\u003c/span\u003e\u003cspan address=\"10.1007/s13304-020-00749-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEren T, Tombalak E, Ozemir IA, et al. Hyperbilirubinemia as a predictive factor in acute appendicitis. Eur J Trauma Emerg Surg. 2016;42(4):471\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00068-015-0562-4\u003c/span\u003e\u003cspan address=\"10.1007/s00068-015-0562-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSon J, Han JW, Oh C. Risk Factors for Postoperative Intra-Abdominal Abscess in Pediatric Perforated Appendicitis Following Laparoscopic Appendectomy: A Multicenter Analysis. Child (Basel). 2024;11(11):1385. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/children11111385\u003c/span\u003e\u003cspan address=\"10.3390/children11111385\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu A, Mohamedahmed AY, Alamin A, et al. Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis. Cureus. 2022;14(11):e32018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.32018\u003c/span\u003e\u003cspan address=\"10.7759/cureus.32018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2022 Nov 29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao BP, Collins G, Ayeni FE, Vagg DJ. Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study. Langenbecks Arch Surg. 2024;409(1):246. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00423-024-03421-w\u003c/span\u003e\u003cspan address=\"10.1007/s00423-024-03421-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2024 Aug 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhangu A, S\u0026oslash;reide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(15)00275-5\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(15)00275-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Amstel P, The SML, Mulder M. The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature. Front Pediatr. 2022;10:908485. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fped.2022.908485\u003c/span\u003e\u003cspan address=\"10.3389/fped.2022.908485\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2022 Jun 20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodr\u0026iacute;guez Pi\u0026ntilde;ero JN, Casas MA, Angeramo CA, Baz Gallego JJ, Laxague F, Schlottmann F. Prospective validation of a therapeutic algorithm for postoperative intra-abdominal abscess after laparoscopic appendectomy. Surg Endosc. 2025;39(8):4929\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-025-11908-w\u003c/span\u003e\u003cspan address=\"10.1007/s00464-025-11908-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeleke MG, Ayalew TL, Ashager K, Beyene HA, Abate MW, Tibebu NS. Unfavorable management outcome and its predictors among appendicitis patients in ethiopia: a systematic review and meta- analysis. BMC Surg. 2025;25(1):354. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12893-025-03108-z\u003c/span\u003e\u003cspan address=\"10.1186/s12893-025-03108-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimelane PB, Kader SS, Madiba TE. Clinicopathological spectrum and outcome of appendicectomy at a South African tertiary hospital: continuing impact of delayed presentation. Afr Health Sci. 2024;24(2):365\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4314/ahs.v24i2.37\u003c/span\u003e\u003cspan address=\"10.4314/ahs.v24i2.37\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRussell KW, Skarda DE, Jones TW, Barnhart DC, Short SS. Cessation of Antibiotics for Complicated Appendicitis at Discharge Does Not Increase Risk of Post-operative Infection. J Pediatr Surg. 2024;59(1):91\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpedsurg.2023.09.023\u003c/span\u003e\u003cspan address=\"10.1016/j.jpedsurg.2023.09.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNikkolo C, Muuli M, Kirsim\u0026auml;gi \u0026Uuml;, Lepner U. Appendicolith as a Sign of Complicated Appendicitis: A Myth or Reality? A Retrospective Study. Eur Surg Res. 2025;66(1):1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000543683\u003c/span\u003e\u003cspan address=\"10.1159/000543683\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu L, Feng W, Yu K, Cao C, Qiang G. Risk factors of abdominal abscess after laparoscopic appendectomy. \u003cem\u003eBMC Surg\u003c/em\u003e. 2025;25(1):482. Published 2025 Oct 15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12893-025-03241-9\u003c/span\u003e\u003cspan address=\"10.1186/s12893-025-03241-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao J, Zhou J, Wang J, Xie G, Wei H. Prophylactic abdominal drainage following appendectomy for complicated appendicitis: A meta-analysis. Front Surg. 2023;9:1086877. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsurg.2022.1086877\u003c/span\u003e\u003cspan address=\"10.3389/fsurg.2022.1086877\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2023 Jan 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu H, Liao B, Cao T, et al. Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis. BMC Gastroenterol. 2024;24(1):411. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12876-024-03500-8\u003c/span\u003e\u003cspan address=\"10.1186/s12876-024-03500-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2024 Nov 16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUkweh ON, Alswang JM, Iya-Benson JN et al. Comparative Analysis of Percutaneous Drainage versus Operative Drainage of Intra-Abdominal Abscesses in a Resource-Limited Setting: The Tanzanian Experience. \u003cem\u003eAnn Glob Health\u003c/em\u003e. 2023;89(1):35. Published 2023 Jun 1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5334/aogh.4070\u003c/span\u003e\u003cspan address=\"10.5334/aogh.4070\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbattista T, Meloni MF, Ferraioli G, Pirri C. The urgent need to extend the appropriate use of ultrasound in Africa and worldwide. Overview, experiences and perspectives. Front Public Health. 2024;12:1363134. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2024.1363134\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2024.1363134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2024 Jun 17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiam B, Al-Kurd A, Simanovsky N, et al. Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents. JAMA Surg. 2017;152(7):679\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamasurg.2017.0578\u003c/span\u003e\u003cspan address=\"10.1001/jamasurg.2017.0578\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkjold-\u0026Oslash;degaard B, Ersdal HL, Assmus J, S\u0026oslash;reide K. Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme. Surg Endosc. 2024;38(9):4939\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-024-11007-2\u003c/span\u003e\u003cspan address=\"10.1007/s00464-024-11007-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTadesse BT, Ashley EA, Ongarello S, et al. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis. 2017;17(1):616. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-017-2713-1\u003c/span\u003e\u003cspan address=\"10.1186/s12879-017-2713-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSartelli M, Catena F, Coccolini F, Pinna AD. Antimicrobial management of intra-abdominal infections: literature's guidelines. World J Gastroenterol. 2012;18(9):865\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3748/wjg.v18.i9.865\u003c/span\u003e\u003cspan address=\"10.3748/wjg.v18.i9.865\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoy I, Kitto S, Adu-Aryee N, Okrainec A. Barriers to the uptake of laparoscopic surgery in a lower-middle-income country. Surg Endosc. 2013;27(11):4009\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-013-3019-z\u003c/span\u003e\u003cspan address=\"10.1007/s00464-013-3019-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamaray B, de Boer MFJ, Popal Z, Rijbroek A, Bloemers FW, Oosterling SJ. AbcApp: incidence of intra-abdominal ABsCesses following laparoscopic vs. open APPendectomy in complicated appendicitis. Surg Endosc. 2023;37(3):1694\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-022-09670-4\u003c/span\u003e\u003cspan address=\"10.1007/s00464-022-09670-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBen Dhaou M, Ghorbel S, Chouikh T, et al. Conservative management of post-appendicectomy intra-abdominal abscesses. Ital J Pediatr. 2010;36:68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1824-7288-36-68\u003c/span\u003e\u003cspan address=\"10.1186/1824-7288-36-68\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2010 Oct 14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Saverio S, Podda M, De Simone B et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. \u003cem\u003eWorld J Emerg Surg\u003c/em\u003e. 2020;15(1):27. Published 2020 Apr 15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13017-020-00306-3\u003c/span\u003e\u003cspan address=\"10.1186/s13017-020-00306-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Appendectomy, intra-abdominal abscess, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-8562776/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8562776/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative intra-abdominal abscess (IAA) remains a significant cause of morbidity after appendectomy, particularly in low-resource settings where delayed presentation and advanced disease are common. This study aimed to identify factors associated with postoperative IAA formation after appendectomy in an African setting and to evaluate management strategies and outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA multicenter retrospective cohort study was conducted at three tertiary hospitals in Mogadishu, Somalia. All patients who underwent appendectomy between January 2024 and July 2025 were included. Demographic, clinical, intraoperative, and postoperative variables were collected from medical records. The primary outcome was the development of an intra-abdominal abscess within 30 days after appendectomy. Patients with and without IAAs were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNinety-two patients were included, of whom 19 (20.7%) developed postoperative IAAs. Delayed presentation beyond 48 hours was significantly more frequent in the abscess group (94.7% vs. 30.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Perforated appendicitis and appendicolith presence were strongly associated with IAA formation. Operative times longer than 60 minutes and drain placement were also more common among patients with IAAs. These patients experienced longer hospital stays and higher rates of wound infection and sepsis. Most abscesses were successfully managed with antibiotics alone.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePostoperative IAA formation after appendectomy in this low-resource setting is primarily driven by delayed presentation and advanced disease severity. Improving early access to surgical care and optimizing perioperative management may reduce postoperative morbidity.\u003c/p\u003e","manuscriptTitle":"Risk Factors for Intra-Abdominal Abscess Formation After Appendectomy: A Multicenter Study from Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-18 13:07:51","doi":"10.21203/rs.3.rs-8562776/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-13T06:58:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-05T18:07:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-15T13:34:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3228155289700208563172911823474538704","date":"2026-01-14T13:11:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133333304366220997270601846430737338887","date":"2026-01-13T14:46:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101122673314235545036710659529268684834","date":"2026-01-13T13:39:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-13T13:30:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-13T12:58:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-12T05:34:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-12T05:33:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-01-09T15:47:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7140c03c-dd66-492c-882c-6f1c30485559","owner":[],"postedDate":"January 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T15:54:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-18 13:07:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8562776","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8562776","identity":"rs-8562776","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}