Surgical outcomes were determined by postoperative follow-up. To evaluate the rate of adverse events, we examined the complication rate occurring within 30 days and the readmission rate. Complications were defined as all events necessitating diagnostic or therapeutic measures that increased the length of stay, or required a patient to visit the outpatient clinic on more than two occasions, or led to readmission. Readmission was defined as repeated hospitalization caused by appendectomy-induced complications. Postoperative complications included wound infections, intra-abdominal abscess, intestinal obstructions, paralytic ileus, and cardiovascular problems. Intra-abdominal abscess was confirmed by percutaneous drainage or either CT scan or ultrasonography. Postoperative complications were graded according to the Clavien-Dindo classification.
In 171 patients, 28 (16.4%) developed postoperative complications. Incidence and type of postoperative complications in patients with PAA are shown in Fig. 2. There was no mortality. In the Clavien-Dindo classification, grade II complications (7.0%) were the most common, followed by grade III (5.3%) and grade I (4.1%). There were no grade IV or V complications. Of the 28 patients who experienced postoperative complications, wound infection (7.6%) had the highest incidence in the total patient, followed by intra-abdominal abscess (4.1%), paralytic ileus (2.9%), and small bowel obstruction (1.2%). More rarely, small bowel obstruction caused by postoperative adhesion and cardiovascular problem (atrial fibrillation) occurred. Seven patients (4.1%) were re-admitted with wound complications (1.8%), intra-abdominal abscess (1.2%), paralytic ileus (0.6%), and small bowel obstruction (0.6%), respectively. There were 8 patients (4.7%) who underwent reoperation and, four of them received reoperation during hospitalization before discharge. Six (3.5%) patients developed complications that required reoperations due to wound complication (wound infection and dehiscence). And two (1.2%) patients required reoperation due to small bowel obstruction.
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Gastrointestinal complications include abdominal pain and rigidity, diarrhea, nausea, vomiting, constipation, and abnormal bowel motility. Postoperative nausea and vomiting (PONV) are among the most common complications following surgery, and patients often rate PONV as worse than postoperative pain. Abnormal bowel motility can lead to the development of paralytic ileus. This can be due to prolonged surgery and time under anesthesia, the handling of the bowel during surgery, or opioid use. For patients who have undergone lower gastrointestinal or abdominal surgery, peristalsis may take longer to return (Hinkle & Cheever, 2018; Ignatavicius et al., 2021).
Common signs and symptoms of paralytic ileus include hypoactive or absent bowel sounds, belching, a lack of flatulence, constipation, abdominal distention, abdominal discomfort, nausea, and bile vomiting (Hinkle & Cheever, 2018; Ignatavicius et al., 2021; Kalff et al., 2021).
Opioids increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. The resultant prolongation in gastrointestinal transit time may be responsible for the constipating effect of fentanyl. Patients should be advised on measures to prevent constipation and prophylactic laxative use should be considered. Extra caution should be used in patients with chronic constipation. If paralytic ileus is present or suspected, treatment with Durogesic DTrans should be stopped.
Common adverse reactions of atropine can be attributed to its antimuscarinic action. These include dryness of the mouth, blurred vision, dry eyes, photophobia, confusion, headache, dizziness, tachycardia, palpitations, flushing, urinary hesitancy or retention, constipation, abdominal pain, abdominal distention, nausea and vomiting, loss of libido, and impotence. Anhidrosis may produce heat intolerance and impairment of temperature regulation in a hot environment. Dysphagia, paralytic ileus, acute angle closure glaucoma, maculopapular rash, petechial rash, and scarlatiniform rash have also been reported. Adverse cardiac reactions, including arrhythmias and myocardial infarction, have been reported with atropine [see WARNINGS AND PRECAUTIONS, CLINICAL PHARMACOLOGY].
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