Abstract / Summary
Appendicitis remains a common surgical emergency with diagnostic challenges, particularly in low-middle-income countries; this study aimed to assess the frequency and associated factors of positive and negative appendectomies, and to evaluate the histopathological variants among positive cases in a low-middle-income setting. This multicenter retrospective cross-sectional study was conducted at five tertiary care hospitals in Karachi, Pakistan, analyzing appendectomy cases performed between 2021 and 2024; a total of 1256 consecutive patients aged 7–50 years who underwent appendectomy with available histopathological reports were included. Data were extracted from medical records, operative notes, and pathology reports, and analyzed using descriptive statistics and Chi-square/Fisher’s exact tests to compare associated of positive and negative appendectomies. Out of 1256 patients, 83.8% ( n = 1052) had positive appendectomies while 16.2% ( n = 204; 95% CI 14.3–18.4%) had negative appendectomies. Positive appendectomies were significantly associated with male sex (61.1%), elevated white blood cell counts (79.6%) and neutrophil counts (76.2%), Alvarado scores ≥ 7 (83.4%; OR 8.68, 95% CI 6.25–12.05), typical migratory right lower quadrant pain (87.6%), fever (74.6%), anorexia (76.2%), nausea/vomiting (80.0%), and inflamed appendix visualized on ultrasound (65.3%) (all p ≤ 0.01). Negative appendectomies were more frequent among females (48.5%) and among patients with lower inflammatory markers, atypical or absent symptoms, and normal or inconclusive ultrasound findings; however, a proportion of these patients had one or more features suggestive of appendicitis. Acute suppurative appendicitis was the most common histopathological variant among positive cases (48.3%). Clinical, laboratory, and imaging parameters were significantly associated with appendectomy outcomes; however notable rate of negative appendectomies persists, highlighting the need for improved diagnostic strategies to optimize surgical decision-making and reduce unnecessary interventions in resource-limited healthcare settings. Not applicable, since the study is a cross-sectional study.