General anesthesia versus regional anesthesia for the management of appendicitis in a county hospital in Northern Guatemala

BACKGROUND: Both laparoscopic and open appendectomies are performed in low-And middle-income countries (LMIC). At a county hospital in Northern Guatemala, patients with appendicitis undergo an open appendectomy typically under regional anesthesia (RA); however, some patients require general anesthesia (GA). Characteristics of patients requiring GA were analyzed. METHODS: Data on 256 appendectomies performed at the Regional Hospital of San Benito Petén in Northern Guatemala were collected and dichotomized by anesthesia type GA (N.=46 [18%]) vs. RA (N.=210 [82%]). The characteristics between these two cohorts were analyzed. RESULTS: Most patients were young adults (age 23.3 14.7 years old, 56% male, 42.2% pediatric). Gross pathology demonstrated perforated, suppurative, and gangrenous appendicitis in 54% of patients. Male gender (70.0% vs. 30.0%), age less than 18 (23.1% vs. 11.6%), tachycardia on presentation, anorexia, and the Modified Alvarado Score (MASS) were significantly associated with GA. Male gender (OR [95% CI], 2.42 [1.08 to 5.42]), age less than 18 (4.21 [1.88 to 9.42]), and MASS (1.49 [1.13 to 1.96]) were independent predictors of patients necessitating GA. CONCLUSIONS: Male, young patients 18.0 years old, and those with a modified Alvarado score 6 should be considered for GA as they are likely to fail RA.