Assessment of frailty and inflammatory burden index as predictors of postoperative IAA in elderly appendectomy patients.

BACKGROUND

Postoperative intra-abdominal abscesses (IAA) remain a significant complication after laparoscopic appendectomy for acute appendicitis. This study investigates the roles of the 5-item modified Frailty Index (mFI-5) and Inflammatory Burden Index (IBI) in predicting IAA risk.

METHODS

This retrospective study analyzed elderly patients who underwent laparoscopic appendectomy from 2015 to 2025. Patients were assessed for frailty using mFI-5 and systemic inflammation using IBI. We collected demographic, clinical, and laboratory data, and univariate and multivariate logistic regression were performed to identify risk factors for IAA. A nomogram was developed based on significant variables from the multivariate analysis by R.

RESULTS

A total of 428 patients were included, with 43 (10.0%) developing IAA. Multivariate analysis revealed that perforated appendicitis (OR: 2.950, 95% CI: 1.210-7.197, P = 0.017), higher mFI-5 scores (OR: 3.370, 95% CI: 1.956-5.806, P < 0.001), and elevated IBI values (OR: 1.104, 95% CI: 1.027-1.186, P = 0.007) were independently associated with IAA. The nomogram, developed from these factors, showed good discriminatory ability with an AUC of 0.776.

CONCLUSIONS

Perforated appendicitis, mFI-5 and IBI are reliable predictors of IAA in elderly patients after laparoscopic appendectomy. The nomogram incorporating these factors can effectively guide clinical decision-making and identify high-risk patients.