4 <0.0001 ICU admission 2.3 1.5-3.7 <0.0001 Immunosuppression 3.8 2.1-6.7 <0.0001 Stepwise multivariate analysis, PR = 0.005 E PE = 0.001

(Hosmer-Lemeshow chi2(8) = 1.68, area under ROC curve = 0.9465). Discussion The CIAOW Study confirmed that acute appendicitis is the most common intra-abdominal condition requiring PI3K Inhibitor Library price emergency surgery worldwide. According to the WSES 2013 guidelines for management of intra-abdominal infections, both open and laparoscopic appendectomies are viable treatment options for complicated appendicitis [6]. CIAOW Study results indicate that the open approach was used in most patients and it was the most common approach in the patients with complicated appendicitis. For patients with peri-appendiceal abscesses, the proper course of surgical treatment remains a point of contention in the medical community. Although guidelines for the management of intra-abdominal infections commonly assert that patients with peri-appendiceal Daporinad nmr abscesses should be treated with percutaneous image-guided drainage [5]. Percutaneous drainage with or without interval appendectomy ALK inhibition to treat peri-appendiceal abscess results in fewer complications and shorter overall length of stay [6–8]. Data from CIAOW Study indicate that

few patients underwent this procedure for a peri-appenceal abscess. Laparoscopic cholecystectomy versus open cholecystectomy question for acute cholecystitis has been extensively investigated. Several studies showed that early laparoscopic cholecystectomy resulted in a significantly reduced length of stay, no major complications, and no significant difference in conversion rates when compared with initial antibiotic treatment and delayed laparoscopic SPTLC1 cholecystectomy [9–12]. The open cholecystectomy was the most common means of

treating complicated cholecystitis; 47.8% (133) of the patients with complicated cholecystitis underwent this procedure. By contrast, 36.7% (102) underwent a laparoscopic procedure. The optimal surgical management of colonic diverticular disease complicated by peritonitis remains a controversial issue. Hartmann’s resection has been considered the procedure of choice in patients with generalized peritonitis and remains a safe technique for emergency colectomy in perforated diverticulitis, especially in elderly patients with multiple co-morbidities [13]. More recently, some reports have suggested that primary resection and anastomosis is the preferred approach to diverticulitis, even in the presence of diffuse peritonitis [14, 15]. According to CIAOW Study data, the Hartmann resection was the most frequently performed procedure to address both complicated diverticulitis and non-diverticular colonic perforations worldwide. The significance of microbiological analysis of infected peritoneal fluid in community-acquired intra-abdominal infections has been debated in recent years.