Clinical, laboratory, operative, and appendiceal morphometric correlates of histopathological appendicitis severity: A retrospective cohort study from Palestine.

BACKGROUND: Clinical, laboratory, and imaging correlates of complicated appendicitis are well studied, but routinely recorded gross-pathology morphometrics and pathology-confirmed evidence from Palestine are less well characterized. We evaluated correlates of histopathological severity and adjusted associations with complicated appendicitis. METHODS: This retrospective cohort included appendectomy encounters at Al-Makassed Islamic Charitable Society Hospital from December 2015 to July 2025. Source reconciliation identified 1,287 unique encounters; 245 histologically normal appendices and 32 records without a classifiable severity category were excluded, leaving 1,010 patients. Complicated appendicitis was defined as gangrenous or perforated disease. Group comparisons used chi-square or Monte Carlo exact tests and Kruskal-Wallis tests. A prespecified logistic model included age, sex, appendicolith, white blood cell count (WBC), and C-reactive protein (CRP). RESULTS: The cohort included 227 catarrhal/simple, 458 suppurative, 262 gangrenous, and 63 perforated cases. Operative approach, nausea and/or vomiting, other intraoperative findings, appendicolith, WBC, neutrophil percentage, operative duration, and hospital stay differed across severity categories. In the adjusted model (n = 991), appendicolith was associated with higher odds of complicated appendicitis (adjusted odds ratio 2.20, 95% confidence interval 1.37-3.52; P = 0.001), whereas WBC showed an unexpected inverse association (adjusted odds ratio 0.938 per 1 × 10⁹/L, 95% confidence interval 0.906-0.971; P < 0.001). Age, sex, and CRP were not independently associated. Discrimination was weak (area under the receiver operating characteristic curve 0.594, 95% confidence interval 0.557-0.632). Maximum diameter, wall thickness, and appendix length showed no significant adjusted linear associations. CONCLUSIONS: Appendicolith was associated with complicated appendicitis, but weak discrimination and limited explained variation preclude use of the model as a clinical prediction tool. The inverse WBC association and negative linear morphometric findings require cautious interpretation.