World Journal of Surgery

, Volume 42, Issue 12, pp 3903–3910 | Cite as

Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study

  • Carlos Augusto Gomes
  • Fikri M. Abu-ZidanEmail author
  • Massimo Sartelli
  • Federico Coccolini
  • Luca Ansaloni
  • Gian Luca Baiocchi
  • Yoram Kluger
  • Salomone Di Saverio
  • Fausto Catena
Original Scientific Report



Our aim is to compare the management approaches and clinical outcomes of acute appendicitis according to annual Gross National Income per Capita (GNI/Capita) of countries.


Consecutive patients who were diagnosed to have acute appendicitis from 116 centers of 44 countries were prospectively studied over a 6-month period (April–September 2016). Studied variables included demography, Alvarado score, comorbidities, radiological and surgical management, histopathology, and clinical outcome. Data were divided into three groups depending on the GNI/Capita.


A total of 4271 patients having a mean (SD) age of 33.4 (17.3) years were studied. Fifty-five percent were males. Two hundred and eighty patients were from lower–middle-income (LMI) countries, 1756 were from upper–middle-income (UMI) countries, and 2235 were from high-income (HI) countries. Patients in LMI countries were significantly younger (p < 0.0001) and included more males (p < 0.0001). CT scan was done in less than 8% of cases in LMI countries, 23% in UMI countries, and 38% in HI countries. Laparoscopy was performed in 73% of the cases in the HI countries, while open appendectomy was done in more than 60% of cases in both LMI and UMI countries (p < 0.0001). The longest mean hospital stay was in the UMI group (4.84 days). There was no significant difference in the complication or death rates between the three groups. The overall death rate was 3 per 1000 patients.


There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis that is related to country income. A global effort is needed to address this variation. Individual socioeconomic status could be more important than global country socioeconomic status in predicting clinical outcome.


Authors’ contributions

CAG designed the study and wrote the manuscript. FAZ defined the research question, performed the statistical analysis, prepared the graphs and figures, wrote the results section, edited the manuscript, and addressed the concerns of the reviewers. All authors participated in the study. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Carlos Augusto Gomes
    • 1
  • Fikri M. Abu-Zidan
    • 2
    Email author
  • Massimo Sartelli
    • 3
  • Federico Coccolini
    • 4
  • Luca Ansaloni
    • 4
  • Gian Luca Baiocchi
    • 5
  • Yoram Kluger
    • 6
  • Salomone Di Saverio
    • 7
  • Fausto Catena
    • 8
    • 9
  1. 1.Surgery Department, Faculdade de Ciências Médicas e da Saúde Juiz de Fora (SUPREMA)Hospital Universitário Therezinha de JesusJuiz de ForaBrazil
  2. 2.Department of Surgery, College of Medicine and Health SciencesUAE UniversityAl-AinUnited Arab Emirates
  3. 3.Department of SurgeryMacerata HospitalMacerataItaly
  4. 4.General, Emergency and Trauma Surgery, Papa Giovanni XXIII HospitalBergamoItaly
  5. 5.Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
  6. 6.Department of General SurgeryRambam Health Care CampusHaifaIsrael
  7. 7.Department of SurgeryAddenbrookes Hospital Cambridge University Hospital NHS TrustCambridgeUK
  8. 8.Department of General SurgeryMaggiore HospitalParmaItaly
  9. 9.Department of Surgery“Infermi” HospitalRiminiItaly

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