Complicated versus uncomplicated acute appendicitis: clinical characteristics, diagnostic scores, surgical management, and outcomes in a tertiary hospital in Mogadishu, Somalia.

Background: Acute appendicitis is the leading cause of acute surgical abdomen worldwide and is associated with substantial morbidity, particularly in complicated cases. Differentiating complicated from uncomplicated appendicitis remains challenging, especially in resource-limited settings where delayed presentation is common. This study compared the clinical characteristics, diagnostic scores, surgical management, and outcomes of complicated and uncomplicated acute appendicitis in a tertiary hospital in Mogadishu, Somalia. Methods: A retrospective cohort study was conducted among 168 patients who underwent appendectomy between January and December 2025. Data were extracted from medical records and analyzed using R software. Multivariable logistic regression was performed to identify independent predictors of complicated appendicitis. Results: Complicated appendicitis accounted for 36.3% of cases. Delayed presentation beyond 48 h was more common in complicated appendicitis but was not independently associated with disease severity after multivariable adjustment. Patients with complicated appendicitis had significantly higher inflammatory markers and higher median Alvarado and Appendicitis Inflammatory Response (AIR) scores, whereas modified Alvarado and RIPASA scores did not differ significantly. Because formal diagnostic performance analyses were not performed, these findings should be interpreted as descriptive comparisons rather than evidence of superior diagnostic accuracy. Laparoscopic appendectomy was the predominant surgical approach, although open surgery and conversion were more frequent in complicated cases. Complicated appendicitis was also associated with higher rates of intra-abdominal complications, ICU admission, and longer hospital stay. Increasing age (adjusted OR 1.03, 95% CI 1.00-1.07) and elevated C-reactive protein (adjusted OR 1.11 per 10 mg/L increase, 95% CI 1.05-1.17) were independently associated with complicated appendicitis. Conclusion: Complicated appendicitis was associated with worse postoperative outcomes. Increasing age and elevated C-reactive protein were independent predictors of complicated appendicitis, whereas delayed presentation was not independently associated after adjustment. Higher median Alvarado and AIR scores were observed in complicated appendicitis; however, formal diagnostic accuracy analyses were not performed. Prospective studies are needed to validate risk stratification tools and improve early diagnosis and timely surgical management in resource-limited settings.