<b>Frequency of Perforated Appendix in Patients of Acute Appendicitis</b>

Background: Appendiceal perforation remains a significant complication of acute appendicitis, associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Despite advances in diagnostic modalities, variability in perforation rates persists globally, and limited regional data exist regarding its frequency and risk factors in Pakistan. Objective: To determine the frequency of perforated appendix among patients with acute appendicitis and to identify demographic and clinical factors associated with increased risk of perforation. Methods: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar, from January to December 2024. A total of 177 patients aged 18–65 years with CT-confirmed acute appendicitis were enrolled through consecutive sampling. Surgical exploration confirmed perforation status. Data on demographics, symptom duration, and residence were collected and analyzed using chi-square tests and odds ratios, with p < 0.05 considered statistically significant. Results: Perforated appendicitis was observed in 19 of 177 patients (10.7%). Patients aged 46–65 years demonstrated the highest perforation rate (21.1%, OR 3.36, 95% CI: 0.96–11.74). Symptom duration >48 hours significantly increased perforation risk (24.0%, OR 7.58, 95% CI: 1.45–39.69, p = 0.001). Rural residence was associated with higher perforation rates (13.5% vs. 6.1% urban, p = 0.031). Gender was not significantly related to perforation (p = 0.623). Conclusion: Approximately one in ten acute appendicitis patients experiences perforation, with advanced age, delayed presentation, and rural residence identified as significant risk factors, underscoring the importance of timely diagnosis and intervention to mitigate complications.