Abstract

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group (P = 0.93, χ(2)). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant (P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

Links

Publisher Full Text

Authors

Nagpal K, Udgiri N, Sharma N, Curras E, Cosgrove JM, Farkas DT

Institution

Department of Surgery, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, USA. knagpal6@gmail.com

Source

The American surgeon 78:8 2012 Aug pg 897-900

MeSH

Adult
Appendectomy
Appendicitis
Chi-Square Distribution
Emergencies
Female
Humans
Intestinal Perforation
Laparoscopy
Length of Stay
Male
New York City
Postoperative Complications
Time Factors
Treatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22856499