Is a One Night Delay of Surgery Safe in Patients With Acute Appendicitis?

PURPOSE: With varied reports on the impact of time to appendectomy on clinical outcomes, the purpose of this study was to determine the effect of preoperative in-hospital delay on the outcome for patients with acute appendicitis. METHODS: A retrospective review of 1,076 patients who had undergone an appendectomy between January 2010 and December 2013 was conducted. RESULTS: The outcomes of surgery and the pathologic findings were analyzed according to elapsed time. The overall elapsed time from onset of symptoms to surgery was positively associated with advanced pathology, increased number of complications, and prolonged hospital stay. In-hospital elapsed time was not associated with any advanced pathology (P = 0.52), increased number of postoperative complications (P = 0.14), or prolonged hospital stay (P = 0.24). However, the complication rate was increased when the in-hospital elapsed time exceeded 18 hours. CONCLUSION: Advanced pathology and postoperative complication rate were associated with overall elapsed time from symptom onset to surgery rather than in-hospital elapse time. Therefore, a short-term delay of an appendectomy should be acceptable.

Must we do immediate appendectomy for acute appendicitis?

1. In a 2-year period starting January, 1970, we embarked on a program of delayed or semi-elective appendectomy for acute appendicitis. Sixty patients of the senior author were admitted with acute appendicitis but only 50 patients were finally selected to qualify for our study2. Regardless of the duration of illness or the time of admission, no immediate operation was done. Instead, the patient was scheduled for appendectomy not until the following day, included among the elective operations3. During this period before operation, the patient was prepared for elective surgery sparing the patient, the nursing and hospital staff and the surgical staff from unnecessary stress and strain of emergency procedure4. Antibiotics and intravenous hydration were among the principal preoperative preparations. Combination penicillin and streptomycin and also chloramphenicol were the antibiotics of choice5. In all cases the clinical diagnosis of acute appendicitis was confirmed at operation and on histopathological examination of the specimen. There was no single instance of perforation nor abscess6. No complication developed in any of the 50 patients who were all followed up for 30 days, at the minimum. There was no single fatality7. This study tends to justify a delayed or semi-elective approach to acute appendicitis. We also believe that this delayed surgical action with safety was mainly made possible by antibiotics among others. (Summary and Conclusions)

Clinical Analysis of Patients with Acute Appendicitis Operated on during

PURPOSE: During the night time decision making on patients suspicious of appendicitis is often difficult because diagnosis and timing for operation are frequently delayed. Therefore, we analyzed above cases and solution is suggested. METHODS: This retrospective study included 360 patients who underwent laparotomies for suspected appendicitis at Hanil Hospital during one year, from March 1998 to Feb. 1999. They were divided into two groups according to presenting time to physician (Day time: 6 a.m. to 6 p.m., Night time: 6 p.m. to 6 a.m.). Sex & age distribution, time of presentation to physician, duration of symptoms, symptoms & physical findings, white blood cell counts, interval from presentation to operation, hospital stay, and pathologic diagnosis were compared. RESULTS: There were no significant differences in sex & age distribution, duration of symptoms, symptoms & physical findings, white blood cell counts, pathologic diagnosis between the two groups. However, during the night time, the interval from presentation to operation was longer than that of the day time (9.15 hours versus 4.83 hours, p<0.001), the rate of delayed appendectomy during the night was 58.0%, the rate of negative laparotomy increased when appendectomy was delayed for more than 12 hours compared with less than 12 hours (28.1% vs 11.7%, p<0.01), and in the cases with perforated appendicitis, delayed appendectomy for more than 12 hours had longer hospital stay compared with less than 12 hours (12 days vs 9.44 days, p<0.01). Factors causing delayed appendectomy were related to the physician (42.5%), lack of anesthetic & nursing supports (19.5%), failure to structure the operation team (20.7%), and patient itself (17.3%). When white blood cell counts were rechecked in the next morning, levels above 10,000 cells/mm3 were highly associated with appendicitis in contrast to that below 10,000 cells/mm3 (91.7% vs 43.5%, p<0.002).