Relationship between the Hospital Visit-to-Operation Time Interval and the Risk of Appendiceal Perforation and Clinical Outcomes

ABSTRACT

PURPOSE: The aim of this study was to investigate the relationship between the elapsed time from hospital visit to operation and perforation risk and surgical site infection (SSI). METHODS: We conducted a single-center, retrospective cohort study using 986 patients who underwent appendectomy between Jan. 2009, and Dec. 2013. We divided hospital visit-to-operation time into multiple sessions and analyzed the statistical differences in univariate and multivariate analysis. RESULTS: Nine-hundred and ninety-six patients were admitted due to appendicitis and 986 (98%) patients underwent an appendectomy. Perforation occurred in 13.2% (n=130) of these patients. Patients with greater than 12 hours of elapsed time between their visit to hospital and surgery demonstrated a higher perforation rate than those who underwent surgery within 12 hours from their visit to the hospital. Upon logistic regression analysis, appendectomy timing was a predictors of appendiceal perforation (adjusted odds ratio, 1.04; 95% confidence interval, 1.00~1.07; p=0.04). The SSI rate of the patients who underwent appendectomy within 12hrs was lower than those who underwent surgery more after than 12 hrs, but hospital visit-to-operation time was not a statistically significant predicting factor of SSI (adjusted odds ratio, 0.99; 95% confidence interval, 0.93~1.05; p=0.796). CONCLUSION: A delay more than 12 hrs between the visit to a hospital and surgery was significantly associated with an increased risk of perforation of the appendix. However, it was not associated with an increase in the risk of SSI. Prompt surgical treatment is needed to decrease the risk of perforation.