Cirugía programada de la pendicitis aguda / Programmed surgery for acute appendicitis

RESUMEN

El tratamiento quirúrgico de la apendicitis aguda no complicada sigue considerándose una urgencia, aunque está descrito que una demora terapéutica razonable (hasta 18 horas, no supone un aumento de complicaciones). En nuestro Servicio programamos la apendicectomía en los procesos no complicados, evitando que el equipo de guardia (cirujanos, anestesistas, enfermeras y auxiliar localizados) realice cirugías a horas inadecuadas. Estudiamos las historias clínicas de pacientes afectos de apendicitis aguda, entre enero del 2001 y diciembre del 2002, valorando clínica, exploración y hallazgos ecográficos, demora terapéutica (tiempo desde la entrada en urgencias hasta el final de la intervención) y evolución. Recogimos 125 varones y 84 niñas (209 pacientes), de edad media 10,1 y desviación estándar 3,02 años. Mediante la valoración clínica y ecográfica distinguimos un grupo de 171 enfermos con apendicitis no complicadas(grupo NC) y otro de 38 enfermos con procesos complicados(grupo C). Los enfermos del grupo NC fueron intervenidos de forma programada, con demoras de hasta 20 horas (media de 7 horas y 45 minutos). La estancia media de este grupo fue de 4,87 días y el porcentaje de complicaciones infecciosas de 1,73%. Los enfermos del grupo C fueron intervenidos con premura. Su estancia media fue de 9,23 días (p <0,0001) y su porcentaje de complicaciones infecciosas del 43,6%. Dentro del grupo NC no hubo diferencias entre los enfermos intervenidos precozmente y aquellos en los que se demoró la intervención. Los enfermos con apendicitis no complicadas pueden ser intervenidos de forma programada, sin mayor riesgo de complicaciones y sin distorsionar la actividad asistencial del Servicio (AU)

ABSTRACT

Non-complicated appendicitis surgery is still considered to be an emergency, although it has been observed that a reasonable therapeutic delay (up to 18 hours) does not imply a higher number of complications. In our department, surgery is programmed for those non-complicated appendicitis, thus avoiding duty staff (surgeons, anaesthesiologists, nurses, assistants) to operate during late night. Acute appendicitis records from august 2001 to december 2002 were reviewed. Collected data included: clinical findings, physical examination, ultrasound findings, surgical delay (recorded time from emergency attendance until the end of the surgery) and evolution. A total of 209 patiens (125 males and 84 females) underwent surgery. Mean age was 10.1 years (standard deviation 3.02). A non-complicated appendicitis group (NC) included 171 subjects while the complicated appendicitis group (C) included 38, assessed by means of clinical evaluation plus ultrasonography. Patients in NC group had programmed surgery, with up to 20-hour delay (mean of 7 hours 45 minutes). Mean admission time was 4.87 days with a percentage of infectious complications of 1.73%. Patients in group C underwent surgery as soon as possible. Mean admission time was 9.23 days (p < 0.0001) and percentage of infectious complications of 43.6%. There was no difference between those operated rapidly and those who were delayed. Patiens with non-complicated disease could undergo programmed surgery, without having a higher risk of complicated disease and without disturbing normal department activity Non-complicated appendicitis surgery is still considered to be an emergency, although it has been observed that a reasonable therapeutic delay (up to 18 hours) does not imply a higher number of complications. In our department, surgery is programmed for those non-complicated appendicitis, thus avoiding duty staff (surgeons, anaesthesiologists, nurses, assistants) to operate during late night. Acute appendicitis records from august 2001 to december 2002 were reviewed. Collected data included: clinical findings, physical examination, ultrasound findings, surgical delay (recorded time from emergency attendance until the end of the surgery) and evolution. A total of 209 patiens (125 males and 84 females) underwent surgery. Mean age was 10.1 years (standard deviation 3.02). A non-complicated appendicitis group (NC) included 171 subjects while the complicated appendicitis group (C) included 38, assessed by means of clinical evaluation plus ultrasonography. Patients in NC group had programmed surgery, with up to 20-hour delay (mean of 7 hours 45 minutes).Mean admission time was 4.87 days with a percentage of infectious complications of 1.73%. Patients in group C underwent surgery as soon as possible. Mean admission time was 9.23 days (p < 0.0001)and percentage of infectious complications of 43.6%. There was no difference between those operated rapidly and those who were delayed. Patiens with non-complicated disease could under go programmed surgery, without having a higher risk of complicated disease and without disturbing normal department activity (AU)