No Risk From Delayed Appendectomy

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Appendectomies are the most common emergent medical procedure worldwide. And according to a new study, delaying emergency appendectomy for 12 hours or more appears to have no adverse effects during a 30-day follow-up period.

A retrospective review of almost 33,000 cases found that the rate of serious complications or death was about three percent, whether the operation occurred within six hours, six to 12 hours, or more than 12 hours after hospital admission. Overall morbidity was about 5.5 percent to 6 percent, regardless of the time from admission to surgery, Dr. Angela M. Ingraham of the American College of Surgeons (ACS) and co-authors reported.

Differences in operative duration and length of hospital stay, while statistically significant, were clinically inconsequential, the investigators wrote in the September issue of the Archives of Surgery.

Excluding disease severity from statistical models used in the analysis did not change the results, suggesting "that there truly is no relationship between time from surgical admission and negative outcomes after appendectomy in this retrospective cohort study," Ingraham and co-authors commented in a discussion of their findings.

"These data might help guide the use of the potentially limited operative and professional resources allocated for emergency surgical care," they added. "Such information will contribute to the efficient allocation of limited surgical resources without negatively affecting patient care."

Increased delay from onset of symptoms to surgery for acute appendicitis is associated with more advanced disease.

Recent developments in imaging and antibiotic therapy have improved preoperative assessment, affording more opportunities for nonoperative management and reducing the need for immediate surgery to prevent disease progression, the authors wrote in the introduction to their report.

Studies in the pediatric literature have indicated that delaying surgery and providing fluids and antibiotics does not increase the risk of adverse outcomes in children. Similar investigations in adults have not provided a definitive answer, although first-line antibiotic therapy for acute appendicitis proved to be safe in one study of carefully selected men.

In an attempt to clarify the risk of surgical delay in acute appendicitis, the authors reviewed data from the ACS National Surgical Quality Improvement Program database and identified all patients 16 or older who underwent appendectomy for a diagnosis of acute appendicitis from January 2005 through December 2008.

The study involved 32,782 patients, consisting of 24,647 (75.2 percent) patients who had an appendectomy within six hours of admission, 4,934 (15.1 percent) patients who underwent surgery six to 12 hours after admission, and 3,201 (9.8 percent) patients who had the operation more than 12 hours after being admitted.

The patients had a mean age of 38, and men accounted for 53.9 percent of the study population. Men and white patients had shorter delays before having surgery, and chronic comorbid conditions were associated with increased delays from admission to the induction of anesthesia.

The authors reported that 83.4 percent of the patients had simple appendicitis and 16.6 percent had complicated appendicitis. Three-fourths of the patients underwent laparoscopic appendectomy.

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