J Korean Surg Soc.  2009 Jun;76(6):360-363. 10.4174/jkss.2009.76.6.360.

The Effect of Delayed Surgery in Adult Patients with Acute Appendicitis

• Lee MA
• Chung M
• Lee YD
• Lee JN
• Lee WK
• Park YH
• Park HG
• Kim KK
• Choi ST
• Kang JM
• Lee WS
• Kim HY
• Park SY
• Yu BC

• KMID: 1464951
• DOI: http://doi.org/10.4174/jkss.2009.76.6.360

Abstract

PURPOSE: There are many reports that delayed operation of appendicitis in children is safe, but it is controversial whether the same principle can be applicable in adult patients. The aim of this study was to evaluate the relationship between the interval from onset of symptoms to operation and the pathologic degree of appendicitis.
METHODS
In this retrospective study, 783 adult patients (16 years old or more) diagnosed with appendicitis pathologically between 2004 and 2007 were included. The time from onset of symptoms to hospital arrival (patient interval) and time from hospital arrival to operation (hospital interval) were investigated. Pathologic and gross state of the appendicitis was graded as G1 (suppurative), G2 (gangrenous), G3 (ruptured), G4 (periappendiceal abscess).
RESULTS
The median time from symptom onset to operation (total interval) was 35 hours. The percentage of G1, G2, G3, and G4 was 86.3%, 11.4%, 2.4%, and 0% when total interval was <24 hours, 61.3%, 21.3%, 15.8%, and 1.6% when between 24 and 72 hours, and 23.8%, 13.9%, 36.9%, and 25.4% when the interval was over 72 hours. The advanced grade of appendicitis correlated with increased hospital stay (P<0.0001).
CONCLUSION
This study suggests that delayed appendectomy in acute appendicitis in adults is a risk factor for advanced grades, and that the sooner the operation is undertaken, the better the outcome is.

Keyword

Acute appendicitis; Appendectomy; Time; Delay

MeSH Terms

Adult
Appendectomy
Appendicitis
Child
Humans
Length of Stay
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Relationship between total interval and grade of appendicitis. The prevalence of advanced pathology positively correlated with prolonged total interval (P<0.0001).

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  Fig. 2 (A) Relationship between patient interval and grade of appendicitis. (B) Relationship between hospital interval and grade of appendicitis. Both patient and hospital interval were associated with advanced grades of appendicitis (P<0.0001). Data are expressed as medians with bars representing 25th and 75th percentile.

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  Fig. 3 The association of appendicitis grade and hospital stay (mean, days). The graph shows advanced pathology associated with prolonged hospital stay (P<0.0001).

Reference

1. Feldman M. Sleisenger & Fordtran's Gastrointestinal and Liver Disease; Pathophysiology, Diagnosis, Management. 1998. 6th ed. Philadelphia: Saunders;1783.

2. Scher KS, Coil JA. The continuing challenge of perforating appendicitis. Surg Gynecol Obstet. 1980. 150:535–538.

3. Karp MP, Caldarola VA, Cooney DR, Allen JE, Jewett TC Jr. The avoidable excesses in the management of perforated appendicitis in children. J Pediatr Surg. 1986. 21:506–510.

4. Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, Coran AG. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg. 2004. 39:464–469.

5. Surana R, Quinn F, Puri P. Is it necessary to perform appendicectomy in the middle of the night in children? BMJ. 1993. 306:1168.

6. Bachoo P, Mahomed AA, Ninan GK, Youngson GG. Acute appendicitis: the continuing role for active observation. Pediatr Surg Int. 2001. 17:125–128.

7. Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg. 2006. 244:656–660.

8. Cho BW, Park SH, Yoon SG, Choi KW. Impact of physician delay on postoperative outcome of patients with acute appendicitis. J Korean Soc Coloproctol. 1998. 14:561–567.

9. Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006. 202:401–406.

10. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998. 338:141–146.

11. Hansen AJ, Young SW, De Petris G, Tessier DJ, Hernandez JL, Johnson DJ. Histologic severity of appendicitis can be predicted by computed tomography. Arch Surg. 2004. 139:1304–1308.

12. Weyant MJ, Eachempati SR, Maluccio MA, Rivadeneira DE, Grobmyer SR, Hydo LJ, et al. Interpretation of computed tomography does not correlate with laboratory or pathologic findings in surgically confirmed acute appendicitis. Surgery. 2000. 128:145–152.