Clinically monitored delay-A valid option in cases with doubtful diagnosis of acute appendicitis

Gupta, Ajay; Regmi, Subodh; Hazra, N K; Panhani, Moti L.; Talwar, Om Praksah

doi:10.1007/s12262-010-0049-9

Cited by 9 publications

(10 citation statements)

References 14 publications

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“…The beginning of in‐hospital delay was defined as arrival or physical examination in the emergency department in 22 studies, as clinical or radiological diagnosis in seven studies, and as hospital admission in 14 studies. In 40 studies complicated appendicitis was a reported outcome measure, 19 studies reported SSI, 19 reported wound infection, 16 reported postoperative intra‐abdominal abscess and 15 studies reported postoperative morbidity as an outcome measure.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Dijk

Dijkgraaf

et al. 2018

British Journal of Surgery

123

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BackgroundThe traditional fear that every case of acute appendicitis will eventually perforate has led to the generally accepted emergency appendicectomy with minimized delay. However, emergency and thereby sometimes night‐time surgery is associated with several drawbacks, whereas the consequences of surgery after limited delay are unclear. This systematic review aimed to assess in‐hospital delay before surgery as risk factor for complicated appendicitis and postoperative morbidity in patients with acute appendicitis.MethodsPubMed and EMBASE were searched from 1990 to 2016 for studies including patients who underwent appendicectomy for acute appendicitis, reported in two or more predefined time intervals. The primary outcome measure was complicated appendicitis after surgery (perforated or gangrenous appendicitis); other outcomes were postoperative surgical‐site infection and morbidity. Adjusted odds ratios (ORs) were pooled using forest plots if possible. Unadjusted data were pooled using generalized linear mixed models.ResultsForty‐five studies with 152 314 patients were included. Pooled adjusted ORs revealed no significantly higher risk for complicated appendicitis when appendicectomy was delayed for 7–12 or 13–24 h (OR 1·07, 95 per cent c.i. 0·98 to 1·17, and OR 1·09, 0·95 to 1·24, respectively). Meta‐analysis of unadjusted data supported these findings by yielding no increased risk for complicated appendicitis or postoperative complications with a delay of 24–48 h.ConclusionThis meta‐analysis demonstrates that delaying appendicectomy for presumed uncomplicated appendicitis for up to 24 h after admission does not appear to be a risk factor for complicated appendicitis, postoperative surgical‐site infection or morbidity. Delaying appendicectomy for up to 24 h may be an acceptable alternative for patients with no preoperative signs of complicated appendicitis.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Dijk

Dijkgraaf

et al. 2018

British Journal of Surgery

123

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“…Despite the fact that surgical appendectomy is the gold standard of AA, there are studies of conservative antibiotic treatment with low morbidity and mortality rate, and a recurrence rate between 7-15 % [ 5 ]. On the other hand, delay of operative treatment can stimulate the development of complications [ 6 - 8 ]. Co-morbidity and negative appendectomy are strongly related with higher mortality, where co-morbidity, diagnostic failure, and the anesthetic or surgical trauma are the important factors [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Is acute appendicitis still misdiagnosed?

et al. 2016

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AbstractObjectiveThe optimal diagnostics and treatment of acute appendicitis continues to be a challenge. A false positive diagnosis of appendicitis may lead to an unnecessary operation, which has been appropriately termed negative appendectomy. The aim of our study was to identify the effectiveness of preoperative investigations in preventing negative appendectomy.MethodsA retrospective study was performed on adult patients who underwent operation for suspected acute appendicitis from 2008 to 2013 at Vilnius University Hospital Santariskiu Klinikos. Patients were divided into two groups: group A underwent an operation, where appendix was found to be normal (non-inflamed); group B underwent an appendectomy for inflamed appendix. Groups were compared for preoperative data, investigations, treatment results and pathology findings.Results554 patients were included in the study. Preoperative laboratory tests results of hemoglobin, hematocrit concentrations and white blood cell count were significantly higher in group B (p<0.001). Ultrasonography was performed for 78 % of patients in group A and 74 % in group B and did not provide any statistically significant results. Comparing Alvarado score results, there were more patients with Alvarado score less than 7 in group A than in group B. In our large series we could find only four independent risk factors, and they could only account for 24 % of cases.ConclusionsIn summary, acute appendicitis is still often misdiagnosed and the ratio of negative appendectomies remains rather high. Additional investigations such as observation and computed tomography should be used to prevent this.

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“…The results of the studies we reviewed indicate that early surgical intervention also can lead to poor patient outcomes 32,29 . Early surgery may increase the risk of removing a healthy appendix (ie, a negative appendectomy), 32,39 which causes the patient to have unnecessary surgery, placing them at risk for complications 40 . The SSAT practice guidelines for treating appendicitis state that a negative appendectomy rate of 15% is acceptable 22 .…”

Section: Discussionmentioning

confidence: 97%

Optimal Time to Surgery for Patients Requiring Laparoscopic Appendectomy: An Integrative Review

Gardiner¹,

Gillespie²

2016

AORN Journal

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Acute appendicitis is the most common condition requiring emergency surgery worldwide. Although current guidelines recommend prompt appendectomy as the preferred treatment, no time interval for surgery has been indicated. We used an integrative review methodology to critically evaluate evidence on the relationship between time to surgery and hospital length of stay and to identify the ideal time to surgery for patients undergoing appendectomy. We included 14 studies in our synthesis, most of which (n = 9/14, 64%) indicated that longer time delays to surgical intervention increased hospital length of stay for patients presenting with appendicitis. Researchers report that the optimal time for surgery is 24 to 36 hours after symptom onset, or 10 to 24 hours from admission. The results of our review indicate that patient symptoms on presentation may signify advancing pathology and may be more important than the time delay interval in defining surgical priority.

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Clinically monitored delay-A valid option in cases with doubtful diagnosis of acute appendicitis

Cited by 9 publications

References 14 publications

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Is acute appendicitis still misdiagnosed?

Optimal Time to Surgery for Patients Requiring Laparoscopic Appendectomy: An Integrative Review

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