Delay to Appendicectomy and Associated Morbidity: A Retrospective Review

Omundsen, Mark; Dennett, Elisabeth

doi:10.1111/j.1445-2197.2006.03673.x

Cited by 83 publications

(73 citation statements)

References 9 publications

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“…14,15 The commonly quoted perforation rate from literature in the developed world ranges from 15% to 30%. 17 Our current study, however, shows a rate of over 60%. Although this far exceeds the rates seen elsewhere in the developed world, it is similar to that from other studies from subSaharan Africa (40-50%).…”

Section: Discussionmentioning

confidence: 63%

Acute appendicitis in the developing world is a morbid disease

Kong

Sartorius

Clarke

2015

annals

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INTRODUCTION Acute appendicitis in the developing world has a markedly different disease profile to that in the developed world. METHODS A retrospective study was undertaken over a four-year period at a university hospital in South Africa to review the disease spectrum and the clinical outcome of acute appendicitis. RESULTS A total of 1,004 patients (54% male, median age: 18 years) with intraoperatively confirmed appendicitis were reviewed. Over half (56%) were from the urban district within the city of Pietermaritzburg and the remaining 44% were from the rural health district. The median duration of illness from onset to definitive care was 4 days. Sixty per cent of appendices were perforated and associated with intra-abdominal contamination. Forty per cent of patients required reoperation to control intra-abdominal sepsis. Ten per cent required admission to the intensive care unit. The median overall length of hospital stay was 5 days. The mortality rate was 1%.Rural patients had a longer median duration of illness (3 vs 5 days, p<0.001) as well as a more advanced disease profile associated with perforation and severe intra-abdominal sepsis (19% vs 71%, p<0.001). Female patients had a longer median duration of illness (3 vs 4 days, p<0.001), were more likely to present with severe intra-abdominal sepsis (31% vs 54%, p<0.001) and were more likely to require a laparotomy (50% vs 73%, p<0.001). The total cost of managing the entire cohort of 1,004 patients over the 4-year period was £2,060,972. CONCLUSIONS Acute appendicitis in South Africa is a serious disease associated with significant morbidity. Late presentation is common. Female and rural patients have the worst clinical outcomes, with significant cost to the health system.

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Section: Discussionmentioning

confidence: 63%

Acute appendicitis in the developing world is a morbid disease

Kong

Sartorius

Clarke

2015

annals

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“…5 Omundsen and Dennett found that surgery for acute appendicitis up to 24 hours does not lead to an increase in morbidity but when exceeds 24 hours, the morbidity and complications increases. 6 Appendicectomy in acute appendicitis can be delayed in contrast to the earlier beliefs that complications and perforation rate increases when delayed. Delayed appendicectomy have become safe due to the parenteral antibiotics which halts the inflammation and disease progression.…”

Section: Discussionmentioning

confidence: 90%

“…2,3,[4][5][6] This is review of 283 cases of acute appendicitis undergoing appendicectomy from January 2016 to December 2016 to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed being taken up on elective basis.…”

mentioning

confidence: 99%

Delayed appendicectomy in patients with non-perforated acute appendicitis

et al. 2017

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Background: Appendicitis remains one of the most common diseases encountered by the surgeon in practice. Appendicectomy is the most common urgent or emergency general surgical operation performed. Emergency appendicectomy is believed to be the standard treatment protocol for patients with acute appendicitis. This study was conducted to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed to be taken up on elective basis.Methods: This is a retrospective study of all the cases undergoing appendicectomy for acute appendicitis over the period of January 2016 to December 2016 in K. R. hospital, Mysuru, Karnataka, India. The cases were divided into two comparison groups: emergency group (operated within 12 hours of admission) and delayed group (operated between 12-72 hours). Parameters like age, sex, duration of symptoms, total leucocytes count, temperature, haemoglobin, radiological investigations, operative procedure, operative time, length of hospital stay, length of post-operative stay were collected and the end points for comparison were: Operative time, perforation rate, post-operative complication, length of hospital stay, readmission rate. Cases of perforated appendicitis in preoperative diagnosis, interval appendicectomy and appendicectomy done in association with other abdominal conditions were excluded from the study.Results: During this one-year period 283 patients have undergone appendicectomy. Out of this 189 (66.8%) patients have undergone surgery within 12 hours of admission and 94 (33.2%) have undergone surgery between 12 to 72 hours of admission. There was no significant difference between the two groups in operative time, per operative perforation rate, post-operative complication rate, readmission rate. Length of the hospital stay was greater in delayed group as compared to emergency group. But there was no significant difference between the post-operative length of hospital stay.Conclusions: Acute appendicitis can be treated surgically in a delayed elective basis without increasing morbidity.

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“…Delay in diagnosis can lead to appendiceal perforation, technical difficulties during surgery and increased morbidity [9], especially when resistant bacteria are involved, as is common in children [10]. According to the renowned teaching of Henri Mondor, surgeons are inclined to operate when the diagnosis is probable, rather than waiting until the diagnosis is certain.…”

Section: Discussionmentioning

confidence: 99%

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

Podevin

Vries

Lardy

et al. 2017

Journal of Visceral Surgery

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Summary Goal:To evaluate physician compliance with use of a diagnostic algorithm for appendicitis in children. Our secondary objective was to determine the impact of the algorithm on diagnostic accuracy and morbidity. Methods: We conducted a clustered randomized trial in eight centers. A total of 866 patients were included and, depending on the period of randomization at particular centers, 543 patients were managed before the formal institution of the diagnostic algorithm; their diagnostic management was compared to that of the subsequent 323 patients. Results: There was a 29.1% mean increase in the use of imaging studies included in the algorithm after algorithm set-up, rising from 50.8 to 79.9% (P < 0.02). When we used a composite endpoint of ''poor results'' (grouping patients with incorrect diagnoses and/or post-operative complications), no statistically significant difference was found between the two periods (85/543 (15.6%) before vs. 45/323 (13.9%) after set-up, P = 0.5). But when the number of incorrect diagnoses of appendicitis made without the use of the algorithm was compared to that of patients who took advantage of the algorithm, the difference was highly significant (67/332 [20.2%] vs. 63/534 [11.8%], P < 0.001), and the rate of unnecessary appendectomy decreased from 11.9 to 5.3% (P < 0.01). Conclusions: Our diagnostic algorithm improved the adherence to good practice for the diagnosis of appendicitis in children, reducing the rates of unnecessary appendectomy and morbidity. This strategy, combining laboratory tests and imaging, should permit pediatric surgeons to adapt their therapeutic approaches to specific cases.

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Delay to Appendicectomy and Associated Morbidity: A Retrospective Review

Abstract: Time to surgery of up to 24 h does not lead to an increase in complicated appendicitis or morbidity. When the time exceeds 24 h, there is an increased rate of complicated appendicitis and morbidity, including complications that are not directly related to the appendicitis.

Cited by 83 publications

References 9 publications

Acute appendicitis in the developing world is a morbid disease

Acute appendicitis in the developing world is a morbid disease

Delayed appendicectomy in patients with non-perforated acute appendicitis

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

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