Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study

Abstract

BackgroundAcute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of prolonged TTT on patient outcome.MethodsA retrospective review of an electronic prospectively maintained database was performed over a 2 year period. Factors thought to influence TTT were highlighted. A delay was defined as TTT >8 hours. Data analysis was performed using SPSS 20.Results1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7%. 68.1% underwent laparoscopic appendicectomy. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between delayed TTT and female gender (p = 0.017), older age (p = 0.001), pre-operative radiology (<0.001), normal WCC (p < 0.001), normal neutrophils (p < 0.001) and histological non-perforated appendix (p < 0.001). However, on multivariate analysis, younger age, a neutrophilia and presence of a perforation had a shorter TTT. Delayed TTT did not affect outcome variables including post-operative collection (3.59% v 4.38%, p = 0.528), readmission rate (6.54% v 5.72%, p = 0.403) and length of stay (3.1 days v 3.34 days, p = 0.823).ConclusionsThis study highlights key hospital factors that influence TTT in patients with suspected appendicitis. Identification of these influential factors adds greatly to our understanding of patient prioritisation. Finally, TTT delays greater than 8 hour do not appear to affect short-term patient outcomes.

Appendicitis in children from a gender perspective

“…In contrast, a longer delay to surgery has been described in adult females, when compared with adult men [22], and to both adult men and children [21]. Our finding of similar surgical delay in girls and boys could be explained by the lower incidence of gynecological conditions in girls compared to adult females, which could decrease the time needed to evaluate differential diagnoses.…”

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

“…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.…”

Diagnosis, Symptoms, and Outcomes of Hirschsprung’s Disease from the Perspective of Gender

“…However, gender differences may already be present during childhood due to anatomical differences, for example, in the pelvis and pelvic floor, or due to comorbidity. Different attitudes and different treatment according to gender have been demonstrated among adult patients [ 23 ], and until illuminated one cannot exclude that a similar difference in attitudes towards boys and girls exists among some health care professionals, and that this might influence treatment decisions and treatment outcomes. This possibility should warrant further study, not only among adults, but also among children.…”