Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study

Abstract

IntroductionPrompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality. Our study was designed to examine whether the time from the beginning of symptoms to operation correlates with the pathological degree of appendicitis, incidence of postoperative complications, or increased length of hospital stay.MethodsA prospective study of 171 patients who underwent emergent appendectomy for acute appendicitis in the course of 2 years was conducted in a single tertiary medical center. The following parameters were monitored and correlated: demographics, time from the onset of symptoms until the arrival to the emergency department (patient interval (PI)), time from arrival to the emergency department (ED) until appendectomy (hospital interval (HI)), time from the onset of symptoms until appendectomy (total interval (TI)), physical examination, preoperative physical findings, laboratory data, pathologic findings, complications, and length of hospital stay.ResultsThe degree of pathology and complications were analyzed according to the time intervals. The time elapsed from the onset of symptoms to surgery was associated with higher pathology grade (p = 0.01). We found that longer time from the onset of symptoms to hospital arrival correlates with higher pathology grade (p = 0.04), while there was no correlation between the hospital interval and pathology grade (p = 0.68). A significant correlation was found between the pathology grade and the incidence of postoperative complications as well as with increased length of hospital stay (p = 0.000).ConclusionTime elapsed from the symptom onset to appendectomy correlates with increased pathology grade and complication rate. This correlation was not related to the HI. Since the HI in our study was short, we recommend an early appendectomy in adults in order to shorten the TI and the resulting complications.

Surgical Versus Conservative Management of Acute Appendicitis During the COVID-19 Pandemic: A Single-Centre Retrospective Study

“…No significant difference was found in length of hospital stay between the two groups (surgical: median 2 [IQR 2-3], conservative: median 3 [IQR 2-4]). WCC (surgical: median 15.9 [IQR 12.2-17.4], conservative: median 12.5 [IQR 10.4-15.6]) and Alvarado score (surgical: median 8 [IQR6-9], conservative: median 6 [ 5 - 8 ]) on admission was significantly higher in the surgical group compared to the conservatively managed group (p=0.012 and p=0.028, respectively). A summary of all patients having complications within six-month follow-up in both groups is provided in Table 3 , including imaging undertaken and initial WCC and Alvarado score.…”

“…The procedure has become routine and is associated with a significantly low mortality [ 4 ]. Early appendicectomy is recommended to avoid serious complications of appendicitis such as perforation, abscess formation and faecal peritonitis [ 5 ]. However, as with any surgical intervention, appendicectomy still involves significant risks [ 4 ].…”

Did the COVID‐19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis?

“…As noted in retrospective studies, acute appendicitis is a time-dependent disease concerning severity and complication rate [ 18 , 19 ]. On the other hand, some studies suggest that perforation is most often a prehospital occurrence and not strictly a time-dependent phenomenon [ 20 ].…”

“…On the other hand, in adults, appendectomy remains the most effective and safe treatment option and provides curative treatment without risk. As noted in retrospective studies, acute appendicitis is a time-dependent disease concerning severity and complication rate [18,19]. On the other hand, some studies suggest that perforation is most often a prehospital occurrence and not strictly a time-dependent phenomenon [20].…”

The Direct Medical Cost of Acute Appendicitis Surgery in a Resource‐Limited Setting of Papua New Guinea

“…A study by James et al reported that 27.8% of people in Milne Bay Province (PNG) did not have access to emergency surgery within two hours [10]. Such delay in presentation increases the risk of developing perforated appendicitis, sepsis and death [11][12][13]. The role of primary health care (PHC) thus becomes paramount in such a resource-limited setting.…”