Operative Delay in Adults with Appendicitis: Time is Money

Aiken, Taylor; Barrett, James; Stahl, Christopher C.; Schwartz, Patrick B.; Udani, Shreyans; Acher, Alexandra W.; Leverson, Glen; Abbott, Daniel E.

doi:10.1016/j.jss.2020.03.038

Cited by 19 publications

(11 citation statements)

References 17 publications

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“…Interestingly, this result appeared during after-hours, which was consistent with the case of expedited surgeries with QIP-DERP implementation in terms of radiology service time. Our results were consistent with those of previous research in the field of surgery regarding the clinical benefits of shorter TES or wait times for surgery [ 10 11 20 21 22 23 24 25 26 27 28 29 30 31 32 ]. McIsaac et al [ 11 ] demonstrated that delayed surgical intervention was associated with higher in-hospital mortality, longer hospital stay, and higher costs.…”

Section: Discussionsupporting

confidence: 92%

Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study

Hong

Lee

et al. 2022

Korean J Radiol

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Objective To investigate the clinical impact of a quality improvement program including dedicated emergency radiology personnel (QIP-DERP) on the management of emergency surgical patients in the emergency department (ED). Materials and Methods This retrospective study identified all adult patients (n = 3667) who underwent preoperative body CT, for which written radiology reports were generated, and who subsequently underwent non-elective surgery between 2007 and 2018 in the ED of a single urban academic tertiary medical institution. The study cohort was divided into periods before and after the initiation of QIP-DERP. We matched the control group patients (i.e., before QIP-DERP) to the QIP-DERP group patients using propensity score (PS), with a 1:2 matching ratio for the main analysis and a 1:1 ratio for sub-analyses separately for daytime (8:00 AM to 5:00 PM on weekdays) and after-hours. The primary outcome was timing of emergency surgery (TES), which was defined as the time from ED arrival to surgical intervention. The secondary outcomes included ED length of stay (LOS) and intensive care unit (ICU) admission rate. Results According to the PS-matched analysis, compared with the control group, QIP-DERP significantly decreased the median TES from 16.7 hours (interquartile range, 9.4–27.5 hours) to 11.6 hours (6.6–21.9 hours) ( p < 0.001) and the ICU admission rate from 33.3% (205/616) to 23.9% (295/1232) ( p < 0.001). During after-hours, the QIP-DERP significantly reduced median TES from 19.9 hours (12.5–30.1 hours) to 9.6 hours (5.7–19.1 hours) ( p < 0.001), median ED LOS from 9.1 hours (5.6–16.5 hours) to 6.7 hours (4.9–11.3 hours) ( p < 0.001), and ICU admission rate from 35.5% (108/304) to 22.0% (67/304) ( p < 0.001). Conclusion QIP-DERP implementation improved the quality of emergency surgical management in the ED by reducing TES, ED LOS, and ICU admission rate, particularly during after-hours.

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Section: Discussionsupporting

confidence: 92%

Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study

Hong

Lee

et al. 2022

Korean J Radiol

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“…Such delay has been considered as a risk factor for complicated appendicitis (CA) ( 9 , 10 ). The delayed medical support is also associated with an increased length of hospital stay (LOS) and increased total hospital cost ( 11 ). Without timely intervention, uncomplicated appendicitis (UA) may proceed to appendix gangrene, abscess, or perforation ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of appendicitis management during COVID-19 pandemic: A study of Chinese adult cohorts

et al. 2022

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BackgroundHealthcare seeking behavior has been widely impacted due to the restricted movements of individuals during the Coronavirus disease-19 (COVID-19) pandemic. This study aims to perform risk stratification in patients requiring timely intervention during the recovery periods.MethodsOperation notes of acute appendicitis (AA) patients within a hospital were analyzed during three six-month periods (23 January-23 July in 2019, 2020, and 2021, respectively). Patient data were collected retrospectively including demographics, pre-emergency status, perioperative information, postoperative outcomes, and follow-up results.Results321 patients were included in this study, with 111, 86, and 124 patients in 2019, 2020, and 2021 groups, respectively. The median age of patients decreased by 4 years in 2020 as compared to that in 2019. The proportion of pre-hospitalization symptoms duration of more than 48 h in the 2020 group was higher (36.05% in 2020 vs. 22.52% in 2019). Length of hospital stay (LOS) in 2020 was shorter than it was during the same period in 2019 (4.77 vs. 5.64) and LOS in 2021 was shorter than in 2019 (4.13 vs. 5.64). Compared to the lockdown period, the proportion of patients with recurrent AA was higher in the post-lockdown period (15.1% vs. 27.4%). The median age was 34 years (vaccinated) vs. 37 years (unvaccinated). Logistic regression suggests that elevated C-reactive protein (CRP) (OR = 1.018, CI = 1.010–1.028), white cell count (WBC) (OR = 1.207, CI = 1.079–1.350), female (OR = 2.958, CI = 1.286–6.802), recurrent (OR = 3.865, CI = 1.149–12.997), and fecalith (OR = 2.308, CI = 1.007–5.289) were associated with complicated appendicitis (CA).ConclusionThe lockdown measures during the COVID-19 epidemic are shown to be correlated with a reduction in the proportion of AA patients who underwent surgery, particularly in older adults. Risk factors for CA include elevated CRP, WBC, female, recurrent, and fecalith.

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“…However, despite being declared safe, delayed appendectomy was associated with increased length of stay and increased total hospital costs compared to appendectomy within 12 hours of reaching the emergency room. 15 Likewise, the results are shown by Almstorm et al (2017) and Boomer et al (2016Boomer et al ( , 2018. Six studies conducted in the Republic of Korea showed no association with delayed appendectomy with SSI.…”

Section: Discussionmentioning

confidence: 74%

The Relationship of Delayed Appendectomy to the Incidence of Surgical Site Infection (SSI) in Acute Appendicitis Patients: A Narrative Review

Ashari

Suswati

Efendi

2021

mpk

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Acute appendicitis is one of the most common causes of surgery worldwide. Appendectomy is a skeptical surgical intervention associated with the risk of Surgical Site Infection (SSI). The purpose of this analysis was to describe the relationship between delayed appendectomy in acute appendicitis and the incidence of SSI. Reviewers selected articles containing data on the incidence of SSI due to appendectomy delays for 3 to 48 hours from seven databases, namely Pubmed, Nature, SpringerLink, Science Direct, ProQuest, Oxford Open Access Journal, and Cochrane Library. The data source was secondary data from international articles published in 2011 to 2020 based on the PICO criteria. The data obtained were then grouped and synthesized without meta-analysis/Synthesis Without Metaanalysis (SWiM) descriptively. A total of 2,778 articles were collected, of which 24 studies met the inclusion criteria. A total of 4 articles showed an association between appendectomy delay and SSI while the other 20 articles did not show a relationship between the two. There was no relationship between appendectomy delays for less than 48 hours since hospital admission to surgery with the incidence of SSI, however a delayed for more than 48 hours showed a significant value. The results showed there was no relationship between delayed appendectomy for less than 48 hours since the time the patientwas admitted to the hospital until the surgery took place, but a delayed appendectomy delay for more than 48 hours showed a significant relationship with the incidence of SSI. This narrative review supports early surgical intervention of acute appendicitis cases by considering the severity of the patient to avoid other surgical complications. Abstrak Apendisitis akut menjadi salah satu penyebab pembedahan yang paling sering ditemukan di seluruh dunia. Apendektomi merupakan intervensi bedah skeptis yang berhubungan dengan risiko terjadinya Surgical Site Infection (SSI). Tujuan analisis ini untuk mendapatkan gambaran hubungan antara penundaan apendektomi pada apendisitis akut dengan kejadian SSI. Reviewer memilih artikel yang memuat data kejadian SSI akibat penundaan apendektomi selama 3 sampai 48 jam dari tujuh basis data yaitu Pubmed, Nature, SpringerLink, Science Direct, ProQuest, Oxford Open Access Journal, dan Cochrane Library. Sumber data berupa data sekunder dari artikel internasional yang diterbitkan pada tahun 2011 hingga 2020 berdasarkan kriteria PICO. Data yang didapatkan kemudian dikelompokkan dan disintesis tanpa meta-analisis/Synthesis Without Meta-analysis (SWiM) secara deskriptif. Total artikel yang dikumpulkan adalah 2.778 artikel, sebanyak 24 studi memenuhi kriteria inklusi. Sebanyak 4 artikel menunjukkan hubungan antara keterlambatan apendektomi dengan SSI sedangkan 20 artikel lainnya tidak menunjukkan hubungan keduanya.Tidak ada hubungan penundaan apendektomi kurang dari 48 jam sejak masuk rumah sakit hingga operasi dengan insidensi SSI namun penundaan lebih dari 48 jam menunjukkan nilai yang signifikan. Berdasarkan hasil analisis, disimpulkan bahwa tidak terdapat hubungan penundaan apendektomi selama kurang dari 48 jam sejak pasien masuk rumah sakit hingga proses pembedahan berlangsung tetapi penundaan apendektomi lebih dari 48 jam menunjukkan adanya hubungan signifikan terhadap kejadian SSI. Tinjauan naratif ini mendukung intervensi bedah yang cepat pada kasus apendisitis akut dengan mempertimbangkan tingkat keparahan pasien dan untuk menghindari komplikasi pembedahan lain.

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Operative Delay in Adults with Appendicitis: Time is Money

Cited by 19 publications

References 17 publications

Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study

Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study

Analysis of appendicitis management during COVID-19 pandemic: A study of Chinese adult cohorts

The Relationship of Delayed Appendectomy to the Incidence of Surgical Site Infection (SSI) in Acute Appendicitis Patients: A Narrative Review

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