Prompt or delayed appendectomy? Influence of timing of surgery for acute appendicitis

Giraudo, Giorgio; F, Baracchi; Pellegrino, Luca; Corso, H. M. Dal; Borghi, Felice

doi:10.1007/s00595-012-0250-5

Cited by 66 publications

(59 citation statements)

References 19 publications

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“…[20][21][22][23][24][25][49][50][51][52][53] The results of our study demonstrate that appendectomy is infrequently performed after hours in Canadian tertiary hospitals, although variation across sites does exist. This practice variation could be explained by site-specific surgical policies or established management pathways, resource availability, or the use of ED observation units.…”

Section: Discussionmentioning

confidence: 78%

“…Traditionally, appendicitis has been considered a surgical emergency in an attempt to mitigate adverse patient outcomes (perforation, abscess formation, sepsis). Recent literature, however, demonstrates that delaying appendectomy until daytime hours may be safe practice and has fueled the debate between emergent and urgent appendectomy, [20][21][22][23][24][25][26] nonsurgical management of uncomplicated appendicitis, [27][28][29] and the potential effect these approaches may have on patient outcomes such as perforation. Antibiotic monotherapy in uncomplicated appendicitis has been proposed as an alternative to traditional triple therapy to simplify ED processes, reduce error, and decrease antibiotic resistance.…”

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confidence: 99%

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Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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Objectives: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.Methods: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with afterhours surgery were determined using generalized estimating equations logistic regression.Results: Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014).Conclusions: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.ACADEMIC EMERGENCY MEDICINE 2015;22:811-822 © 2015 by the Society for Academic Emergency Medicine A ppendicitis is the most common nontraumatic surgical emergency in children, 1,2 yet it continues to present diagnostic and management uncertainty.3 Current strategies for diagnosing appendicitis include the use of clinical scoring systems, 4-7 laboratory markers of infection and inflammation, [8][9][10] and

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Section: Discussionmentioning

confidence: 78%

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confidence: 99%

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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“…Among these three features, the CRP level was the only preoperative risk factor for SSI in patients with appendicitis. Although gangrenous or perforated appendicitis and delayed diagnosis have already been reported as risk factors for postoperative complications in patients undergoing appendectomy [20,21], few reports have demonstrated that the preoperative CRP level (>65 mg/l) is a risk factor for SSI in such patients. CRP is synthesized in the liver in response to interleukin-6 (IL-6) and is commonly used as a non-specific inflammatory marker in patients with an acute abdomen in many clinical settings [22].…”

Section: Discussionmentioning

confidence: 99%

The preoperative serum C-reactive protein level is a useful predictor of surgical site infections in patients undergoing appendectomy

2014

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“…It is known that there is a correlation between the time since the onset of symptoms and the risk factor for an event of complicated appendicitis [14]. However, that does not impact patients who are hospitalised and treated with intravenous hydration and antibiotics [15,16]. In developed countries 15% to 30% of appendicitis cases are complicated [17,18].…”

Section: Discussionmentioning

confidence: 99%

Incidence of complicated acute appendicitis: a single-centre retrospective study

Piotrowska¹,

Osman²,

Wolak³

2017

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Introduction: Abdominal pain has been one of the most common reasons patients seek medical care for centuries. Nowadays, together with laboratory diagnostics and imaging, we are able to make an early diagnosis. This leads to the introduction of early adequate treatment. Aim of the research: To analyse the incidence and causes of complicated acute appendicitis in one medical centre in between 2004 and 2016. Material and methods: A retrospective study covered the period from December 23, 2004 to November 07, 2016. It included 2048 cases of children between 0 and 18 years of age undergoing surgery for suspected acute appendicitis. Demographic and clinical characteristics as well as length of hospitalisation, antibiotics schemes, and intraoperative diagnosis were reviewed. Complicated acute appendicitis cases were distinguished and compared with the incidence in world literature. Results: The percentage of complicated acute appendicitis ranged from 39% to 60%. Complicated acute appendicitis occurs much more often in children under 5 years of age. Conclusions: The delay and failure in diagnosis of acute appendicitis results in higher incidence of complicated acute appendicitis; consequently, there are higher costs of treatment. Improving the awareness of parents and primary care physicians may allow faster diagnosis and treatment of acute appendicitis. It was noted that the reform of the National Emergency Medical Services in Poland contributed to a reduction in the incidence of complicated appendicitis.

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Prompt or delayed appendectomy? Influence of timing of surgery for acute appendicitis

Abstract: Performing appendectomy within 24 h from presentation does not increase the length of hospital stay or rate of complications. However, delayed appendectomy after 24 h from onset increases the rate of complications.

Cited by 66 publications

References 19 publications

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

The preoperative serum C-reactive protein level is a useful predictor of surgical site infections in patients undergoing appendectomy

Incidence of complicated acute appendicitis: a single-centre retrospective study

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