Is it safe to delay appendectomy in adults with acute appendicitis?

To examine whether delayed surgical intervention in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standar...

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Bibliographic Details
Published in:Annals of surgery 2006-11, Vol.244 (5), p.656-660
Main Authors: DITILLO, Michael F, DZIURA, James D, RABINOVICI, Reuven
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Appendectomy - methods
Appendicitis - surgery
Biological and medical sciences
Female
Follow-Up Studies
General aspects
Humans
Incidence
Male
Medical sciences
Postoperative Complications - epidemiology
Retrospective Studies
Risk Factors
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Time Factors
Treatment Outcome
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Summary:To examine whether delayed surgical intervention in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 1081 patients who underwent an appendectomy for acute appendicitis between 1998 and 2004 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was 71 hours group compared with total interval
ISSN:0003-4932
1528-1140
DOI:10.1097/01.sla.0000231726.53487.dd