Ideal timing of surgery for acute uncomplicated appendicitis
Frederick N Eko1, Gabriel E Ryb2, Leslie Drager3, Eva Goldwater4, Jacqueline J Wu5, Timothy C Counihan5
1 Department of Plastic and Reconstructive Surgery, Tulane University Hospital and Clinics, 1430 Tulane Avenue, New Orleans, Louisiana, USA
2 Department of Surgery, University of Maryland School of Medicine, Program in Trauma, 22 South Greene Street, Baltimore, Maryland, USA
3 Department of Applied and Clinical Research, Berkshire Medical Center, 725 North Street, Pittsfield, USA
4 Biostatistical Consulting Center at University of Massachusetts, Amherst, 418 Arnold House, 715 North Pleasant Street, University of Massachusetts, Amherst, USA
5 Department of Surgery, Berkshire Medical Center, 725 North Street, Pittsfield, Massachusetts, USA
Jacqueline J Wu
Department of Surgery, Berkshire Medical Center, 725 North Street, Pittsfield, MA
Source of Support: None, Conflict of Interest: The authors of this
study have nothing to to disclose and have no conflicts of interest.
The research was made possible through the Department of surgery
at Berkshire medical centre. No grants were used to fund this research.
Background: Early surgery for appendicitis is thought to avoid complications associated with appendiceal rupture. Aims: This study was to evaluate the effect of timing of surgery on complications, length of stay (LOS) and cost in patients undergoing appendectomy. Materials and Methods: Retrospective review of 396 patients with appendectomies from January 1, 2005 to December 31, 2007 was performed. Demographic data, time of presentation, physical findings, diagnostic data, operating room times, LOS, cost and complications were collected. Patients were divided into 4 groups based on time from presentation to appendectomy. Results: Pathology confirmed appendicitis in 354 (89%) patients. Most patients (90%) had surgery within 18 h of presentation. Timing of surgery did not affect the incidence of purulent peritonitis ( P = 0.883), abscess ( P = 0.841) or perforation ( P = 0.464). LOS was significantly shorter for patients with emergency department registration to operating room times less than 18 h ( P < 0.0001). Costs were significantly higher for patients with times to operating room greater than 18 h ( P < 0.001). Conclusion: Timing of surgery did not affect the incidence of complications or perforated appendicitis. However, delay in surgical consultation and surgery are associated with increased LOS and increased hospital costs. The optimal timing of appendectomy for uncomplicated acute appendicitis appears to be within 18 h of emergency department presentation.