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How Urgent Is Appendectomy For Acute Appendicitis? Do We Have To Operate In The Middle Of The Night?

Fadi Abou-Nukta, Charles Bakhos, Kervin Arroyo, Young Koo, Jeremiah Martin, Randolph Reinhold, Kenneth Ciardiello
Hospital of Saint Raphael, New Haven, CT

Objective: To determine if delaying appendectomy for twelve hours to avoid disturbing the operating room schedule and to minimize the number of operations during the night negatively affects the outcome of patients with acute appendicitis.
Design: Retrospective study.
Setting: Tertiary care teaching hospital.
Patients: The medical records of 380 patients who underwent an appendectomy between 2002- 2004 were reviewed. Patients proven to have an inflamed appendix on the pathology report were divided into 2 groups. The early group consisted of patients who had surgery within 12 hours of presentation to the emergency room, including patients with generalized sepsis. The late group consisted of patients who had surgery more than 12 hours after presentation.
Main Outcome Measures: Length of stay (LOS), operative time (OT) or the rate of perforations and complications.
Interventions: Laparoscopic or open appendectomies.
Results: 309 patients were included in our study. There were no statistically significant differences between the two groups in the LOS, OT, the percentage of advanced appendicitis or the rate of complications.
Early group
(<12 hours to OR)
Late Group
(>12 hours to OR)
P value
n23376
Age (years)41.2 +/- 16.939.6 +/- 15.90.85
Males
Females
129
104
36
40
0.2
Temperature (F)99.2 +/- 1.499.3 +/- 1.60.78
WBC13.6 +/- 3.914.1 +/- 3.80.3
LOS2.5 +/- 2.32.9 +/- 1.80.17
Advanced appendicitis32% (n=75)37% (n=28)0.56
OT: Laparoscopic
OT: Open
81 +/- 31 (n=98)
77 +/- 31 (n=135)
81.5 +/- 31 (n=40)
86 +/- 33 (n=36)
0.93
0.14
Abscess(s)
Wound infection(s)
6
2
1
1
0.74

Conclusions: In selected patients, delaying appendectomies for acute appendicitis to 12-24 hours after presentation does not significantly increase the rate of perforations, OT or the LOS. It decreases the utilization of nursing care, anesthesia team and surgical house staff during the night shifts, and the interruption of the regular OR schedule.

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