90th Annual Meeting Abstracts

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What is the Optimal Timing of Surgery for Acute Appendicitis?
*Frederick N Eko, MD¹, *Kushi B Bhatt, MD¹, *Basil M Michaels, MD¹, *Eva Goldwater², Timothy C Counihan, MD^1
1Berkshire Medical Center, Pittsfield, MA;²University of Massachusetts, Amherst, MA

Background: Early surgery for appendicitis is thought to avoid complications associated with rupture of the appendix and peritonitis.
Objective: The purpose of this study is to evaluate the effect of timing of surgery on complications, length of stay and cost of patients undergoing appendectomy at our hospital during a two year period.
Design: A retrospective chart review of patients who had undergone appendectomy at our facility from January 1, 2005 to December 31, 2007 was performed. Demographic data, time of presentation, physical findings and diagnostic data, operating room times, length of stay and cost, incidence of complications, as well as outpatient office visit data was collected. Data was analyzed using six-hour and twelve-hour intervals.
Results: Our study included 396 patients (220 male). Pathology confirmed appendicitis in 352 (89%) patients. An insignificant number of postoperative wound infections occurred (N=5 or 1.3%). Timing of surgery did not significantly affect the incidence of post-operative wound infections or other complications.

ED to OR (hours)	# of Patients	Av. LOS (Days)	Av. Postop LOS (Days)	Av. OR Time (min)	Av. Cost ($)
< 6h	124	1.9	3.28	82	$14,076
6-12h	165	2.1	3.33	81	$15,414
12-18h	69	2.5	3.43	87	$16,061
>18h	38	4.0	3.68	87	$19,374
< 12h	289	2.0	3.31	81	$14,840
> 12h	107	3.0	3.52	87	$17,238

Length of stay was shorter for patients with emergency department (ED) to operating room (OR) time less than 12 hours compared to greater than 12 hours (p<0.01). Hospital costs were higher for ED to OR greater than 12 hours compared to less than 12 hours (p<0.01).
Conclusion: Timing of surgery did not affect the incidence of complications or adverse intra-operative findings. Delay in surgical consultation and treatment resulted in a slightly longer operating room time, increased length of stay, as well as increased cost. In adults, delay in appendectomy is safe but not cost-effective.

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