BACKGROUND/ PURPOSE: Over the last 4 years, the authors changed their management of acute nonperforated appendicitis from emergent surgery within the first 2 to 6 hours of admission to initiation of antibiotic therapy with operation within 24 hours of admission in those seen in the late evening or early morning. They examined, therefore, whether a delay in operation for acute appendicitis would affect outcome measures of patient morbidity and resource use. METHODS: The medical records of 126 patients with acute appendicitis occurring between 1998 and 2001 were retrospectively reviewed. Incidence of perforation at surgery, length of stay (LOS), hospital charges, operating time, and complications as a function of duration between emergency room (ER) triage and operation (ER-OR) or admission and operation (Admit-OR) were analyzed by Student's t test, and regression analysis with P less than.05 considered significant. RESULTS: Thirty-eight children (26%) were operated on within 6 hours of ER triage, whereas the remaining 88 children (74%) were operated on between 6 and 24 hours from ER triage. No significant difference was noted in perforation rate, LOS, costs, or operative time, nor were substantial changes in complications noted between those with an ER-OR < or =6 hours and greater than 6 hours. Likewise, no significant differences in these outcome measures were noted for Admit-OR greater than 6 when compared with < or =6 hours. Only costs with ER-OR greater than 12 hours and LOS with Admit-OR greater than 6 hours were significantly (without Bonferroni correction) different than < or = 6 hours. Multivariable linear regression analysis identified only LOS as a significant predictor of time to OR. CONCLUSIONS: In children with acute appendicitis, delaying surgery until the daytime hours did not significantly affect operating time, perforation rate, or complications. Delayed management allows greater efficiency and effective use of physician and hospital resources, including decreased resident involvement in operations during the night.
BACKGROUND/ PURPOSE: Over the last 4 years, the authors changed their management of acute nonperforated appendicitis from emergent surgery within the first 2 to 6 hours of admission to initiation of antibiotic therapy with operation within 24 hours of admission in those seen in the late evening or early morning. They examined, therefore, whether a delay in operation for acute appendicitis would affect outcome measures of patient morbidity and resource use. METHODS: The medical records of 126 patients with acute appendicitis occurring between 1998 and 2001 were retrospectively reviewed. Incidence of perforation at surgery, length of stay (LOS), hospital charges, operating time, and complications as a function of duration between emergency room (ER) triage and operation (ER-OR) or admission and operation (Admit-OR) were analyzed by Student's t test, and regression analysis with P less than.05 considered significant. RESULTS: Thirty-eight children (26%) were operated on within 6 hours of ER triage, whereas the remaining 88 children (74%) were operated on between 6 and 24 hours from ER triage. No significant difference was noted in perforation rate, LOS, costs, or operative time, nor were substantial changes in complications noted between those with an ER-OR < or =6 hours and greater than 6 hours. Likewise, no significant differences in these outcome measures were noted for Admit-OR greater than 6 when compared with < or =6 hours. Only costs with ER-OR greater than 12 hours and LOS with Admit-OR greater than 6 hours were significantly (without Bonferroni correction) different than < or = 6 hours. Multivariable linear regression analysis identified only LOS as a significant predictor of time to OR. CONCLUSIONS: In children with acute appendicitis, delaying surgery until the daytime hours did not significantly affect operating time, perforation rate, or complications. Delayed management allows greater efficiency and effective use of physician and hospital resources, including decreased resident involvement in operations during the night.
Authors: R R Gorter; J H van der Lee; P M N Y H Go; M H W A Wijnen; R W Meijer; H A Cense; C M F Kneepkens; H A Heij Journal: Pediatr Surg Int Date: 2013-03-02 Impact factor: 1.827
Authors: Anne Andert; H P Alizai; C D Klink; N Neitzke; C Fitzner; C Heidenhain; A Kroh; U P Neumann; M Binnebösel Journal: Langenbecks Arch Surg Date: 2017-07-27 Impact factor: 3.445
Authors: Luis Angel Medina Andrade; Franz Yeudiel Pérez Muñoz; María Valeria Jiménez Báez; Stephanie Serrano Collazos; Maria de Los Angeles Martinez Ferretiz; Brenda Ruiz; Oscar Montes; Stephanie Woolf; Jessica Gonzalez Noriega; Uriel Maldonado Aparicio; Israel Gonzalez Gonzalez Journal: World J Surg Date: 2016-11 Impact factor: 3.352
Authors: Frederick Thurston Drake; Neli E Mottey; Ellen T Farrokhi; Michael G Florence; Morris G Johnson; Charles Mock; Scott R Steele; Richard C Thirlby; David R Flum Journal: JAMA Surg Date: 2014-08 Impact factor: 14.766