BACKGROUND: Emergent appendectomy (EA) in children is still considered surgical dogma and continues to be recommended as a standard of care. This study examined whether emergent operation has any outcome advantages over urgent operation. METHODS: The charts of children treated for appendicitis during a recent 28-month period at 2 children's hospitals, where appendectomies are not performed between midnight and 7 am, were reviewed. Outcomes were compared between patients who underwent EA (within 8 hours of presentation) vs those who underwent urgent appendectomy (UA, after 8 hours). RESULTS: Three hundred sixty-five children met the criteria for the study. One hundred sixty-one (44%) were in the EA group (5.3 +/- 2.1 hours), and 204 (56%) were in the UA group (16.8 +/- 9.7 hours). The incidence of gangrenous or perforated appendicitis was significantly higher in the EA group (47% vs 36%, P = .04). There were no significant differences between EA and UA in postoperative outcomes, including readmissions (3.7% vs 1.0%, P = .08), wound infections (0.6% vs 2.4%, P = .17), or postoperative abscesses (1.9% vs 1.5%, P = .77). There were no significant differences in average hospital stay or average hospital charges between EA and UA (3.2 days for both, 14,775 dollars vs 14,850 dollars), respectively. CONCLUSIONS: Emergent appendectomy in children has no advantages over UA with respect to gangrene and perforation rates, readmissions, postoperative complications, hospital stay, or hospital charges. Performance of a UA at a time convenient to the surgeon should be considered within the standard of care.
BACKGROUND: Emergent appendectomy (EA) in children is still considered surgical dogma and continues to be recommended as a standard of care. This study examined whether emergent operation has any outcome advantages over urgent operation. METHODS: The charts of children treated for appendicitis during a recent 28-month period at 2 children's hospitals, where appendectomies are not performed between midnight and 7 am, were reviewed. Outcomes were compared between patients who underwent EA (within 8 hours of presentation) vs those who underwent urgent appendectomy (UA, after 8 hours). RESULTS: Three hundred sixty-five children met the criteria for the study. One hundred sixty-one (44%) were in the EA group (5.3 +/- 2.1 hours), and 204 (56%) were in the UA group (16.8 +/- 9.7 hours). The incidence of gangrenous or perforated appendicitis was significantly higher in the EA group (47% vs 36%, P = .04). There were no significant differences between EA and UA in postoperative outcomes, including readmissions (3.7% vs 1.0%, P = .08), wound infections (0.6% vs 2.4%, P = .17), or postoperative abscesses (1.9% vs 1.5%, P = .77). There were no significant differences in average hospital stay or average hospital charges between EA and UA (3.2 days for both, 14,775 dollars vs 14,850 dollars), respectively. CONCLUSIONS: Emergent appendectomy in children has no advantages over UA with respect to gangrene and perforation rates, readmissions, postoperative complications, hospital stay, or hospital charges. Performance of a UA at a time convenient to the surgeon should be considered within the standard of care.
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; Anthony A Castelli; Michael G Florence; Morris G Johnson; Scott R Steele; Richard C Thirlby; David R Flum Journal: Surgery Date: 2016-08-31 Impact factor: 3.982
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
Authors: Massimo Sartelli; Pierluigi Viale; Kaoru Koike; Federico Pea; Fabio Tumietto; Harry van Goor; Gianluca Guercioni; Angelo Nespoli; Cristian Tranà; Fausto Catena; Luca Ansaloni; Ari Leppaniemi; Walter Biffl; Frederick A Moore; Renato Poggetti; Antonio Daniele Pinna; Ernest E Moore Journal: World J Emerg Surg Date: 2011-01-13 Impact factor: 5.469