Henna E Sammalkorpi1, Ari Leppäniemi, Panu Mentula. 1. Department of Abdominal Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland, henna.sammalkorpi@hus.fi.
Abstract
PURPOSE: Debate on the effect of in-hospital delay on the risk of perforation in appendicitis persists, and the results from previous studies are controversial. The aims of this study were to present the effect of in-hospital delay on the risk of perforation in appendicitis and to assess the utility of C-reactive protein (CRP) measurement in detecting the patients with complicated appendicitis. METHODS: Prospectively collected data of 389 adult patients who underwent surgery for acute appendicitis were analyzed in order to find the most accurate method for recognizing the pre-hospital perforations. The effect of in-hospital delay on the further risk of perforation in patients with not yet perforated acute appendicitis was then analyzed. RESULTS: Out of 389 patients with appendicitis, 91 patients (23.4 %) had complicated appendicitis, 23 with abscess, and 68 with free perforation. Admission CRP level of 99 mg/l or higher was 90.3 % specific for complicated appendicitis. In patients with admission CRP less than 99 mg/l, the incidence of perforation doubled from 9.5 to 18.9 % when the in-hospital delay increased from less than 6 h to more than 12 h. CONCLUSIONS: Complicated appendicitis can be identified with a high CRP level on admission. Delaying surgery can increase the risk of perforation.
PURPOSE: Debate on the effect of in-hospital delay on the risk of perforation in appendicitis persists, and the results from previous studies are controversial. The aims of this study were to present the effect of in-hospital delay on the risk of perforation in appendicitis and to assess the utility of C-reactive protein (CRP) measurement in detecting the patients with complicated appendicitis. METHODS: Prospectively collected data of 389 adult patients who underwent surgery for acute appendicitis were analyzed in order to find the most accurate method for recognizing the pre-hospital perforations. The effect of in-hospital delay on the further risk of perforation in patients with not yet perforated acute appendicitis was then analyzed. RESULTS: Out of 389 patients with appendicitis, 91 patients (23.4 %) had complicated appendicitis, 23 with abscess, and 68 with free perforation. Admission CRP level of 99 mg/l or higher was 90.3 % specific for complicated appendicitis. In patients with admission CRP less than 99 mg/l, the incidence of perforation doubled from 9.5 to 18.9 % when the in-hospital delay increased from less than 6 h to more than 12 h. CONCLUSIONS: Complicated appendicitis can be identified with a high CRP level on admission. Delaying surgery can increase the risk of perforation.
Authors: Angela S Earley; John P Pryor; Patrick K Kim; Joseph H Hedrick; Jibby E Kurichi; Amy C Minogue; Seema S Sonnad; Patrick M Reilly; C W Schwab Journal: Ann Surg Date: 2006-10 Impact factor: 12.969
Authors: Augusto Zani; Warwick J Teague; Simon A Clarke; Munther J Haddad; Sanjeev Khurana; Thomas Tsang; Ramesh M Nataraja Journal: Pediatr Surg Int Date: 2017-04-29 Impact factor: 1.827