Itamar Ashkenazi1,2, Abdel-Rauf Zeina3, Oded Olsha4. 1. Hillel Yaffe Medical Center, Hadera, Israel. i_ashkenazi@yahoo.com. 2. General Surgery Department, Rambam Medical Center, HaAliya HaShniya St 8, 3109601, Haifa, Israel. i_ashkenazi@yahoo.com. 3. Radiology Department, Hillel Yaffe Medical Center, Hadera, Israel. 4. General Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Abstract
PURPOSE: Current practice allows for surgery for acute appendicitis to be delayed up to 24 h in the belief that there will be no increase in complicated appendicitis rates. We evaluated the combined effect of Patient Time (between symptom onset and hospital admission) and Hospital Time (between hospital admission and surgery) on the surgical outcome. We hypothesized that in patients with a short Patient Time, increased Hospital Times will be associated with a higher rate of complicated appendicitis, even in patients operated within 24 h. METHODS: Retrospective evaluation of medical files of patients operated for acute appendicitis between 12/2006 and 12/2016. RESULTS: Of 2749 patients with acute appendicitis included in this analysis, 818 (29.8%) were admitted with symptom onset the same day as admission, 577 (21.0%) reported symptom onset had started the previous day but less than 24 h before admission, and 1354 (49.3%) had over 24 h of symptoms. In patients with symptom onset the same day, a gradual increase in the rate of complicated appendicitis was noted with increasing Hospital Times (≤ 6 h-6.3%; 6-12 h-9.9%; 12-18 h-14.7%; and 18-24 h-12.7%; p = 0.017). In all other patients no differences in the rate of complicated appendicitis were noted as long as the patients were operated within 24 h of admission. CONCLUSION: In patients with a short Patient Time, delaying operation is associated with an increased rate of complicated appendicitis and this group of patients should be prioritized for early surgery. CLINICAL TRIALS: Study registered as ClinicalTrials.gov Identifier: NCT04689906 ( https://clinicaltrials.gov/ct2/show/NCT04689906?term=ashkenazi+itamar&draw=2&rank=2 ).
PURPOSE: Current practice allows for surgery for acute appendicitis to be delayed up to 24 h in the belief that there will be no increase in complicated appendicitis rates. We evaluated the combined effect of Patient Time (between symptom onset and hospital admission) and Hospital Time (between hospital admission and surgery) on the surgical outcome. We hypothesized that in patients with a short Patient Time, increased Hospital Times will be associated with a higher rate of complicated appendicitis, even in patients operated within 24 h. METHODS: Retrospective evaluation of medical files of patients operated for acute appendicitis between 12/2006 and 12/2016. RESULTS: Of 2749 patients with acute appendicitis included in this analysis, 818 (29.8%) were admitted with symptom onset the same day as admission, 577 (21.0%) reported symptom onset had started the previous day but less than 24 h before admission, and 1354 (49.3%) had over 24 h of symptoms. In patients with symptom onset the same day, a gradual increase in the rate of complicated appendicitis was noted with increasing Hospital Times (≤ 6 h-6.3%; 6-12 h-9.9%; 12-18 h-14.7%; and 18-24 h-12.7%; p = 0.017). In all other patients no differences in the rate of complicated appendicitis were noted as long as the patients were operated within 24 h of admission. CONCLUSION: In patients with a short Patient Time, delaying operation is associated with an increased rate of complicated appendicitis and this group of patients should be prioritized for early surgery. CLINICAL TRIALS: Study registered as ClinicalTrials.gov Identifier: NCT04689906 ( https://clinicaltrials.gov/ct2/show/NCT04689906?term=ashkenazi+itamar&draw=2&rank=2 ).
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