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Time to or Does Not Effect Outcomes in Acute Uncomplicated Appendicitis
Jill Smolevitz*, John Kubasiak, Benjamin Veenstra, Jonathan Myers, Daniel J. Deziel, Minh B. Luu, Keith W. Millikan
Rush University Medical Center, Chicago, IL
Background:
The standard of care for patients with acute uncomplicated appendicitis is immediate operation. However, there is dispute within recent literature regarding this dictum. Some authors demonstrate that delaying surgery results in greater complication rates, while others have shown that there is no increased risk with delay. We aim to examine the correlation between complication rates and time to operative intervention in patients undergoing appendectomy at a single large urban academic medical center.
Methods:
We performed a retrospective chart review using a prospectively collected database of patients undergoing appendectomy by general surgeons at a single academic medical center over a one-year period. We identified patients with acute uncomplicated appendicitis with documentation of duration of symptoms, n = 108. Time was noted in three parts: onset to emergency department (ED) presentation, ED presentation to operating room (OR) and total time of symptoms to OR. Patients were grouped by time: 0-12 hours, 12-24 hours, 24-36, 36+ hours of total duration of symptoms. We identified 12 outcome variables for evaluation: perforation at the time of operation, conversion from laparoscopic to open appendectomy; post-operative superficial surgical site infection, deep surgical site infection or organ space infection; post-operative blood transfusion, sepsis, myocardial infarction (MI), pulmonary embolism (PE), acute renal failure (ARF), pneumonia, and death. The number of outcomes that occurred in each cohort was recorded, and the cohorts were compared to one another in a t-test analysis.
Results:
None of the cohorts demonstrated statistical differences in any of the measured outcomes based on t-test analysis. There were few events in any of the cohorts. Of the 12 post-op outcome variables included, five had events: seven patients were noted to be perforated at the time of operation (average total symptom duration = 35 hours), one patient required conversion to open appendectomy (total symptom duration = 85 hours), one patient had superficial SSI (88 hours), one had deep SSI (22 hours) and one had deep organ space infection (29 hours); none required blood transfusion and no patients experienced MI, PE, ARF, sepsis, pneumonia or death. However, these events were distributed across cohorts; there was no statistically significant difference in the rate of occurrence of these outcomes based on the patients' duration of symptoms.
Conclusion:
Our data demonstrate no significant difference in the outcomes measured between the four cohorts. This data suggests that there may be a longer window for safe resuscitation prior to operative intervention, contradicting previous findings in acute appendicitis. Because the conclusions drawn from this study are derived from retrospective data, a prospective study is required to more strongly validate our results.
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