Appendectomy: Should it be Performed So Quickly?
Controversy surrounds appendectomy timings and their effects on postoperative outcomes. This study evaluated the influence of hospital delays on perforation rates and complications in patients with acute appendicitis. From January 2008 to December 2013, the cases of 4148 consecutive patients who had...
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| Veröffentlicht in: | The American surgeon 2016-01, Vol.82 (1), p.65-74 |
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| creator | Jeon, Byeong Geon Kim, Hyuk Jung Jung, Kuk Hyun Lim, Hye In Kim, Sang Wook Park, Jin Soo Kim, Ki Ho Kim, Il Dong |
| description | Controversy surrounds appendectomy timings and their effects on postoperative outcomes. This study evaluated the influence of hospital delays on perforation rates and complications in patients with acute appendicitis. From January 2008 to December 2013, the cases of 4148 consecutive patients who had undergone appendectomies for suspected appendicitis were reviewed. The patients’ demographic data, times from symptom onset to hospital arrival (prehospital delay), times from hospital arrival to surgery (hospital delay), histological findings, and postoperative outcomes were documented. Perforation rates and complications were assessed at each time interval between symptom onset and surgery. Perforation rates and complications increased with longer prehospital delays, but no correlations were evident between hospital delays and perforation rates or between hospital delays and complications. Although delaying appendectomies for >18 hours had no statistically significant impact on perforation rates (25.3 vs 19.4%, P = 0.133), it caused more complications (8.7 vs 3.8%, P = 0.023) compared with cases delayed for 12 to 18 hours. Multivariate analyses determined that hospital delays were not associated with increased risks of perforation, complications, wound infections, or intra-abdominal abscesses. However, a >18-hour hospital delay was associated with a significantly increased risk of postoperative ileus (odds ratio = 2.94, 95% confidence interval = 1.17–7.41, P = 0.022). Hospital delays were not associated with significantly increased risks of perforation and complications. However, patients with perforated appendicitis had higher risks of developing postoperative ileus if hospital delays were >18 hours. Therefore, hospital delays of ≤18 hours are safe, but caution is required if delays are >18 hours. |
| doi_str_mv | 10.1177/000313481608200126 |
| format | Article |
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This study evaluated the influence of hospital delays on perforation rates and complications in patients with acute appendicitis. From January 2008 to December 2013, the cases of 4148 consecutive patients who had undergone appendectomies for suspected appendicitis were reviewed. The patients’ demographic data, times from symptom onset to hospital arrival (prehospital delay), times from hospital arrival to surgery (hospital delay), histological findings, and postoperative outcomes were documented. Perforation rates and complications were assessed at each time interval between symptom onset and surgery. Perforation rates and complications increased with longer prehospital delays, but no correlations were evident between hospital delays and perforation rates or between hospital delays and complications. Although delaying appendectomies for >18 hours had no statistically significant impact on perforation rates (25.3 vs 19.4%, P = 0.133), it caused more complications (8.7 vs 3.8%, P = 0.023) compared with cases delayed for 12 to 18 hours. Multivariate analyses determined that hospital delays were not associated with increased risks of perforation, complications, wound infections, or intra-abdominal abscesses. However, a >18-hour hospital delay was associated with a significantly increased risk of postoperative ileus (odds ratio = 2.94, 95% confidence interval = 1.17–7.41, P = 0.022). Hospital delays were not associated with significantly increased risks of perforation and complications. However, patients with perforated appendicitis had higher risks of developing postoperative ileus if hospital delays were >18 hours. Therefore, hospital delays of ≤18 hours are safe, but caution is required if delays are >18 hours.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481608200126</identifier><identifier>PMID: 26802860</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Abdomen ; Adolescent ; Adult ; Analysis of Variance ; Appendectomy - adverse effects ; Appendectomy - methods ; Appendicitis ; Appendicitis - diagnosis ; Appendicitis - surgery ; Confidence intervals ; Databases, Factual ; Emergency medical care ; Emergency Treatment - methods ; Female ; Hospitals ; Humans ; Infections ; Laboratories ; Length of Stay ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Prognosis ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Studies ; Surgery ; Time-to-Treatment ; Treatment Outcome ; Young Adult</subject><ispartof>The American surgeon, 2016-01, Vol.82 (1), p.65-74</ispartof><rights>2016 Southeastern Surgical Congress</rights><rights>Copyright Southeastern Surgical Congress Jan 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-c8146a5b5239057679d765fe86a6efb31658833e18a21013a32e39ef14f911e23</citedby><cites>FETCH-LOGICAL-c415t-c8146a5b5239057679d765fe86a6efb31658833e18a21013a32e39ef14f911e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/000313481608200126$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/000313481608200126$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21799,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26802860$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeon, Byeong Geon</creatorcontrib><creatorcontrib>Kim, Hyuk Jung</creatorcontrib><creatorcontrib>Jung, Kuk Hyun</creatorcontrib><creatorcontrib>Lim, Hye In</creatorcontrib><creatorcontrib>Kim, Sang Wook</creatorcontrib><creatorcontrib>Park, Jin Soo</creatorcontrib><creatorcontrib>Kim, Ki Ho</creatorcontrib><creatorcontrib>Kim, Il Dong</creatorcontrib><title>Appendectomy: Should it be Performed So Quickly?</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Controversy surrounds appendectomy timings and their effects on postoperative outcomes. This study evaluated the influence of hospital delays on perforation rates and complications in patients with acute appendicitis. From January 2008 to December 2013, the cases of 4148 consecutive patients who had undergone appendectomies for suspected appendicitis were reviewed. The patients’ demographic data, times from symptom onset to hospital arrival (prehospital delay), times from hospital arrival to surgery (hospital delay), histological findings, and postoperative outcomes were documented. Perforation rates and complications were assessed at each time interval between symptom onset and surgery. Perforation rates and complications increased with longer prehospital delays, but no correlations were evident between hospital delays and perforation rates or between hospital delays and complications. Although delaying appendectomies for >18 hours had no statistically significant impact on perforation rates (25.3 vs 19.4%, P = 0.133), it caused more complications (8.7 vs 3.8%, P = 0.023) compared with cases delayed for 12 to 18 hours. Multivariate analyses determined that hospital delays were not associated with increased risks of perforation, complications, wound infections, or intra-abdominal abscesses. However, a >18-hour hospital delay was associated with a significantly increased risk of postoperative ileus (odds ratio = 2.94, 95% confidence interval = 1.17–7.41, P = 0.022). Hospital delays were not associated with significantly increased risks of perforation and complications. However, patients with perforated appendicitis had higher risks of developing postoperative ileus if hospital delays were >18 hours. Therefore, hospital delays of ≤18 hours are safe, but caution is required if delays are >18 hours.</description><subject>Abdomen</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Analysis of Variance</subject><subject>Appendectomy - adverse effects</subject><subject>Appendectomy - methods</subject><subject>Appendicitis</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - surgery</subject><subject>Confidence intervals</subject><subject>Databases, Factual</subject><subject>Emergency medical care</subject><subject>Emergency Treatment - methods</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Laboratories</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Prognosis</subject><subject>Republic of Korea</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Surgery</subject><subject>Time-to-Treatment</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp10M9LwzAUB_AgipvTf8CDFLzsUpeXNGnqRcbwFwxUpueStq_a2S41aQ_7783YFFE8hQef933hS8gp0AuAOJ5QSjnwSIGkilEKTO6RIQghwkQxvk-GGxBuxIAcObf0YyQFHJIBk4oyJemQ0Gnb4qrAvDPN-jJYvJm-LoKqCzIMHtGWxjZYBAsTPPVV_l6vr47JQalrhye7d0Rebq6fZ3fh_OH2fjadh3kEogtzBZHUIhOMJ1TEMk6KWIoSldQSy4yDFEpxjqA0Awpcc4Y8wRKiMgFAxkdkvM1trfno0XVpU7kc61qv0PQuhVjSBFiipKfnv-jS9Hblf-eViiJJuRJesa3KrXHOYpm2tmq0XadA002f6d8-_dLZLrrPfBHfK18FejDZAqdf8cfd_yM_AViceOM</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>Jeon, Byeong Geon</creator><creator>Kim, Hyuk Jung</creator><creator>Jung, Kuk Hyun</creator><creator>Lim, Hye In</creator><creator>Kim, Sang Wook</creator><creator>Park, Jin Soo</creator><creator>Kim, Ki Ho</creator><creator>Kim, Il Dong</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>201601</creationdate><title>Appendectomy: Should it be Performed So Quickly?</title><author>Jeon, Byeong Geon ; Kim, Hyuk Jung ; Jung, Kuk Hyun ; Lim, Hye In ; Kim, Sang Wook ; Park, Jin Soo ; Kim, Ki Ho ; Kim, Il Dong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-c8146a5b5239057679d765fe86a6efb31658833e18a21013a32e39ef14f911e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdomen</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Analysis of Variance</topic><topic>Appendectomy - adverse effects</topic><topic>Appendectomy - methods</topic><topic>Appendicitis</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - surgery</topic><topic>Confidence intervals</topic><topic>Databases, Factual</topic><topic>Emergency medical care</topic><topic>Emergency Treatment - methods</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Laboratories</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Prognosis</topic><topic>Republic of Korea</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Surgery</topic><topic>Time-to-Treatment</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeon, Byeong Geon</creatorcontrib><creatorcontrib>Kim, Hyuk Jung</creatorcontrib><creatorcontrib>Jung, Kuk Hyun</creatorcontrib><creatorcontrib>Lim, Hye In</creatorcontrib><creatorcontrib>Kim, Sang Wook</creatorcontrib><creatorcontrib>Park, Jin Soo</creatorcontrib><creatorcontrib>Kim, Ki Ho</creatorcontrib><creatorcontrib>Kim, Il Dong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeon, Byeong Geon</au><au>Kim, Hyuk Jung</au><au>Jung, Kuk Hyun</au><au>Lim, Hye In</au><au>Kim, Sang Wook</au><au>Park, Jin Soo</au><au>Kim, Ki Ho</au><au>Kim, Il Dong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Appendectomy: Should it be Performed So Quickly?</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2016-01</date><risdate>2016</risdate><volume>82</volume><issue>1</issue><spage>65</spage><epage>74</epage><pages>65-74</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Controversy surrounds appendectomy timings and their effects on postoperative outcomes. This study evaluated the influence of hospital delays on perforation rates and complications in patients with acute appendicitis. From January 2008 to December 2013, the cases of 4148 consecutive patients who had undergone appendectomies for suspected appendicitis were reviewed. The patients’ demographic data, times from symptom onset to hospital arrival (prehospital delay), times from hospital arrival to surgery (hospital delay), histological findings, and postoperative outcomes were documented. Perforation rates and complications were assessed at each time interval between symptom onset and surgery. Perforation rates and complications increased with longer prehospital delays, but no correlations were evident between hospital delays and perforation rates or between hospital delays and complications. Although delaying appendectomies for >18 hours had no statistically significant impact on perforation rates (25.3 vs 19.4%, P = 0.133), it caused more complications (8.7 vs 3.8%, P = 0.023) compared with cases delayed for 12 to 18 hours. Multivariate analyses determined that hospital delays were not associated with increased risks of perforation, complications, wound infections, or intra-abdominal abscesses. However, a >18-hour hospital delay was associated with a significantly increased risk of postoperative ileus (odds ratio = 2.94, 95% confidence interval = 1.17–7.41, P = 0.022). Hospital delays were not associated with significantly increased risks of perforation and complications. However, patients with perforated appendicitis had higher risks of developing postoperative ileus if hospital delays were >18 hours. Therefore, hospital delays of ≤18 hours are safe, but caution is required if delays are >18 hours.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>26802860</pmid><doi>10.1177/000313481608200126</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Adolescent Adult Analysis of Variance Appendectomy - adverse effects Appendectomy - methods Appendicitis Appendicitis - diagnosis Appendicitis - surgery Confidence intervals Databases, Factual Emergency medical care Emergency Treatment - methods Female Hospitals Humans Infections Laboratories Length of Stay Male Middle Aged Multivariate Analysis Postoperative Complications - epidemiology Postoperative Complications - physiopathology Prognosis Republic of Korea Retrospective Studies Risk Assessment Severity of Illness Index Studies Surgery Time-to-Treatment Treatment Outcome Young Adult |
| title | Appendectomy: Should it be Performed So Quickly? |
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