Prompt appendectomy has always been a standard of care because of the risk of progression in pathology. This time honored practice has been recently challenged by studies, suggesting that appendicitis can be operated on electively. The aim of this study is to examine whether delayed intervention in acute appendicitis is safe by correlating the interval from presentation to operation with the operative and postoperative complications. Retrospective review of patients who underwent appendectomy for acute appendicitis in 2009 was done. The following parameters were recorded: demographics, duration from presentation to evaluation by emergency room attending, performing CT scan, surgical consult, and operation. The pathology, post operative complications, and length of stay were also recorded. Patients were divided into two groups: incision time < 10 hours (early group) and incision time > 10 hours (delayed group). The end points chosen for comparison were: 1) laparoscopic to open conversion rate, 2) complications, 3) readmissions, and 4) length of stay. Number of cases totaled 201, with 76 in the < 10 hours group and 125 in the > 10 hours group. The male to female ratio for the < 10 hours group was 54:22 and for the > 10 hours group was 59:66 ( P < 0.001). Length of stay for the early group was 75.52 hours and for the delayed group, 89.15 hours ( P = 0.04). There was one intra-abdominal abscess in the early group and 10 in the delayed group ( P = 0.04). The early group had 0.2 (2.6%) open conversions, and the delayed group had five (4.1%) conversions ( P = 0.58). There were six (4.8%) readmissions in the delayed group and none in the early group ( P = 0.05). Our study reveals that the complication rate, length of stay, and readmissions are more in the delayed group. Conversion rate was more in the delayed group, but the difference was not significant. We conclude that early surgical intervention is beneficial in acute appendicitis.

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group ( P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant ( P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

HighlightsVery sparse literature exists that describe the clinical profile of primary MZL of breast.Radiotherapy alone might cure an indolent lymphoma localized to breast (i.e. stage IE).5-yr survival rates of surgery are inferior to radiotherapy and chemo-radiation.Greater appreciation of the lesser role of surgery is warranted.