Background The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial. Methods A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (B12 vs. [12 h). Results Delay [ 12 h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P = 0.010) whereas a delay of 6 or 9 h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (B65 years vs. [65 years, odds ratio (OR) 4.5, P \ 0.001); co-morbidity (Charlson index [ 0 vs. Charlson index = 0, OR 2.3, P \ 0.001); time of admission (after hours vs. regular hours, OR 0.8, P = 0.040), in-hospital delay ([12 vs. B12 h, OR 1.5, P = 0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P \ 0.001) and longer length of hospital stay (9.5 vs. 4.4 days; P \ 0.001).Conclusions In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12 h, age over 65 years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay.

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system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTSData on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively ( P < 0.001). CONCLUSIONSThe results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.

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