Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night?

Yardeni, Dani; Hirschl, Ronald B.; Drongowski, Robert A.; Teitelbaum, Daniel H.; Geiger, James D.; Coran, Arnold G.

doi:10.1016/j.jpedsurg.2003.11.020

Cited by 211 publications

(164 citation statements)

References 16 publications

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“…Active observation of patients with suspected appendicitis has been shown over decades to be a safe and effective method without increasing the risk of perforation and minimizing negative appendectomies. 28,[45][46][47][48] None of the study patients developed perforation while in hospital, which has been previously shown by others. 49,50 Despite previously reported inverse association between the use of diagnostic US and negative appendectomy rate in children, 26,51,52 this pathway was associated with a higher negative appendectomy rate than that reported in the two key U.S.-wide studies by Bachur and colleagues and other authors.…”

Section: Discussionmentioning

confidence: 57%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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Objectives: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US.Methods: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies.Results: Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. Conclusions:The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans.

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Section: Discussionmentioning

confidence: 57%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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“…4 Kim SH et al, studied 1805 patients over a period of 5 years and found that delayed appendicectomy is safe in acute non-perforated appendicitis. 5 Omundsen and Dennett found that surgery for acute appendicitis up to 24 hours does not lead to an increase in morbidity but when exceeds 24 hours, the morbidity and complications increases.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,[4][5][6] This is review of 283 cases of acute appendicitis undergoing appendicectomy from January 2016 to December 2016 to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed being taken up on elective basis.…”

mentioning

confidence: 99%

Delayed appendicectomy in patients with non-perforated acute appendicitis

et al. 2017

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Background: Appendicitis remains one of the most common diseases encountered by the surgeon in practice. Appendicectomy is the most common urgent or emergency general surgical operation performed. Emergency appendicectomy is believed to be the standard treatment protocol for patients with acute appendicitis. This study was conducted to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed to be taken up on elective basis.Methods: This is a retrospective study of all the cases undergoing appendicectomy for acute appendicitis over the period of January 2016 to December 2016 in K. R. hospital, Mysuru, Karnataka, India. The cases were divided into two comparison groups: emergency group (operated within 12 hours of admission) and delayed group (operated between 12-72 hours). Parameters like age, sex, duration of symptoms, total leucocytes count, temperature, haemoglobin, radiological investigations, operative procedure, operative time, length of hospital stay, length of post-operative stay were collected and the end points for comparison were: Operative time, perforation rate, post-operative complication, length of hospital stay, readmission rate. Cases of perforated appendicitis in preoperative diagnosis, interval appendicectomy and appendicectomy done in association with other abdominal conditions were excluded from the study.Results: During this one-year period 283 patients have undergone appendicectomy. Out of this 189 (66.8%) patients have undergone surgery within 12 hours of admission and 94 (33.2%) have undergone surgery between 12 to 72 hours of admission. There was no significant difference between the two groups in operative time, per operative perforation rate, post-operative complication rate, readmission rate. Length of the hospital stay was greater in delayed group as compared to emergency group. But there was no significant difference between the post-operative length of hospital stay.Conclusions: Acute appendicitis can be treated surgically in a delayed elective basis without increasing morbidity.

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“…This can be uncomfortable for patients and leads to delays in test acquisition and subsequent diagnosis. 10 While there is some evidence that delays in diagnosis and treatment make little difference to clinically important outcomes, [10][11][12][13] other studies suggest treatment delays may lead to increased rates of perforation. 14 Our objective was to determine the value of bladder filling prior to pelvic US in children with suspected appendicitis.…”

Section: Introductionmentioning

confidence: 99%

The Effect of a Full Bladder on Proportions of Diagnostic Ultrasound Studies in Children with Suspected Appendicitis

Ross

Selby

Poonai

et al. 2016

CJEM

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Objectives: We examined the effect of a full bladder on proportions of diagnostic ultrasound (US) studies in children with suspected appendicitis. We also examined the effect of a full bladder on proportions of fully visualized ovaries on US in children with suspected appendicitis. Methods: We conducted a retrospective health record review of children aged 2-17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis who had an ultrasound performed. We compared proportions of diagnostic US studies in children with full and sub-optimally filled bladders. We also compared proportions of ovarian visualization in females with full and sub-optimally filled bladders. Results: 678 children were included in our final analysis. The proportion of diagnostic US studies did not vary significantly between groups with a full (132/283, 47%, 95% confidence interval [CI] 38%-56%) or sub-optimally filled bladder (205/ 395, 52%, 95% CI 47%-57%) (p = 0.17). Rates of ovarian visualization were higher in females with a full bladder (196/ 205, 96%, 95% CI 93%-99%) compared to those with a suboptimally filled bladder (180/223, 81%, 95% CI 76%-86%) (p < 0.01). Conclusions: Administrators and clinical decision makers should consider removing routine bladder filling practice from current pediatric appendicitis protocols in males and in pre-pubertal females where ovarian pathology is not suspected. Selective bladder filling prior to US should be performed in females when ovarian pathology is suspected. Conclusions: Les gestionnaires et les décideurs en matière de pratiques cliniques devraient envisager le retrait du remplissage systématique de la vessie, des protocoles actuels de traitement de l'appendicite, chez les garçons et chez les filles prépubères ainsi que chez les filles chez qui tout doute d'affection des ovaires est écarté. Par contre, on devrait procéder à un remplissage sélectif de la vessie avant une échographie chez les filles chez qui il y a des doutes quant à l'existence d'une affection des ovaires.

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Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night?

Cited by 211 publications

References 16 publications

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Delayed appendicectomy in patients with non-perforated acute appendicitis

The Effect of a Full Bladder on Proportions of Diagnostic Ultrasound Studies in Children with Suspected Appendicitis

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