In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children

Almström, Markus; Svensson, Jan F.; Patkova, Barbora; Svenningsson, Anna; Wester, Tomas

doi:10.1097/sla.0000000000001694

Cited by 56 publications

(36 citation statements)

References 23 publications

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“…Two‐thirds of the studies were published in or after 2010. Seven studies analysed only children under the age of 18 years; the other 38 studies analysed adults alone or children and adults combined.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Dijk

Dijkgraaf

et al. 2018

British Journal of Surgery

130

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BackgroundThe traditional fear that every case of acute appendicitis will eventually perforate has led to the generally accepted emergency appendicectomy with minimized delay. However, emergency and thereby sometimes night‐time surgery is associated with several drawbacks, whereas the consequences of surgery after limited delay are unclear. This systematic review aimed to assess in‐hospital delay before surgery as risk factor for complicated appendicitis and postoperative morbidity in patients with acute appendicitis.MethodsPubMed and EMBASE were searched from 1990 to 2016 for studies including patients who underwent appendicectomy for acute appendicitis, reported in two or more predefined time intervals. The primary outcome measure was complicated appendicitis after surgery (perforated or gangrenous appendicitis); other outcomes were postoperative surgical‐site infection and morbidity. Adjusted odds ratios (ORs) were pooled using forest plots if possible. Unadjusted data were pooled using generalized linear mixed models.ResultsForty‐five studies with 152 314 patients were included. Pooled adjusted ORs revealed no significantly higher risk for complicated appendicitis when appendicectomy was delayed for 7–12 or 13–24 h (OR 1·07, 95 per cent c.i. 0·98 to 1·17, and OR 1·09, 0·95 to 1·24, respectively). Meta‐analysis of unadjusted data supported these findings by yielding no increased risk for complicated appendicitis or postoperative complications with a delay of 24–48 h.ConclusionThis meta‐analysis demonstrates that delaying appendicectomy for presumed uncomplicated appendicitis for up to 24 h after admission does not appear to be a risk factor for complicated appendicitis, postoperative surgical‐site infection or morbidity. Delaying appendicectomy for up to 24 h may be an acceptable alternative for patients with no preoperative signs of complicated appendicitis.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Dijk

Dijkgraaf

et al. 2018

British Journal of Surgery

130

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“…26 Our data showed that patients with appendiceal perforation required a significantly longer hospitalization period and a greater number of radiographic imaging procedures during hospitalization. One of the interesting findings of this study is the fact that delayed appendectomy was associated with a significant increase in perforation rates, whereas no such negative effect was observed in the rate of SSI.…”

Section: Discussionmentioning

confidence: 86%

“…The mean age of patients was 33.1±18 and, 41.8±20.7 years 26.4% of the non-perforation group patients and 37.7% of the perforation group patients (p=0.0075). Also, the mean hospital visitto-operation time was 9.2±5.6, 11±6.3 hours, respectively in non-perforation group and perforation group (p<0.0001).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…In addition, a common limitation of previous research was obscurity regarding the timing of appendiceal perforation, especially 'before arrival to hospital' or 'while waiting for surgery in hospital. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] The aim of this study was to investigate the relationship between elapsed time from hospital visit to operation and perforation risk and surgical site infection (SSI) in patients that were radiologically diagnosed with appendicitis with no evidence of perforation at a single medical center.…”

Section: Introductionmentioning

confidence: 99%

“…However, the acceptable in-hospital time before surgical treatment that can minimize complication rates remains controversial. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Many surgeons have stated that appendectomy should be performed without delay, irrespective of the time of day. They emphasize that longer hospital visit-to-operation time increases perforation risk.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between the Hospital Visit-to-Operation Time Interval and the Risk of Appendiceal Perforation and Clinical Outcomes

Park

Lee

2018

J Minim Invasive Surg

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Purpose:The aim of this study was to investigate the relationship between the elapsed time from hospital visit to operation and perforation risk and surgical site infection (SSI). Methods:We conducted a single-center, retrospective cohort study using 986 patients who underwent appendectomy between Jan. 2009, and Dec. 2013. We divided hospital visit-to-operation time into multiple sessions and analyzed the statistical differences in univariate and multivariate analysis.Results: Nine-hundred and ninety-six patients were admitted due to appendicitis and 986 (98%) patients underwent an appendectomy. Perforation occurred in 13.2% (n=130) of these patients. Patients with greater than 12 hours of elapsed time between their visit to hospital and surgery demonstrated a higher perforation rate than those who underwent surgery within 12 hours from their visit to the hospital. Upon logistic regression analysis, appendectomy timing was a predictors of appendiceal perforation (adjusted odds ratio, 1.04; 95% confidence interval, 1.00~1.07; p=0.04). The SSI rate of the patients who underwent appendectomy within 12hrs was lower than those who underwent surgery more after than 12 hrs, but hospital visit-to-operation time was not a statistically significant predicting factor of SSI (adjusted odds ratio, 0.99; 95% confidence interval, 0.93~1.05; p=0.796). Conclusion:A delay more than 12 hrs between the visit to a hospital and surgery was significantly associated with an increased risk of perforation of the appendix. However, it was not associated with an increase in the risk of SSI. Prompt surgical treatment is needed to decrease the risk of perforation.

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Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children—Reply

Rangel

2018

JAMA Pediatr

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Conflict of Interest Disclosures: None reported. 1. Ralston SL. Could this be the last word on hypertonic saline? JAMA Pediatr. 2017;171(8):e171345. 2. Angoulvant F, Bellêttre X, Milcent K, et al; Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) Study Group. Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2017;171(8):e171333. 3. Brooks CG, Harrison WN, Ralston SL. Association between hypertonic saline and hospital length of stay in acute viral bronchiolitis: a reanalysis of 2 meta-analyses.

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In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children

Cited by 56 publications

References 23 publications

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis

Relationship between the Hospital Visit-to-Operation Time Interval and the Risk of Appendiceal Perforation and Clinical Outcomes

Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children—Reply

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