Risk of perforation increases with delay in recognition and surgery for acute appendicitis

Abstract

Background Appendicitis remains a common indication for urgent surgical intervention in the United States, and early appendectomy has long been advocated to mitigate the risk of appendiceal perforation. To better quantify the risk of perforation associated with delayed operative timing, this study examines the impact of length of inpatient stay preceding surgery on rates of perforated appendicitis in both adults and children. Methods This study was a cross-sectional analysis using the National Inpatient Sample and Kids’ Inpatient Database from 1988–2008. We selected patients with a discharge diagnosis of acute appendicitis (perforated or nonperforated) and receiving appendectomy within 7 d after admission. Patients electively admitted or receiving drainage procedures before appendectomy were excluded. We analyzed perforation rates as a function of both age and length of inpatient hospitalization before appendectomy. Results Of 683,590 patients with a discharge diagnosis of appendicitis, 30.3% were recorded as perforated. Over 80% of patients underwent appendectomy on the day of admission, approximately 18% of operations were performed on hospital days 2–4, and later operations accounted for <1% of cases. During appendectomy on the day of admission, the perforation rate was 28.8%; this increased to 33.3% for surgeries on hospital day 2 and 78.8% by hospital day 8 (P < 0.001). Adjusted for patient, procedure, and hospital characteristics, odds of perforation increased from 1.20 for adults and 1.08 for children on hospital day 2 to 4.76 for adults and 15.42 for children by hospital day 8 (P < 0.001). Conclusions Greater inpatient delay before appendectomy is associated with increased perforation rates for children and adults within this population-based study. These findings align with previous studies and with the conventional progressive pathophysiologic appendicitis model. Randomized prospective studies are needed to determine which patients benefit from nonoperative versus surgically aggressive management strategies for acute appendicitis.

Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound

“…While there is some evidence that delays in diagnosis and treatment make little difference in outcomes, [4][5][6] some studies suggest treatment delays lead to increased rates of perforation, 7 and treatment delayed for more than 36 hours may lead to a perforation rate as high as 65%. 8 To improve diagnostic accuracy, imaging studies have been used with increasing frequency; 9 however, significant limitations such as the ionizing radiation associated with computed tomography (CT) and reduced off-hours availability with ultrasound (US) exist.…”

Incidence, Risk Factors and Complications of Acute Perforated and Non - Perforated Appendicitis in a Rural Setup of Andhra Pradesh

“…9.10 Furthermore the overall rate of complication like sepsis leading to ICU care, urinary and respiratory complications and mortality due to complication was higher in the perforated appendicitis cases. 11,12 CONCLUSION: Incidence of perforated and non-perforated appendicitis in our hospital was 15% and 85% respectively. Incidence of Non-perforated appendices was common in the age group between 30 -40 years.…”

Laparoscopic Appendectomy as Main Therapeutic Option of Appendicitis

“…Delayed surgery usually prolonged the hospital length of stay [10]. There was a 2-fold increase in complication rate for patients delayed longer than 48 hours [11] or greater inpatient delay is associated with increased perforation rates [12]. Some researchers reported that 55 years was the only predictor for perforation or postoperative complications [13].…”