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Arch Surg. 2010 Sep;145(9):886-92. doi: 10.1001/archsurg.2010.184.

Effect of delay to operation on outcomes in adults with acute appendicitis.

Author information

1
Division of Research and Optimal Patient Care, American College of Surgeons, 633 N St Clair Street, Chicago, IL 60611. aingraham@facs.org

Abstract

OBJECTIVE:

To examine the effect of delay from surgical admission to induction of anesthesia on outcomes after appendectomy for acute appendicitis in adults.

DESIGN:

Retrospective cohort study with the principal exposure being time to operation. Regression models yielded probabilities of outcomes adjusted for patient and operative risk factors.

SETTING:

Data were submitted to the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, through December 31, 2008.

PATIENTS:

Patients with acute appendicitis who underwent an appendectomy.

MAIN OUTCOME MEASURES:

Thirty-day overall morbidity and serious morbidity/mortality.

RESULTS:

Of 32,782 patients, 24,647 (75.2%) underwent operations within 6 hours of surgical admission, 4934 (15.1%) underwent operations more than 6 through 12 hours, and 3201 (9.8%) underwent operations more than 12 hours after surgical admission. Differences in operative duration (51, 50, and 55 minutes, respectively; P < .001) were statistically significant but not clinically meaningful. The length of postoperative stay (2.2 days for the >12-hour group vs 1.8 days for the remaining groups; P < .001) was statistically significant but not clinically meaningful. No significant differences were found in adjusted overall morbidity (5.5%, 5.4%, and 6.1%, respectively; P = .33) or serious morbidity/mortality (3.0%, 3.6%, and 3.0%, respectively; P = .17). Duration from surgical admission to induction of anesthesia was not predictive in regression models for overall morbidity or serious morbidity/mortality.

CONCLUSIONS:

In this retrospective study, delay of appendectomy for acute appendicitis in adults does not appear to adversely affect 30-day outcomes. This information can guide the use of potentially limited operative and professional resources allocated for emergency care.

Comment in

PMID:
20855760
DOI:
10.1001/archsurg.2010.184
[Indexed for MEDLINE]

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