Appendectomy a procedure performed for removing appendix is apparently considered to be a most common emergency surgery in the world. But if this piece of information is to be believed then, it may not be true. According to a recent study, delays of 12 hours or more prior to surgery do not affect 30-day outcomes significantly among patients subjected to appendectomies for acute appendicitis.
The study encompassed 32,782 patients treated at hospitals enrolled in the ACS National Surgical Quality Improvement Program. These participants were made to undergo an appendectomy for acute appendicitis between 2005 and 2008. From a total number of study subjects, 24,647 which formed 75.2 percent were subjected to surgery within six hours of being admitted to the hospital. On the other hand, 4,934 comprising 15.1 percent went through the surgical procedure after more than six to 12 hours and 3,201 representing 9.8 percent after more than 12 hours.
Investigators add, “Appendectomy is the most common emergent surgical procedure performed worldwide, with appendicitis accounting for approximately 1 million hospital days annually. Increased time from onset of symptoms to operative intervention is associated with more advanced disease. Recent developments in imaging and antibiosis have afforded improved preoperative assessment and treatment, allowing for non-operative management of abscesses and phlegmons (diffuse inflammation of the soft or connective tissue due to infection) and potentially limiting the need for immediate operative intervention to halt disease progression.”
At the end of 30 days, Angela M. Ingraham, M.D., M.S., of the American College of Surgeons (ACS), Chicago, and colleagues were seemingly unable to note any adverse variations in complications or deaths between the three groups. Though changes in operation timings for those who waited appeared, but these differences were not clinically relevant. The first group undergoing surgery within six hours displayed operation time of 51 minutes. And while operation time was 50 minutes for patients between six and 12 hours, the third group that waited for more than 12 hours had an operation time of 12 hours and 55 minutes.
Authors elucidate, “Because of the growing issues surrounding access to emergency care and specialist coverage, care for emergency general surgery patients is increasingly the responsibility of acute care surgeons and specialized services, which cover the specialties of trauma, emergency general surgery and critical care. As the elderly population continues to increase, the medical needs of patients presenting for emergency general surgical care will become increasingly complex and will demand additional resources and attention. Because of potentially limited physical and professional staffing resources, an acute care surgeon may need to delay the operation of less critically ill patients to appropriately care for those requiring immediate attention.”
Even differences in length of hospital stay that were observed may not be significant. It appeared that the more than 12-hour group had a hospital stay of 2.2 days, whereas for the other two groups it was 1.8 days. With cases of appendicitis increasing each year, delaying appendectomy can probably be acceptable.
The study is published in the September issue of Archives of Surgery, one of the JAMA/Archives journals.