Early operative management of complicated appendicitis is associated with improved surgical outcomes in adults

Abstract

BackgroundThere is no consensus on the ideal management of complicated appendicitis. MethodsThe New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and undergoing appendectomy within 1-year. Primary outcome was any complication. Secondary outcomes included length of stay (LOS), hospital charges, and laparoscopy use. Outcomes were compared in appendectomy before or after 48h from admission. Results31,167 patients ≥18yo were identified for analysis, 28,015(89.9%) underwent early appendectomy. Early appendectomy patients were more likely to be White (69.8% vs. 64.2% p < 0.01), and commercially insured (53.1% vs. 45.4%, p < 0.01). Of the 3152 undergoing delayed surgery, 1610(51.1%) had surgery later during the index admission, 715(22.7%) were readmitted urgently and underwent appendectomy, and 827(26.2%) had elective appendectomy. Patients undergoing delayed surgery had more complications (OR 1.34 95%CI 1.23–1.45), readmissions (OR 1.55 95%CI 1.42–1.70), high hospital charges (OR 4.79 95%CI 4.35–5.27), and prolonged LOS (OR 6.12 95%CI 5.61–6.68). ConclusionsIn this population-level study of complicated appendicitis we found more complications, longer LOS, and higher charges in patients undergoing delayed surgery.