Abstract
Abstract Introduction: Historically, surgery without delay was the standard of treatment for acute appendicitis. This has been challenged by studies focussing on defining a safe time frame for delaying surgery without any increase in morbidity. Methods: A single-center, retrospective, two-year descriptive cohort study was undertaken at a regional hospital. This study examined the effect of pre- and in-hospital delay on the outcomes of patients with clinically acute unperforated appendicitis. Descriptive statistics described the patient population, pre- and in-hospital delay, and surgical outcomes, namely, severity of appendicitis, morbidity, and length of hospital stay. Results: A total of 103 patients were included in this study. The median age was 25 years (IQR 21-33), and 60 (58%) were male. The median pre-hospital delay was 48 hours (IQR 24-72), and the in-hospital delay was 16.1 hours (IQR 9.5-22.5). Pre-hospital delay rather than in-hospital delay was associated with findings of suppurative/ gangrenous appendicitis at surgery (p = 0.032), more likely to develop post-operative complications (p = 0.002) and have more extended hospital stays (median 4 days (IQR 3-6). Age (aRR 1.34 (95% CI [0.99, 1.80]) and white cell count (aRR 1.55 (95% CI [1.09, 2.20]) independently predicted adverse outcomes. Conclusion: A safe time frame for delaying appendicectomies could not be determined. However, patients older than 25 years, with a pre-hospital delay of > 2 days and a white cell count of ≥ 11 cells/ul on presentation, should be fast-tracked for surgery.
Published Version
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