Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study

Salma Abu Foul,Ella Egozi,Ahmad Mahajna,Yoram Kluger,Ahmad Assalia

doi:10.1186/s13017-018-0221-2

Salma Abu Foul, Ella Egozi + Show 3 more

Open Access

https://doi.org/10.1186/s13017-018-0221-2

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Abstract

IntroductionPrompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality. Our study was designed to examine whether the time from the beginning of symptoms to operation correlates with the pathological degree of appendicitis, incidence of postoperative complications, or increased length of hospital stay.MethodsA prospective study of 171 patients who underwent emergent appendectomy for acute appendicitis in the course of 2 years was conducted in a single tertiary medical center. The following parameters were monitored and correlated: demographics, time from the onset of symptoms until the arrival to the emergency department (patient interval (PI)), time from arrival to the emergency department (ED) until appendectomy (hospital interval (HI)), time from the onset of symptoms until appendectomy (total interval (TI)), physical examination, preoperative physical findings, laboratory data, pathologic findings, complications, and length of hospital stay.ResultsThe degree of pathology and complications were analyzed according to the time intervals. The time elapsed from the onset of symptoms to surgery was associated with higher pathology grade (p = 0.01). We found that longer time from the onset of symptoms to hospital arrival correlates with higher pathology grade (p = 0.04), while there was no correlation between the hospital interval and pathology grade (p = 0.68). A significant correlation was found between the pathology grade and the incidence of postoperative complications as well as with increased length of hospital stay (p = 0.000).ConclusionTime elapsed from the symptom onset to appendectomy correlates with increased pathology grade and complication rate. This correlation was not related to the HI. Since the HI in our study was short, we recommend an early appendectomy in adults in order to shorten the TI and the resulting complications.

Highlights

Prompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality
The aim of this study is to determine the relationship between the time of the symptom onset to surgery (patient interval (PI) and hospital interval (HI)) in regard to pathological severity, complications, and hospital stay in patients with acute appendicitis
Exclusion criteria included patients younger than 16 years, patients who could not recollect the exact timing of symptom onset, and patients who had no appendicitis in the pathology examination

Summary

Introduction

Prompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality. Acute appendicitis is one of the most common surgical emergencies encountered in the ED This condition may be associated with complications and significant rise in morbidity and even mortality if diagnosis and treatment are delayed [1]. Despite the fact that conservative treatment with antibiotics has been shown to be safe in adults, laparoscopic appendectomy remains the standard of care for acute appendicitis in adults [11–13]. This operation is frequently done by junior staff and can be performed in selected cases as an ambulatory surgery [14, 15].

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