Timing of Surgery and Complications of Acute Appendicitis: A Retrospective Study

Abstract

Introduction: Acute appendicitis (AA) is the most frequent surgical condition of the abdomen during childhood. Its clinical presentation in children under 5 may be atypical and thus causes a delay in diagnosis, which often leads to complications such as perforation and peritonitis. Patients with unperforated AA at hospital admission may have their surgery postponed up to 24 hours while antibiotics are initiated without significant increase in complications, instead of undergoing immediate surgery. Immediate surgery to prevent complications has been questioned. Delaying surgery in patients admitted to hospital with AA has not increased the risk of perforation. Objective: To determine the impact of timing of surgery of patients with AA admitted to our Pediatric Surgery Ward of the Sorocaba Hospital Complex of the Medical Science and Health Faculty (CHS-PUC/SP) on the rate of complications (perforation, peritoneal drainage and infection of the surgical wound). Methods: We reviewed the records of 195 children aged 4 to 12 years, admitted between 2010 and 2014. They were separated in 2 groups according to timing of surgery under 7 hours (group A) and 7 to 24 hours (group B) and had their rate of complications (infection of the surgical wound, drainage and perforation (grade IV) assessed. Results: Ninety-seven children underwent surgery less than 7 hours after admission (group A) and 98 children were operated between 7 and 24 hours after admission (group B). Groups A and B had no significant difference regarding the rates of wound infection (p = 0.2277), peritoneal drain insertion (p = 0.4085) or perforation (p = 0.7125). Conclusions: In our study, timing of surgery for AA had no impact on the occurrence of complications, such as infection of the surgical wound, peritoneal drainage or perforation.