S. Tiboni, A. Bhangu, N. J. Hall; British Journal of Surgery 2014

 

  1. S. Tiboni, A. Bhangu, N. J. Hall* and on behalf of the Paediatric Surgery Trainees Research Network and the National Surgical Research Collaborative.   Article first published online: 2 APR 2014

Collaborator: P. Szatmary (East Cheshire NHS Trust)

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Szatmary, P, et al; Annals of Surgery, May 2014,

Safety of short, in-hospital delays before surgery for acute appendicitis: Multicentre cohort study, systematic review, and meta-analysis

Citation: Annals of Surgery, May 2014, vol./is. 259/5(894-903), 0003-4932;1528-1140 (May 2014)

Author(s): Bhangu A.; Panagiotopoulou I.G.; Chatzizacharias N.; Rana M.; Rollins K.; Ejtehadi F.; Jha B.; Tan Y.W.; Fanous N.; Markides G.; Tan A.; Marshal C.; Akhtar S.; Mullassery D.;  P. Szatmary (East Cheshire NHS Trust, Macclesfield);

OBJECTIVE:  To determine safety of short in-hospital delays before appendicectomy.   BACKGROUND:   Short organizational delays before appendicectomy may safely improve provision of acute surgical services.

METHODS: The primary endpoint was the rate of complex appendicitis (perforation, gangrene, and/or abscess). The main explanatory variable was timing of surgery, using less than 12 hours from admission as the reference. The first part of this study analyzed primary data from a multicentre study on appendicectomy from 95 centers. The second part combined this data with a systematic review and meta-analysis of published data.

RESULTS: The cohort study included 2510 patients with acute appendicitis, of whom 812 (32.4%) had complex findings. Adjusted multivariable binary regression modelling showed that timing of operation was not related to risk of complex appendicitis [12-24 hours odds ratio (OR) 0.98 (P = 0.869); 24-48 hours OR 0.88 (P = 0.329); 48+ hours OR 0.82 (P = 0.317)]. However, after 48 hours, the risk of surgical site infection and 30-day adverse events both increased [adjusted ORs 2.24 (P = 0.039) and 1.71 (P = 0.024), respectively]. Meta-analysis of 11 nonrandomized studies (8858 patients) revealed that delay of 12 to 24 hours after admission did not increase the risk of complex appendicitis (OR 0.97, P = 0.750).

CONCLUSIONS: Short delays of less than 24 hours before appendicectomy were not associated with increased rates of complex pathology in selected patients. These organizational delays may aid service provision, but planned delay beyond this should be avoided. However, where optimal surgical systems allow for expeditious surgery, prompt appendicectomy will still aid fastest resolution of pain for the individual patient.

Copyright 2014 by Lippincott Williams & Wilkins.
Publication Type: Journal: Article
Source: EMBASE
Full Text: Available from Ovid in Annals of Surgery

Impact of the Increased Use of Preoperative Imaging and Laparoscopy on Appendicectomy Outcomes

Abstract

The diagnosis of appendicitis is based on clinical picture. The aim of this retrospective study was to analyse variation of outcomes and impact of increasing use of radiological investigations and laparoscopy over a 5-year period. A retrospective audit of appendicectomies over the last 5 years (01 January 2007–31 December 2011) was conducted. The negative appendicectomy rate (NAR), perforation rate and complication rate were used as outcome endpoints. A statistical analysis was performed to evaluate the difference in outcomes with surgical approach and use of radiology. One thousand fifty-five appendicectomies were performed in this period. The NAR was 22.65 % (21 % for open and 28 % for laparoscopic) and perforation rate was 14 %. There was no statistically significant difference in NAR with the use of ultrasound (P 0.3814) but there was a significant reduction in NAR with the use of computed tomography (CT) (P <0.0001). Intra-abdominal abscess (2.3 %) and wound infection (1.4 %) were the common complications with the former being higher with laparoscopy and the latter with open appendicectomy. Over 5 years, there were no significant changes in appendicectomy outcomes. The impact of diagnostic imaging on NAR varies with age, gender and the use of CT. CT can significantly reduce the negative appendicectomy rate in equivocal presentations. Complication rates vary with surgical approach.