Institutional members access full text with Ovid®

Share this article on:

Safety of Short, In-Hospital Delays Before Surgery for Acute Appendicitis: Multicentre Cohort Study, Systematic Review, and Meta-Analysis

The United Kingdom National Surgical Research Collaborative

doi: 10.1097/SLA.0000000000000492
Meta-Analysis

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.

Supplemental Digital Content is Available in the Text.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 adequate facilities and personnel allow, prompt appendicectomy stills remains the optimal treatment for patients.

From the West Midlands Research Collaborative, Academic Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.

Reprints: Aneel Bhangu, MBChB, MRCS, West Midlands Research Collaborative, Academic Department of Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH, UK. E-mail: aneelbhangu@doctors.org.uk.

The National Surgical Research Collaborative members are shown at the Acknowledgment section.

Disclosure: No funding was received for this study, and the authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2014 by Lippincott Williams & Wilkins.