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Appendectomy delay doesn’t affect short-term outcomes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Whether appendectomy for acute appendicitis is performed within 6 hours or more than 12 hours after admission has no clinically meaningful effect on length of stay or overall 30-day morbidity, according to a study conducted by the American College of Surgeons.

Dr. Angela M. Ingraham, with the American College of Surgeons in Chicago, Illinois, and colleagues report the findings in the September issue of the Archives of Surgery.

The team analyzed data from the ACS’s National Surgical Quality Improvement Program to compare outcomes in 32,782 adult appendectomy patients categorized by time from surgical admission to induction of anesthesia: 6 hours or less, more than 6 hours through 12 hours, and more than 12 hours.

“The duration of operation (55 minutes for the >12-hour group, 51 minutes for the <\= 6-hour group, and 50 minutes for the >6- through 12-hour group; p<.001) was statistically, but not clinically significantly different among the 3 groups,” the team reports. Similarly, length of postoperative stay (2.2 days for the >12-hour group vs 1.8 days for the remaining two groups) was also statistically significantly different but not clinically relevant.

The odds ratios for overall 30-day morbidity, with the 6-hour-or-less group being the referent, were 0.91 in the 6-12-hour group and 1.05 in the >12-hour group.

Furthermore, the adjusted rates of serious morbidity or death in the three groups were 3.0%, 3.6% and 3.0%

“These data might help guide the use of the potentially limited operative and professional resources allocated for emergency surgical care,” the authors conclude. “Such information will contribute to the efficient allocation of limited surgical resources without negatively affecting patient care.”

Arch Surg 2010;145:886-892.