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Outcome of Delaying Appendectomy More Than 12 Hours


Bahrain Medical Bulletin, Vol. 32, No. 2, June 2010

Outcome of Delaying Appendectomy More Than 12 Hours

Sameer A Softa, MD, FRCSCl* Objective: To assess the outcome of delaying appendectomy more than twelve hours. Design: Retrospective study. Setting: Herra General Hospital, Makkah.

Method: Two hundred and forty-five positive pathological report of acute appendicitis from 10th February to 6th April 2008 were reviewed. The patients were divided into two groups. The early group comprised of patients who had undergone appendectomies within 12 hours of hospital admission. The late group comprised patients who had undergone appendectomies after more than 12 hours of admission. The measure of outcomes, length of stay, operative time, rate of perforation and complications were analyzed.

Result: From 10th February to 6th April 2008, 245 cases of appendectomy were included in the present study, 142 males and 103 females. Their age ranged from 6 to 71 years, an average of 20.59 + 9.89 years and a median of 18 years. Two hundred patients were in the early group (operated within 12 hours of admission) and 45 patients were in late group (operated after 12 hours of admission). We found that there is no difference in age, sex, operative time, rate of perforation and early or late postoperative complications.

Conclusion: This study shows that in simple uncomplicated acute appendicitis, delaying appendectomies for more than 12 hours after hospital admission does not affect the outcome.

Bahrain Med Bull 2010; 32(2):

Acute appendicitis is the most common general surgical condition, patient may present to the emergency room any time during the day or night; it may occur during the night when the surgical personnel and operating room staff are limited. If operating room and the personnel are working for 24 hours, it would be easy to deal with emergency appendicitis at any time. It is difficult for small hospital when the on-call team had to deal with emergencies at night, which might disrupt the regular operating room schedule.

The management of acute appendicitis varies, some studies suggest expeditious surgery and others may question the necessity of appendectomy1-3.

* Assistant Professor and Faculty of Medicine

Umm Al-Qura University

Saudi Arabia

Email: sasofta@uqu.edu.sa

The author supports the school of appendectomy whether delayed or immediate and how much delay could be entertained till the time is convenient for the operating room staff and schedule.

The aim of the study was to see if appendectomy operations can be minimized during night calls, by delaying the operation up to 12 hours without any complication to the patients.

METHOD

Two hundred and forty-five patients had positive pathological report of acute appendicitis from 10th February to 6th April 2008 were reviewed, The patients were divided into two groups. The early group comprised of patients who had undergone appendectomies within 12 hours of hospital admission. The late group comprised of patients who had undergone appendectomies after more than 12 hours of admission. Herra General Hospital does not admit children; therefore, all patient population in this study were over 12 years old.

The Following Outcome Measures were Assessed:

  • Length of stay
  • Operative time
  • Rate of perforation
  • Complications

RESULT

From 10th February to 6th April 2008, 245 cases of appendectomy were included in the present study. The criteria of inclusion is positive pathological report of inflamed appendix; 142 males and 103 females. Their age ranged from 6 to 71 years with an average of 20.59 + 9.89 years and a median of 18 years. Two hundred patients were in the early group (operated within 12 hours of admission) and 45 patients in the late group (operated after 12 hours of admission). The early group (200) were operated within an average period of 6.16 + 2.85 hours from admission. The late group (45) were operated within an average period of 21.22 + 8.96 hours from admission.

Personal Characteristics and Preoperative Data of Early and Late Groups (Table 1)

Both groups were comparable in terms of age and sex (P<0.05). Similarly, no significant differences were found between both groups regarding preoperative white blood cell count and preoperative temperature.

Table 1: Demographic and Preoperative Data of the Study Groups

Characteristics

Early Group         Late Group _(n=200)_(n=45)

Age in Years: (mean + SD) 20.31 + 8.68       21.87 + 14.01

Temperature on arrival in oC (mean + SD) 37.44 + 0.625 37.29 + 0.59 WBC count (mean + SD) 12.37 + 5.18        12.29 + 5.56

Males 121 (60.5%)        21 (46

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